摘要
研究背景
中医药是我国医疗卫生体系的重要组成部分,几千年来,为中华民族的繁衍昌盛做出了重要贡献。但是近年来,中医药服务发展面临着许多新问题,与西医服务相比,中医药服务开展数量少、收费价格较低、亏损比较严重。医疗机构开展的中医服务项目越多,亏损就越多,经济效益成为影响中医药服务供方提供中医药服务积极性的主要原因,中医药服务发展面临萎缩。
中医药简、便、验、廉的特色和优势在我国基层医疗卫生体系中发挥着重要的作用,对于居民防病治病、养生保健都有显著疗效,能够有效缓解“看病难”、“看病贵”现象。新医改以来,政府充分发挥中医药在我国基本医疗卫生制度建设中的作用,一定程度上促进了中医药的发展,但是政策效力十分有限。
政府补偿、药品收费补偿和医疗服务收费补偿是中医药发展的主要补偿渠道。长期以来,中医医疗机构形成了以药品收入为主的补偿方式,公立医院改革取消药品加成政策,相当于切断了中医医疗机构的主要收入来源；由于中医药服务收费价格低,开展项目少,医疗服务收费无法成为中医药服务发展的主要补偿方式。中医药事业的可持续发展无法依靠市场机制和自身发展实现,只能依靠政府财政扶持。
目前对医疗服务财政补偿的研究基本上仅仅围绕补偿制度的某一方而进行研究,研究存在补偿方式不确定,补偿对象不明确,补偿标准不易量化等问题,并且很少有研究系统设计财政补偿流程。在以何种方式补偿,补偿哪些服务,以什么标准补偿,以什么方式支付补偿资金等方面尚缺乏实证研究。因此,本论文从设计系统的财政补偿模式出发,通过性分析、筛选和测算,设计相对科学的补偿方式、补偿对象、补偿标准和支付方式,为中医药服务财政补偿政策提供参考依据。
本研究提出四个研究问题,具体为：(1)财政补偿的方式是什么?是补供方还是补需方?补医疗机构还是补医疗服务?(2)财政补偿的对象是哪些或哪类服务?如何筛选出这些服务项目?(3)财政补偿的标准是什么?如何使补偿兼顾政府财政支付能力、医疗服务运营以及医务人员激励间的关系?(4)财政补偿如何支付?通过什么渠道落实财政补偿,以充分发挥财政补偿的效率?
研究目的
本论文的总目标是通过理论研究和实证分析探索科学合理的中医药服务财政补偿模式,包括补偿方式、补偿对象、补偿标准和支付方式,并提出财政补偿政策实施的配套措施,为促进中医药服务发展提供政策参考。具体目标是：通过样本地区中医药服务提供和运营情况,分析中医药服务存在的问题；通过理论研究,分析政府中医药服务财政补偿方式；综合评价各类基层医疗机构的中医药服务项目,筛选中医药服务补偿对象；分析测算不同补偿标准对政府财政支付能力、医疗服务项目运营、医务人员激励的影响,以确定合理的补偿标准；构建合理的财政补偿支付方式；提出中医药服务财政补偿政策的配套措施,以促进财政补偿政策的有效实施。
研究方法
本研究为横断面研究,资料来源于山东省自然科学基金项目《中医药服务项目纳入基本医疗卫生服务制度保障机制研究》,调查研究包括定量调查和定性调查两部分,于2009年4-5月份完成。定量调查通过问卷调查形式,主要内容包括样本地区基本情况调查、样本机构基本情况调查、中医服务项目调查三部分。定性调查使用半结构式访谈提纲,访谈重点是中医药服务在本地区、本机构的总体应用情况、影响因素、对中医药服务补偿的意见和建议等,通过定性调查对定量结果做进一步补充和解释。
本研究以山东省泰安宁阳县,淄博张店区、潍坊青州市,威海荣成市作为项目研究的样本县(区),选取每个样本县(区)的县级中医院、县级综合医院,并在各样本县(区)随机抽取2个乡镇卫生院(社区卫生服务中心),在每个乡镇卫生院(社区卫生服务中心)随机抽取3个村卫生室(社区卫生服务站)。本研究共调查4个样本县(区)的基本情况,4所县级中医院、4所县级综合医院、8所乡镇卫生院(包括2所社区卫生服务中心)、24所村卫生室(包括6所社区卫生服务站)的机构基本情况,1160项中医服务项目成本调查,定性访谈54人。
本研究利用医疗服务项目成本核算方法对医疗机构开展的所有中医服务项目进行成本核算,分析项目盈亏情况及成本构成情况；利用两轮德尔菲法建立补偿对象筛选指标体系,利用层次分析法计算指标体系的权重系数,通过线性加权综合法确定项目的综合评价值,根据综合评价值的大小对项目排序,作为补偿对象的筛选基础；利用项目本量利方法分析项目补偿之后的保本和盈亏情况,分析不同补偿比例对服务项目运营的影响。
论文分析过程由两部分组成,第一部分主要分析样本地区中医药服务的提供情况和运营情况,资料来源于样本地区医疗机构基本情况和中医药服务项目成本核算；第二部分是从补偿方式、补偿对象、补偿标准和支付方式四个方面系统设计财政补偿制度,资料主要来源于第一部分的成本核算数据、样本地区关键人物访谈、中国统计年鉴,山东省卫生统计年鉴,全国中医药统计摘编等。
研究结果
(1)基层医疗机构中医药服务开展情况：样本县三类基层医疗机构的收入以药品收入为主,并且以西药和中成药收入为主,财政收入和上级补助收入在医疗机构总收入中所占比例非常小,在县级中医院、乡镇卫生院和村卫生室分别占1.89%、5.50%和1.33%。中医服务项目收入占医疗收入的比例也较低,分别占医疗收入的19.93%、9.20%、9.48%。
医疗机构中医服务项目开展率不高,县级中医院项目平均开展率为48.57%,乡镇卫生院项目平均开展率为17.68%,村卫生室项目平均开展率为11.94%。推拿类、针灸类项目开展广泛,中医外治、中医特殊疗法等项目开展较少。
不同医疗机构的中医药服务项目收费价格存在较大差异,具体表现在：县级中医院中医服务项目平均收费价格最高,平均收费316.45元,收费价格集中于10-20元和100-300元；乡镇卫生院平均收费130.75元,收费集中于0-10元和10-20元；村卫生室平均收费12.23元,收费集中于0-10元。不同类别中医项目收费价格也存在较大差异,中医骨伤和中医肛肠项目的收费价格明显高于同级别其它类项目价格,中医外治、针灸项目、推拿疗法的平均收费价格明显低于同级别其它类项目。
(2)中医服务项目成本核算结果：各类医疗机构开展的中医服务项目存在不同程度亏损,村卫生室项目亏损比例为60%,县级中医院和乡镇卫生院项目亏损比例约为30%。中医综合类、针灸类和推拿类项目亏损数量最多,100%的中医综合项目、50%以上的针灸项目、40%以上的推拿项目收费价格无法弥补实际成本。
医疗机构开展的中医服务项目的固定成本高于变动成本,人力成本和一次性材料成本在总成本中占比例很高,人力成本约占总成本的60%-70%,一次性材料成本约占16%-31%。不同类别中医服务项目的成本构成存在差异,中医骨伤和中医肛肠类项目的一次性材料成本比例最大,针灸、推拿和中医综合疗法的人力成本在总成本中的比例最大。
(3)补偿方式选择：现阶段尤其是新医改以来,对医疗服务需方的补偿途径主要是鼓励中医药在医疗保险中的应用,文献研究和理论分析发现,以需方为主体的中医药服务补偿政策均已到位,但是需方补偿对中医药发展的促进作用有限。
中医药的特殊性、经济原因所致的中医药服务萎缩现象、中医医疗机构面临的西医化问题、中医医务人员的工资待遇和社会地位等问题揭示了政府对中医药服务供方补偿的必要性。因此,本研究重点探讨中医药服务供方补偿机制。
根据补偿对象不同,供方补偿分为医疗机构补偿和医疗服务补偿。政府对医疗机构补偿仍然是计划经济体制下的行政化补偿方式,养人不养事,不利于提高供方的服务积极性,也不利于发挥卫生资源的效率。研究提出按中医服务项目补偿,这种补偿方式有利于提高供方中医药服务积极性,降低财政成本和管理成本,更好的达成财政补偿目的。
(4)补偿对象筛选：通过两轮德尔菲法建立补偿对象筛选指标体系由3个一级指标和10个二级指标构成,一级指标包括经济价值、社会价值和应用价值；利用层次分析法确立筛选指标体系权重系数,指标权重表明筛选应首先关注项目的经济价值,其次是其应用价值和社会价值。二级指标分别是项目利润、项日技术劳务价值、项目安全边际率、项目收费标准、项目开展机构数、项目年服务量、项目是否适合在本级机构开展、是否针对常见病、多发病、项目疗效、项目价值。筛选结果显示应该优先补偿绝大多数针灸、推拿项目以及部分骨伤项目。由于按照单个项目补偿的方式操作复杂,执行繁琐,因此,本研究以项目类别为单位打包补偿,即将针灸类、推拿类、中医手法整复类项目优先纳入财政补偿范围
(5)补偿标准确定：现阶段无法实现在成本核算基础上,以项目实际成本与收费标准差距作为补偿依据。研究提出以服务量形式进行补偿,将针灸类、推拿类、中医手法整复三类服务包各自的平均收费价格作为财政补偿基点。分别测算三类服务包平均收费价格的10%、20%、30%、40%、50%、60%、70%、80%、100%、150%、200%等12个补偿比例,分析不同补偿比例对政府财政支付能力、医疗服务运营状况、医务人员激励程度的影响,从而确定合理的财政补偿比例。
财政支付能力：样本地区县级财政的支付能力存在差异,总体来看,样本地区县级财政能够支付以各类服务包平均收费价格的50%所确定的补偿数额。
医疗服务运营状况：补偿服务包收费价格的50%对亏损项目弥补程度最大,能够使县级中医院、乡镇卫生院和村卫生室80%以上的亏损中医项目达到保本乃至盈利,补偿50%后,样本县县、乡、村三级医疗机构开展的中医项目平均盈利2.69元、2.00元、0.87元。
对医务人员的激励程度：县级中医院三类服务项目补偿50%后,将对提供各类服务的中医人员服务积极性产生激励作用；乡镇卫生院针灸推拿项目补偿50%时,将对提供该类服务的医生服务积极性产生激励作用,中医手法整复项目补偿至60%时将对医务人员产生激励作用。仅从激励系数来看,补偿对村卫生室医生的激励作用较小,补偿至平均收费价格200%时,才会对村医产生激励作用,但由于村医原来的变动工资就很低,激励系数也很低,补偿50%之后,激励系数已经翻倍,因此,补偿将会产生激励作用。
总体分析财政补偿比例对样本县县级财政支付能力、亏损项目运营状况、医务人员激励作用等三个方面的影响程度,研究提出将补偿比例设定为：中医手法整复项目包、针灸项目包、推拿项目包各自服务包平均收费价格的50%。
(6)支付方式选择：研究认为要首先建立科学合理的考核评估指标体系对医疗机构提供的服务进行评估考核,每半年作为一个评估周期,依据评估考核结果进行分层补偿。考核评估体系包括基础设施建设、人才队伍建设、技术水平与业务开展、组织管理等指标,从项目应用规范性、创新性、质量、数量角度进行评价。
财政补偿资金建议由国家、省、市、县(市、区)四级财政根据经济发展水平,按比例共同承担。补偿经费拨付采取预付制和后付制相结合的支付方式,由各级政府先行拨付一定数额启动资金,政府定期对项目开展情况进行考核评估后,根据考核结果进行补偿,拨付补偿经费。
结论与配套措施
我国基层医疗机构中医药服务开展和运营面临许多问题。与西医服务相比,中医服务项目开展少,项目开展率低；医疗服务收费价格低,许多项目的收费价格无法弥补成本,项目亏损较严重。中医药服务经济效益低成为影响基层医疗机构和医务人员提供中医药服务积极性的主要原因。中医药服务发展需要国家政策、财政及制度等各个方面的扶持。但是财政投入并不与医疗服务发展成正比,要有效发挥财政投入效率,必须设计科学合理的财政补偿机制,包括补偿方式、补偿对象、补偿标准及支付方式。研究认为应该采取补偿中医药服务的方式对中医药进行财政扶持,优先补偿中医针灸类、推拿类、中医手法整复类项目,以促进这些开展广泛、服务量大、需求量大,简便、价廉、有效的服务项目的提供和利用。研究认为将针灸类、推拿类、中医手法整复三类服务包各自平均收费价格的50%作为补偿标准,在县级政府的财政支付能力内,能够弥补80%以上的亏损项目,使其扭亏为盈,获得较好的成本效益,将会激励医务人员提供中医药服务的积极性。同时,财政补偿应该建立在对服务进行评估考核的基础上,根据考核指标体系定期考核医疗机构提供的中医服务,依据考核结果进行分层补偿。采取预付制和后付制相结合的补偿资金支付方式,补偿资金建议由国家、省、市、县(区)四级财政按比例共同承担。
主要配套措施：要充分发挥财政补偿的作用,除了设计合理的财政补偿制度外,还需要发挥其它配套措施的补充和保障作用。研究认为主要的配套措施有：(1)建立健全相应的监督机制,贯穿于对医疗机构考核评估、补偿资金落实、资金使用管理等各个环节,保证补偿资金落实,充分发挥财政补偿的效果。(2)加大需方补偿及政策倾斜力度,继续促进中医药参与各类医疗保险政策的广度和深度。(3)调整中医药服务收费价格：首先要在充分调研和完全成本核算的基础上,适当调整中医服务项目的收费价格,充分体现中医的真实价值及中医医务人员的技术劳务价值：其次,缩短中医药服务收费价格调整周期,使收费价格与项目实际成本、社会经济发展水平、物价上涨水平及群众需求相一致。(4)完善中医服务项目成本核算：首先,探索能够体现中医特殊性的医疗服务项目成本核算方法；其次,建立完善统一的医疗服务项目成本核算系统,提高成本核算分析结果的科学性和可比性。
Background
Traditional Chinese Medicine(TCM) is an important feature of Chinese characteristic medical and health undertakings. For thousands of years, TCM has made important contributions to the thriving of Chinese nation. However, with the economic globalization, scientific and technological progress and the rapid development of modern medicine, TCM faces with many new problems. Compared with western medicine service, TCM services has less quantity, lower price, and is more serious in loss. The low economic benefit of Service project restricts the positivity of medical institutions and medical personnel to provide TCM services. The application of TCM services is gradually atrophic.
TCM features and advantages such as simple, easy, effective, and inexpensive plays an important role in primary health care system, has a significant effect on disease prevention and health care, alleviates the medical treatment difficult and expensive phenomenon effectively.From the medical reform, the government give full play role to TCM in China's basic medical and health system building, promoted the development of TCM certain extent, but the policy effectiveness is very limited.
Government compensation, drug charges compensation and medical services charges compensation is the main channel for TCM development. For a long time, The TCM institutions compensation based on drug income.public hospital reform cancel drug addition policy, the equivalent of cutting off the TCM institutions main source of income.TCM has the low price,small number, medical services charge can not become the main development of TCM compensation.TCM Sustainable development can not rely on market mechanisms, can only rely on government financial support.
The research of compensation for medical services currently basic on one part of the compensation system, there exists many issues,such as compensation ways uncertain, compensation objectives wasn't clear, difficult to quantify compensation standards and so on. And there are few studies financial compensation process design systematic。There is lack of empirical research in the financial compensation ways, compensation objectives, compensation standard, and the payment of compensation funds.The study have developed a system of financial compensation with the scientific compensation mode, compensation object, compensation standards and payment,as to provide reference to TCM financial compensation.
This study puts forward four research questions:the way of financial compensation, the compensation object, the compensation standard and the payment method. They are specifically as follows:(1)what is the way of financial compensation? Is the supplier to be compensated or the buyer? Is medical institutions to be compensated or medical services?(2)Which or what kind of service does financial compensate? How to select the service project?(3)What is the financial compensation standard? How to balance the relationship between government financial pay ability, medical services operations and the incentive of medical staff?(4) How does financial compensation pay? How do channels complete the financial compensation and give full play to the efficiency of the financial compensation?
Objectives
The general goal is to put forward supporting measures of government financial compensation and to supply references for promoting TCM development strategies through theoretical research and analyzing the mode of government financial compensation for Chinese medicine services. The specific goals are as follows: analyzing the financial compensation mode of TCM services of government by means of theoretical study; conducting comprehensive evaluation on Chinese medicine services and screening compensation object of Chinese medical service on the basis of cost accounting; analyzing and measuring the influence of different compensation standards on the government financial pay ability, medical services operations and the incentive of medical staff in order to determine reasonable compensation standard; building up a reasonable mode of financial compensation payment; putting forward supporting measures of financial compensation policy of TCM services and promoting the effective implementation of the financial compensation policy.
Methods
This is a cross-sectional study. The information is gathered from natural science fund projects named Chinese medicine services bringing into the basic medical and health services system guarantee mechanism research of Shandong province. The study includes both quantitative survey and qualitative survey and is completed in4-52009. Quantitative study is through the questionnaire survey, and the main content includes basic situation investigation of sample area, basic situation investigation of sample organization, the survey of TCM services and medical personnel questionnaire survey. Qualitative study uses semi-structured outline interview which focuses on TCM services in the region, and the agency about general application situation, influence factors, opinions and suggestions of the compensation for the services of TCM etc. producing further supplement and explanation of quantitative results through qualitative investigation.
The study selects the county project Ningyang, Zhangdian, Qingzhou and Rongcheng in Shandong province as research samples.then selects each county sample from the level hospital and county level comprehensive hospital, and selects sample at random of2health clinics in towns and townships. In each of the health clinics in towns and townships,it selects sample at random of three village clinics.The total investigation include4at the county level hospital,4at the county level comprehensive hospital,8village clinics in towns and townships,24village clinics. This study investigates4at the county level hospital,4at the county level comprehensive hospital,8village clinics in towns and townships,24village clinics,319medical personnel of TCM of intention survey questionnaire and1160services project cost of TCM research. Use the method of qualitative interview54people.
The study uses the method of medical service project cost accounting to carry out cost accounting of all of the Chinese medicine services and analyzes project of the profit and loss situation and cost situation. It uses two rounds of Delphi method to establish selection index system of compensation object, and uses the linear weighted synthesis method to determine the comprehensive evaluation value of the project, and then orders the project according to the size of the comprehensive evaluation value as the basis of compensation object selection.
Main Results
(1) Basic situation of Chinese medicine services in medical institutions:drug income which was dominated by Western medicine and Traditional chinese medicine income was the main part of the income of medical institutions. Revenues from the government and grant from the higher authority in the medical share of total income was very small, of which proportion were1.89%,5.50%and1.33%respectively in Traditional Chinese Medicine hospitals at the level of county, township and village. TCM Services revenue was relatively low in the three types of medical institutions, accounting for19.93%,9.20%and9.48%of the medical income respectively.
The rate of carrying out TCM services items in medical institutions was not high. The average rate was48.57%,17.68%and11.94%respectively in county-level hospital of Chinese medicine, township hospitals and Village clinics. Judging from the types of items undertaken, massotherapy and acupuncture were carried out more extensive, external treatment of TCM and Chinese medicine special treatment etc. were not much.
Meanwhile, the charging prices of TCM services were showing an increasing tendency with the rise of medical institutions grade, which was demonstrated as follows:the average price of TCM services in county-level hospitals of TCM was highest with316.45yuan which concentrated on10-20yuan and100-300yuan; the average price of township hospitals was130.75yuan which concentrated on0-10yuan and10-20yuan; the average price of village clinics was12.23yuan which concentrated on0-10yuan. There was an obvious diversity among different services of TCM. The prices of bone fracture and anorectum services of TCM were much higher than other services with the same grade while the average prices of external treatment, massotherapy, acupuncture of TCM were lower than other services with the same grade obviously.
(2) The cost accounting results of TCM services:there was deficit in TCM services carried out by medical institutions to different extents. The deficit proportion of TCM services in village clinics was60%while the proportions of county-level hospitals of TCM and township hospitals both were30%approximately. Acupuncture and massotherapy took the most amounts of TCM general services deficit. In fact,100%TCM general services, more than50%acupuncture and40%massotherapy could not make up the actual cost with the prices.
The fixed costs of TCM services carried out by medical institutions were higher than variable costs. The proportions of human cost and disposable material cost in total cost were very high, and these two types of cost are both showing an increasing tendency with the rise of medical institutions grade. The proportion of human cost was60%-70%approximately while disposable material cost was16%-31%. There was a difference among the cost composition of different TCM services. The proportion of disposable material cost was biggest in bone fracture and anorectum services of TCM. The proportion of human cost is biggest in acupuncture, massotherapy and general services of TCM.
(3) Compensation choice:At this stage, especially since the new medical reform, the compensation pathway for demand-side is encouraging the use of TCM in the medical insurance. Some research and literature analysis found that demand side compensation policy of Chinese medicine services had been in place, but its role in promoting the development of Chinese medicine was limited. Therefore, this study focuses on the supply-side compensation mechanism of Chinese medicine services.
The particularity and atrophy of Chinese medicine, the western issue of Chinese medical institutions, Chinese medicine medical staff wages and social status and other issues reveal the necessity of Chinese medicine services supply-side compensation.
According to compensation object, the supply-side compensation is divided into compensation of medical institutions and medical services compensation. The study found that compensation of medical institutions was still the administrative compensation under the planned economic system, and it was only benefit for personnel, not for the supply-side service enthusiasm and the efficiency of health resources. Therefore, this study proposes compensation for Chinese Services items. This method is conducive to improve the enthusiasm of the supply side of Chinese medicine services, reduce financial costs and management costs, and better achieve the purpose of financial compensation.
(4) The compensation object filtering:the compensation objects index system was created by two cycle of expert consultation and consisted3first-level indicators and10secondary-level indicators. The first-level indicators are economic value, social value and application value. The weight of index system indicated that the filtering should focus on its economic value of the services, followed by applications and social values. Secondary-level indicators are profit on the item, the technical value, the marginal rate of safety, item fees, the number of institutions, amount of services, whether the item is suitable to carry out at the institutions, whether for common and frequently-occurring diseases, items effect and the value of the items. The screening results showed that the vast majority of acupuncture, massage, bone-setting project had the priorities for financial compensation. For the reason that compensation in accordance with the individual items is complicated and cumbersome, this study proposes to take to the project category as a unit to operate package compensation. The acupuncture, massage, Chinese medicine Manipulation was priority included in the financial compensation.
(5) Compensation criteria:It is not possible at this stage to take the price and the cost gap as compensation basis, the study proposed the average price of Acupuncture, massage, Chinese medicine Manipulation as the basis of financial compensation. The study measured12compensation proportion, respectively10%,20%,30%,40%,50%, 60%,70%,80%,100%,150%and200%of the average price of the three types of service packages, and analyzed the impact of the different type of compensation proportion to the Government's financial ability to pay, medical services operating conditions and the medical personnel incentive extent, in order to determine a reasonable proportion of financial compensation.
When the price is up to50%of compensation service, it can make up the defective item to the greatest and can make more than80%of defective item in county hospital of Chinese medicine, Township hospitals and village clinics break even or even profit. What's more, when the compensation reach to50%, all the TCM projects carried by medical institutions are profitable, the profit was2.69yuan,2.00yuan,0.87yuan respectively.
As the compensation of the three types of project in county hospital of Chinese medicine up to50%, it will encourage the service enthusiasm of medical staff. When the compensation of acupuncture and massage projects in township hospitals was50%, the physician services enthusiasm was inspired, so was the Practices reconstructive project of TCM when the compensation was60%.From the perspective of incentive coefficient, the encouragement to doctor in village clinic of compensation was the least, only until to200%, the encouragement appeared. However, due to the low original salary of village doctor and incentive coefficient, when the compensation up to50%, the incentive coefficient has already doubled, hence, the compensation could produce encouragement.
Through the aggregate analysis of influence of pecuniary compensation on this three types, our study proposed that compensation proportion should be set at the50%of average price of practices reconstructive project of TCM, Acupuncture and moxibustion program, Massage project.
(6) Payment options:the study suggested that the first task was to establish scientific and reasonable evaluation indicators system in order to assess s to the services provided by medical institution, evaluation cycle was every six months, and give compensation according to the assessment results. The evaluation indicators system contains infrastructure construction, talent team construction, The technical level and the business, organization and management and so on, in the light of their standardization, innovation, quality, quantity.
Financial compensation funds should shared by national, provincial, municipal, county,4financial level, according to their development level of economic. The compensation funds adapt the way of combining payment in advance and post-paid, the governments at all levels allocate a certain amount of start-up capital and evaluate project situation at regular intervals, then according to the assessment results to examination and evaluation and allocated the compensate.
Conclusions and Suggestions
The developing and operating of TCM services are facing many problems in Chinese basis medical institutions. Compared with western medicine service, there were less service projects of TCM and the lower development rate. Medical service price is low, many items of charge price cannot cover the cost of the project, the loss is serious. The low economic benefits of TCM services restricted the enthusiasm of basis medical institutions and medical personnel to provide Chinese medicine service. The development of Chinese medicine service needs government policy, financial and institutional support and so on, but high financial investment didn't improved the development of the traditional medicine a lot. So must be designed to build scientific and reasonable financial compensation mechanism, including compensation ways, compensation objects, compensation standard and the way of payment, in order to play a more effective efficiency of government financial investment. The research showed that should compensate TCM services to support the financial to support for TCM, should compensate the projects of acupuncture, massage and the technical features of traditional Chinese Anaplasty in priority to promote the extensive, service capacity, demand is big, easy, cheap, effective service to provide and use. The research showed that should compensate the50%average price charged as compensation standards to three types of service packages including acupuncture, massage, the technical features of traditional Chinese Anaplasty respectively. Under the ability of the county-level government to pay, can make up more than80%of the loss items, make it cease to lose and begin to turn out a profit and get the best cost-effective moreover will inspire the enthusiasm of the medical staff to provide Chinese medicine services. Meanwhile financial compensation should be based on the evaluation and assessment of the service, to evaluate the service of medical institutions according to the evaluation index system and compensate at the different levels based on assessment. Take the combination "advance" with "post-paid" as the payment way, recommend that nation, province, municipal and countyour levels to pay the compensation funds together.
To give full play to the role of financial compensation, besides a reasonable financial compensation system, need to need to complement and support role of other supporting measures.(1)Establish a sound supervision mechanism corresponding, passes through the assessment and evaluation of medical institutions, the implementation of compensation funds at all levels of government, the management of the compensation usage, to implement the compensation funds and make it working completely.(2) Strengthen the compensation and policy for buyer, continue to promote the width and depth of the participation of Chinese medicine in various medical insurance policy.(3) Adjust the TCM services prices:first, on the basis of investigation and complete cost accounting, adjust the TCM services fees price properly, totally reflect the real value of technical services of TCM and traditional Chinese medical personnel's value; secondly, to shorten the TCM services price adjustment period, make the price fit to the actual cost,economic development, The level of price increases and the needs of the people.(4) Improve the TCM services project cost accounting:first, to explore the method of cost accounting ways can reflect the characteristics of Chinese medicine medical service; secondly, establish a unified cost accounting system, the results of this system will be comparable, improve cost accounting results comparability.
引文
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