摘    要:目的：本研究以浙江省中医院和米市巷社区卫生服务中心扩大中医诊疗项目服务和利用的需求为出发点，旨在论证筛选可纳入医保支付的中医诊疗项目，主要是早治疗类，以完善浙江省基本医疗保险诊疗项目目录，促进中医治疗思想在医保“保基本”诊疗上的应用。方法：采用访谈法了解中医非药物疗法医保支付的现状、需求和难点。结合需求及利用，梳理出20项初筛项目，采用德尔菲法，运用德尔菲法从七个指标进行评分，利用层次分析法对筛选项目进行客观赋权重，主客观相结合，从而筛选出“建议纳入医保目录的中医诊疗项目”。结果：专家权威系数均达到0.7以上，第二轮专家意见协调系数W=0.628，专家意见趋于一致（P＜0.05）通过两轮专家咨询筛选出两轮中得分靠前的中医诊疗项目为中药封包治疗、中药热奄包治疗、中药蒸汽浴治疗、中医体质辨识、中医整体调摄方案（套餐）、督灸（包括大灸）、雷火灸（包括太乙神针灸）、手指点穴和芒针九项。结论：医保在中医诊疗项目偿付上没有给予足够支持，本研究提倡的扩大中医诊疗项目在医保目录中的占比在建议推行上受阻，我们在专家咨询的基础上，探讨如何有针对性解决阻力问题，提请研究结果给医保部门和进一步完善结算的建议：建立和统一结算编码、单病种付费、设置限制支付条件，探索推进研究结果在制度上的顺畅实施。

关键词：中医诊疗项目 ；医保 ；支付

ABSTRACT:Objective: this study in zhejiang province hospital and community health service centers were lane expanding services and utilization of TCM diagnosis and treatment projects demand as a starting point, aims to demonstrate screening can be incorporated into the medical insurance payment of traditional Chinese medicine diagnosis and treatment projects, mainly early treatment, to improve the diagnosis and treatment of insurance of primary medical treatment to project directory in zhejiang province, to promote Chinese medicine treatment of thoughts in the application of medical care "basic" diagnosis and treatment. Methods: the current situation, requirements and difficulties of medical insurance payment in traditional Chinese medicine were studied by interview. Combining with the demand and utilization, tease out at the beginning of the 20 screen project, using the Delphi method, using the Delphi method from seven indexes rating, screening programs to make use of analytic hierarchy process (ahp) objectively, combination of subjective and objective, and selected "suggestion in medical insurance directory of TCM diagnosis and treatment projects". Results: the coefficient of experts more than 0.7, the second round of expert opinion coordination coefficient W = 0.628, the experts tend to agree (P < 0.05) through two rounds of expert consultation out scored the first points of two rounds of packet treatment, Chinese medicine of traditional Chinese medicine diagnosis and treatment projects for hot sauna I treatment, Chinese medicine treatment and physical identification of traditional Chinese medicine, Chinese medicine overall cultivate scheme (package), du jiu (including big jiu), thunder fire moxibustion acupuncture (including b god), finger point and nine awn needle. Conclusion: medical insurance has not been sufficiently supported in the reimbursement of TCM diagnosis and treatment projects, and this study advocates the expansion of TCM diagnosis and treatment.

Keyword: traditional Chinese medicine diagnosis and treatment projects ;basic medical insurance ;payment

目    录

1研究目的和方法 6

1.1研究目的 7

1.2研究方法 7

1.2.1访谈法 7

1.2.2专家咨询法 7

1.2.3层次分析法 7

2结果 8

2.1项目、指标及专家的选择 8

2.1.1中医诊疗项目初筛 8

2.1.2中医诊疗项目释义 8