青岛确定11个中医优势病种“按疗效价值付费”

Core Viewpoint - The new policy in Qingdao aims to enhance the role of traditional Chinese medicine (TCM) in healthcare by implementing a value-based payment system for 11 TCM advantage diseases, aligning their treatment efficacy with that of Western medicine surgeries [1][2]. Group 1: Policy Implementation - The Qingdao Medical Security Bureau and Health Commission have jointly issued a notice to explore payment methods that support TCM development [1]. - The policy introduces 11 TCM advantage diseases, including radial bone fractures and anal fistulas, which will be reimbursed based on their therapeutic effectiveness [1]. - The payment model aims to shift TCM services from a "price-based" to a "value-based" approach, ensuring that TCM treatments are recognized for their efficacy [1]. Group 2: Payment Criteria and Standards - Cases eligible for the new payment model must meet both TCM and Western medicine diagnostic criteria and have surgical indications [1]. - The treatment must follow a standardized clinical pathway, with TCM treatment costs accounting for at least 50% of the total treatment expenses [1]. - The notice emphasizes the importance of TCM's role in achieving equivalent outcomes to Western surgical treatments [1]. Group 3: Patient Rights and Safety Measures - Medical institutions are required to inform patients about the criteria for inclusion in the value-based payment system, ensuring informed consent [2]. - A payment exit mechanism is established to protect the medical insurance fund and patient rights, disallowing payments in cases of treatment failure or readmission within three months for the same issue [2]. - The clinical pathways for the 11 pilot diseases must be completed with an execution rate of at least 80% to qualify for evaluation and payment settlement [2].