[目的] 总结DRG改革前后南通市某三级综合医院中医药发展实践经验,并提出相应对策,为解决中医药发展面临的困境提供参考。[方法] 以南通市某三级综合医院为例,分析该院DRG改革前后中医科病房中医药费用、病房中医外治法费用、门诊人次及收入、与其它科室中医费用对比、中医优势病种情况。[结果] DRG改革后,中医科住院的中草药费用、中医外治法费用、医疗总费用和中医费用占比均先下降再升高, 第二年升高率为14.45%;人均中草药费用、人均外治法费用、人均总费用及中医费用占比基本保持稳定,差异无统计学意义;针刺、穴位贴敷、刮痧、中药熏药费用降低,差异均有统计学意义(P＜0.05);火罐费用明显升高,差异有统计学意义(P＜0.001);外治法总费用保持稳定,差异无统计学意义。中医科门诊的月门诊人次、月门诊中草药收入、月门诊外治法收入、月门诊总费用均升高,差异均有统计学意义(P＜0.01)。中西医结合肝病科人均住院中医费用及人均中医费用占比均较改革前升高,差异均有统计学意义(P＜0.05);中医优势病种为短暂性大脑缺血性发作、肺部感染和恶性肿瘤中医治疗等。[结论] DRG支付背景下综合医院中医药发展仍存在种种困境,未来需探索一系列相关对策以促进中医药发展。

Objective This paper summarizes the practical experience of TCM development in a tertiary general hospital of Nantong before and after the DRG reform, and puts forward corresponding countermeasures to provide the reference for solving the dilemma faced by TCM development. Methods Taking a tertiary general hospital in Nantong as an example, the cost of Chinese medicine in the TCM ward, the cost of external treatment of TCM in the ward, outpatient visits and income, the comparison of the cost of Chinese medicine with other departments, and the situation of dominant diseases treated by TCM before and after the DRG reform were analyzed. Results After the DRG reform, Chinese herbal medicine expenses, TCM external treatment expenses, total medical expenses and the proportion of TCM expenses of inpatients of TCM department first decreased and then increased, with an increase rate of 14.45% in the second year. The per capita cost of Chinese herbal medicine, per capita cost of external treatment, per capita total cost and the proportion of TCM cost remained basically stable, and the difference was not statistically significant. The cost of acupuncture, acupoint application, skin scraping and TCM fumigation decreased, and the differences were statistically significant (P<0.05). The cost of cupping increased significantly, and the differences were statistically significant (P<0.001). The total cost of external treatment remained stable and differences had no statistical significance. Monthly outpatient visits, monthly outpatient income of Chinese herbal medicines, monthly outpatient income of external treatment and monthly total outpatient expenses increased in TCM departments, and the differences were statistically significant (P<0.01). The per capita inpatient TCM expenses and the proportion of per capita TCM expenses in the department of liver disease of integrated Chinese and western medicine were higher than that before the reform, and the differences were statistically significant (P<0.05). The dominant diseases treated by TCM were transient ischemic attack, lung infection, malignant tumor and so on. Conclusions There are still various difficulties in the development of TCM in general hospitals under the background of DRG payment. In the future, a series of relevant countermeasures should be explored to promote the development of traditional Chinese medicine.