The last kilometer of TCM legislation is difficult to be implemented

Source: medical economic news 2015-12-14 recently, the executive meeting of the State Council passed the law on traditional Chinese medicine (Draft), which marks that the state attaches great importance to the inheritance and promotion of traditional Chinese medicine, adheres to both support and regulation, and uses national legislation to protect the development of traditional Chinese medicine This is a law that the Chinese medicine community has been waiting for for for more than 30 years If it is finally deliberated and passed, it will be a great benefit to the Chinese medicine community and it is worth celebrating Calm down, we must also be clear to see that the passage of TCM legislation is only the first step in the long march In order to achieve real take-off of TCM, we must solve several key problems at present 1 In China, where TCM is seriously short of the right to speak and the right to make policy, TCM is often suppressed or even controlled by the context of Western medicine, ranging from concept system, theoretical model, thinking method, to national medical policy-making, to hospital rating, title evaluation, scientific research evaluation, and paper publication All these coordinates are based on Western medicine Even in the medical insurance policy, TCM lacks the right to speak Many TCM policies are formulated by western medicine In the process of marginalization, people's property will be increasingly far away from traditional Chinese medicine, which is a matter of life and death If this problem is not solved, "equal emphasis on traditional Chinese and Western medicine" will always be a slogan 2 It is a unique theory of traditional Chinese medicine to construct the whole concept of evaluation system, syndrome differentiation and treatment, and the unity of form and spirit The vitality of traditional Chinese medicine lies in the curative effect, especially in improving the syndromes and the quality of life of patients However, how to evaluate the clinical curative effect of traditional Chinese medicine objectively and accurately, and how to establish the recognized, reliable and popularized evaluation standard of clinical curative effect need to be solved urgently Because of the lack of TCM standard and TCM evaluation system, TCM scientific research evaluation and clinical evaluation are just applying or borrowing the evaluation standard of Western medicine, so TCM is forced to be in a passive and subordinate position Therefore, the establishment of clinical evaluation system of traditional Chinese medicine and the formation of internationally recognized and popularized evaluation system in various fields of clinical evaluation are of far-reaching significance for improving the quality and level of clinical research of traditional Chinese medicine, making the research results of traditional Chinese medicine persuasive, improving the self-confidence of traditional Chinese medicine and promoting the development of social run traditional Chinese medicine 3 After thousands of years of development, the advantages of traditional Chinese medicine, such as wide indications, low medical cost, easy to promote and apply, have been fully proved The traditional Chinese medicine service is simple, convenient and effective, but in recent years, the market failure of traditional Chinese medicine service is serious, while the traditional Chinese medicine service has a huge positive external effect, but there is no corresponding compensation, resulting in the long-term "blood loss anemia" of traditional Chinese medicine service According to the survey, the loss rate of medical revenue and expenditure of TCM medical institutions is 24%, and that of general hospitals is 15.7% The loss rate of traditional Chinese medicine hospitals is much higher than that of general hospitals The main reason is that there are few charging items and low charging level in traditional Chinese medicine hospitals, which can not be compared with general hospitals with many charging items and high medical expenses The key to the serious "Westernization" of TCM hospitals in China lies in the government's unreasonable way of compensation for TCM hospitals, the relatively small subsidies given by the state finance, and the relatively low price of TCM has become a weak point hindering the development of TCM medical institutions Therefore, we must actively explore the service compensation mode of traditional Chinese medicine We can pay by disease Under the given price standard, after a certain disease is cured, the cost saved will be returned to the service provider of traditional Chinese medicine in a certain proportion, so that the low price of traditional Chinese medicine can become an advantage and gain benefits, encourage and encourage the practitioners of traditional Chinese medicine to carry out pure traditional Chinese medicine medical services, explore and improve Medical technology and level of traditional Chinese medicine 4 It's difficult for the "last kilometer" of policy implementation to land The scientific research team of the author learned from the interview that, in terms of supporting TCM policies, the state has articles, and all provinces and cities have articles, but they are lack of unified implementation rules or outdated management methods To the grass-roots level (each district) due to different explanations or inconsistent policies, there are management problems, and the policies can't be implemented For example, the opinions of the State Council on supporting and promoting the development of traditional Chinese medicine clearly states that "medical security policies and basic drug policies should encourage the provision and use of traditional Chinese medicine services", but there are problems such as inconsistent and unstable understanding and implementation of policies at the grass-roots level Taking a city in the east of China as an example, in the process of starting the project of improving the service capacity of TCM at the grass-roots level, the medical insurance for urban residents and the new rural cooperative medical insurance were integrated into the basic medical insurance for residents, and were integrated into the unified management of the human resources and social security department, but the scheme of medical insurance for residents did not explicitly propose to encourage the content of TCM Therefore, the city even stopped implementing the encouragement policy of traditional Chinese medicine, which had been successfully implemented by the new rural cooperative medical system before the integration, which led to a significant increase in patients' out of pocket expenses when looking at traditional Chinese medicine, and inhibited the provision and use of traditional Chinese medicine services If we don't make up our mind to solve the problem of "last mile" policy implementation, no matter how good legislation or policy is, it will easily become a castle in the air (the author is an associate professor of management, School of economics and management, Guangzhou University of traditional Chinese Medicine)