Research on evidence of medical insurance payment for TCM dominant diseases based on evidence-based medicine
JIN Yinghui
YAN Puliu
BI Zhengan
WEN Mengting
HU Wei
LI Xiping
Abstract：Objective To advance the reform of medical insurance payment for TCM(Traditional Chinese Medicine)dominant diseases,it is necessary to develop evidence-based research on medical insurance payment for TCM dominant diseases based on evidence-based medicine.Methods Computer-based retrieval was conducted to collect information on dominant diseases published on the official websites of the National Health Commission of the People's Republic of China(hereafter referred to as NHCC),the National Administration of Traditional Chinese Medicine(NATCM),as well as the health commissions,medical insurance administrations and TCM administrations of various provinces and municipalities.The CNKI database was searched to identify whether there were corresponding primary studies,secondary studies,guidelines,expert consensuses and clinical pathways for TCM dominant diseases released by various provinces and municipalities.Lumbar disc herniation,the disease with the highest repetition rate among dominant diseases,was selected as an example to evaluate the quality of evidence-based evidence for this disease.Results A total of 127 TCM dominant diseases were identified after removing duplicate diseases from 37 cities across 17 provinces.Among these,3 diseases(2.4％)had no relevant primary studies,and 24 diseases(18.9％)had no relevant secondary studies.There were 63 diseases(49.6％)with available TCM guidelines or consensuses,and 81 diseases(63.8％)with TCM clinical pathways.For lumbar disc herniation,A Measurement Tool to Assess Systematic Reviews 2(AMSTAR-2)evaluation results of its secondary literature all showed moderate to low credibility,with no high-level credibility.Specifically,25％of the literature had low credibility,and 75％had moderate credibility.The guidelines and consensuses were evaluated using the Appraisal of Guidelines for Research&Evaluation Ⅱ(AGREE Ⅱ),among which one guideline achieved the highest quality.When matching the PICO(Population,Intervention,Comparison,Outcome)framework,conclusions of secondary studies on lumbar disc herniation,and guidelines/consensuses(as evidence-based evidence)with corresponding clinical pathways,only acupuncture was supported by the most sufficient secondary study evidence.Conclusion At present,TCM dominant diseases included in medical insurance payment have accumulated a certain foundation of evidence-based medicine research.However,on the whole,this foundation remains weak,which is reflected in the generally low quality of existing evidence.The quantity and level of evidence from evidence-based medicine research are not sufficient to fully support the inclusion of TCM dominant diseases in medical insurance payment and meet the demand for providing comprehensive information for medical insurance payment evidence.To carry out the reform of medical insurance payment based on TCM dominant diseases,it is necessary to conduct extensive and in-depth evidence-based medicine research on links such as the establishment of TCM dominant diseases,clinical pathways,efficacy evaluation standards,and the reform direction of the medical insurance payment system,and establish a working system for acquiring medical insurance payment evidence of TCM dominant diseases based on evidence-based medicine research.
Keywords：evidence-based medicineTCM dominant diseasesreform of medical insurance paymentevaluation by appraisal of guidelines for research and evaluation(AGREE Ⅱ)
Publication Date：2025-10-20
Online Publishing Date：2025-12-03(First online date of this platform, not the publication date of the document)
Pages：7( 1171-1177 )