全民健保中醫門診總額支付制度針灸及傷科審查作業之研究

許昇峰
中國醫藥學
目前中醫針灸及傷科之專業審查，在不同地區的審核標準未臻一致，造成尺度寬鬆不一，不但造成審查醫師的困擾，也使申報醫師未必能真正信服其執行尺度，衍生許多申覆案件之爭端緣起。由於目前中醫尚無一本可供參考的審查手冊，因此本研究將擬聚各地專家、學者之共識，共同研究審查要點之編定，並參考國內外團體專業審查之優點，逐年改進審查工作。依照行政院衛生署中醫藥委員會九十年度研究計畫所完成之針灸及傷科臨床治療指引手冊，每2個月定期召開由全國中醫師全國聯合會所主持之各分區中保會審查醫師代表的聯合會議，製定出各針灸及傷科常見病症的審查的標準手冊，參考牙醫界之規範經驗，與資深中醫審查委員的意見，建立業界的共同認可的審核標準，並附以範例，說明常見遭到中保會核減個案之例子及造成核減錯誤之個案分析，以期避免中保會與執業中醫師之間不必要的爭議，並且能有規則可供依循，並由此更為確保及提昇中醫針傷科的醫療服務品質。
關鍵字：中醫門診總額支付審查、針灸、傷科

The study on the evaluation principles of acupuncture/moxibustion and traumatologic care of Chinese medicine in global budget system of National Health Insurance (NHI).

SHENG-FENG HSU
Chinese Medical College
In this study , we want to establish an evaluation regulatinon handbook of acupuncture/moxibustiion and traumatologic care of Chinese medicine in global budget system of NHI.This handbook will based on CCMP projects which combined acupunture and traumatologic care treatment reference reports in 2001.It will be discussed in the committee of every local TCM doctor，s association ,and this handbook will tell all the T.C.M. doctors how to avoid the deletion of the money from the regulation committee of the every local TCM doctor，s association.It will give some rules for all the examination Dr，s to follow , and ensure the medical quality in acupuncture and traumatologic care of T.C.M. OPD.We will give some examples to let the T.C.M. Drs. know what kind of errors should be avoided.
關鍵字：evaluation principles of Chinese medicine in global budget , acupuncture , traumatologic care