What Is Important During the Selection of Traditional Chinese Medicine (TCM) in a Health Care Reimbursement or Insurance System?” Critical Issues of Assessment from the Perspective of TCM Practitioners

Abstract

ObjectiveComplementary and alternative medicine (CAM) has gained increasing popularity over the last several decades internationally, leading to an increasing interest from decision makers and researchers as to how to assess the effectiveness of CAM. The attempts, however, have been unsatisfactory. The most important reason is a lack of attention to the theoretical characteristics of CAM, which are completely different from those of allopathic medicine or biomedicine. This study attempted to survey expert Traditional Chinese Medicine (TCM) practitioners in China to elucidate critical issues when assessing the effectiveness of TCM. MethodsA questionnaire (with 20 close-ended and 2 open-ended questions) about the influencing factors of measuring the cost and effectiveness of TCM was distributed to TCM practitioners who had been working in the field of research for at least 5 years and had published at least one related scientific article in the last 5 years. Internal consistency test was performed for all questions to verify the reliability of the questionnaire. Principal-component analysis was performed for remaining items after Kaiser-Meyer-Olkin (KMO) index and Bartlett’s test of sphericity. A linear combination model was then built to evaluate the contribution of various factors involved for the selection of TCM into the health care reimbursement or insurance system. ResultsOf 429 questionnaires issued, 137 were returned from respondents from 31 medical and research institutions, giving a recovery rate of 31.93%. Internal consistency coefficient obtained was 0.745, indicating good reliability of this measurement scale, and the data passed the KMO test and Bartlett’s test of sphericity (KMO index = 0.691). In addition, eight common factors were extracted after the rotation of principal-component analysis with a cumulative variance of 70.92%. ConclusionsOur findings suggested that factors to be considered during the selection of TCM in health care reimbursement or insurance system include patient preference, long-term outcomes, comparative study of alternative options between TCM and allopathic medicine or biomedicine, pharmacoeconomic evaluation results and the overall economic burden of patients, and side effects of TCM. In addition, the TCM experts stressed the need of cost-effectiveness assessment of the expensive TCM of similar therapeutic functions during the selection process. Moreover, during the evaluation of health-related quality of life of TCM, they warned to avoid overexaggeration of their roles and that the generic scale should be modified according to the clinical circumstances.