自美国总统特朗普去年10月24日签署法令，计划将针灸纳入美国医保，并责令美国卫生部一年内提交评估报告以来，终于等来了美国卫生部的大动作，正式开启了对针灸等疗法纳入美国医保的评估。

 

2018年12月28日，美国卫生部（United States Department of Health and Human Services；HHS；又译美国健康及人类服务部或美国卫生与公众服务部）在其官方网站上正式发布以上文章，题目是：”最佳疼痛管理治疗报告（草案）：进展、差距、不协调因素及建议”，文章中介绍由29名专家组成的疼痛专家委员会给出的这份草案将公示90天，之后定稿的评估报告将于2019年提交给国会，以完成最后的针灸进入医保的法律程序。

 

在该草案中，一共出现了18次针灸（acupuncture），18次按摩（massage），12次太极拳（tai chi），并对这三种疗法进行了较大篇幅的论述，提供了引文。

 

该草案推荐将针灸、按摩、太极拳等作为疼痛的治疗方法。除此之外，还推荐了瑜伽、冥想、水疗等。

 

针灸纳入美国医保的日期越来越近了。

 

 

AAPAS认为，今年是针灸治疗疼痛纳入美国联邦保险的关键一年，希望全体针灸行业的同仁共同努力，向卫生部等有关部门提供全方位证据，使针灸能够在治疗疼痛中得到更广泛应用。AAPAS也设立了特别专家组和网站，将组织有关讨论，及时发布行业指导建议。

 

草案中关于针灸部分摘要如下：

 

对针灸的评估：

Acupuncture is a recognized form of therapy that has its origins in ancient Chinese medicine. It involves manipulating a system of meridians where “life energy” flows by inserting needles into identified acupuncture points. An estimated 3 million American adults receive acupuncture each year.323 Acupuncture is generally considered safe when performed by a licensed, experienced, well-trained practitioner using sterile needles, although there are risks as with any intervention. The therapeutic value of acupuncture in the treatment of various pain conditions, including osteoarthritis; migraine headaches; and low-back, neck, and knee pain has growing evidence in the form of systematic reviews and meta-analyses.324-330 Existing CPGs  (Clinical Practice Guideline) concerning the use of acupuncture for pain are inconsistent and often differ regarding the evidence-based science and accepted mechanisms by which acupuncture has persisting effects on chronic pain.48,315-320,327,331-334 As with all medicine, a risk-benefit analysis, consideration of clinical indications, and patient acceptance need to be considered.

 

对保险支付的建议：

Recommendation 1b: CMS and private payors should investigate and implement innovative payment models that recognize and reimburse holistic, integrated, multimodal pain management, including complementary and integrative health approaches.

 

对保险支付管理方式的建议：

Recommendation 4a: Payors should reimburse pain management using a chronic disease management model. CMS and private payors should reimburse integrative, multidisciplinary pain care by using a chronic disease management model in the manner they currently reimburse cardiac rehabilitation and diabetes chronic care management programs. In addition, reimburse care team leaders for time spent coordinating patient care.

 

对科学研究的建议：

Recommendation 4a: Increase the levels of research into novel strategies that target the underlying mechanisms of chronic pain, including pharmacologic and biologic research and development, medical devices, new and innovative technological advancements, medication delivery systems, neuromodulation, regenerative medicine, and complementary and integrative health approaches, as well as movement-based modalities.

 

文源：本文部分内容引自AAPAS官方公众号。