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我国医保药品目录中药饮片管理现状分析
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| 篇名： | 我国医保药品目录中药饮片管理现状分析 |
| TITLE： | Current management status of Chinese herbal pieces in China’s national healthcare security drug catalog |
| 摘要： | 目的 为进一步提高纳入医保基金支付范围的中药饮片（简称“医保中药饮片”）的管理水平提供参考。方法收集国家医保局及各省（自治区、直辖市）医保局官方网站中有关医保中药饮片的政策文件，采用文本分析法，从医保中药饮片管理办法和目录形式两个维度，对我国各省医保中药饮片管理现状进行分析。结果在医保中药饮片管理办法维度，对于饮片的执行标准，部分省份执行国家标准和省级标准，少部分限定为国家标准和本省标准；对于支付类别，大部分省份以甲类为主，部分省份按乙类进行管理，还有部分省份同时存在甲、乙类管理或按丙类管理的情况；对于申报主体，存在仅医疗机构、仅饮片生产企业、医疗机构和饮片企业均可申报3种情况；对于申报程序，有的省份需要地方医保部门初评并上报推荐名单，有的不需要初评而由省级医保部门统一评审；对于目录制定及调整办法，各省份区别不大。在医保中药饮片目录形式维度，部分省份在国家医保目录的基础上对目录字段有所补充，有的省份目录则比较简单；有的省级增补目录按饮片名称的中文笔画进行排序，但大部分目录未见明确的排序规则。结论各省份在医保中药饮片管理办法和饮片目录制定方面已取得一定的成效，部分地区仍需结合实际和中药饮片特点，拟定针对性及适应性强的管理条款，完善医保中药饮片目录内容及格式，持续追踪最新管理政策，提高目录制定的准确性和可操作性。 |
| ABSTRACT： | OBJECTIVE To provide references for further improving the management level of Chinese herbal pieces covered by the healthcare security drug catalog （hereinafter referred to as “healthcare security covered Chinese herbal pieces”）. METHODS Policy documents related to healthcare security covered Chinese herbal pieces were retrieved from official websites of National Healthcare Security Administration and medical insurance bureaus of various provinces （autonomous regions， municipalities directly under the central government）. Using text analysis， the current management status of healthcare security covered Chinese herbal pieces in various provinces was analyzed from two dimensions： management regulations and catalog formats. RESULTS In terms of the management regulations for healthcare security covered Chinese herbal pieces， some provinces implemented both national and provincial standards for Chinese herbal pieces， while a small number of provinces adopted national standards alongside their own provincial standards. Regarding the payment categories of healthcare security covered Chinese herbal pieces， most were classified as category A， though some provinces managed them as category B， and others included both categories A and B or category C. In terms of applicants， there were three kinds： only medical institutions， only herbal piece enterprises， or both medical institutions and herbal piece enterprises being allowed to apply. During the application process， some provinces required preliminary evaluations by local healthcare security departments with recommended lists submitted， while some provinces omitted preliminary evaluations and relied solely on unified evaluation by provincial healthcare security departments. Regarding the methods for catalog formulation and adjustment， there was little variation among the provinces. In terms of the catalog format for healthcare security covered Chinese herbal pieces， some provinces had supplemented the catalog fields based on the national medical insurance catalog. In contrast， some provinces had relatively simple catalogs. Regarding the sorting of the herbal pieces catalog， some catalogs were arranged by the number of Chinese character strokes in the names of the herbal pieces， but most catalogs lacked clear sorting rules. CONCLUSIONS Significant resultshave been achieved in formulating management measures and the catalog of healthcare security covered Chinese herbal pieces. However， there is still a great necessity to develop targeted and adaptable management clauses based on local conditions and the characteristics of Chinese herbal pieces. The content and format of healthcare security drug catalog of Chinese herbal pieces should be improved； in addition， continuous tracking of the latest management policies is also essential to improve the accuracy and operability of formulated catalog. |
| 期刊： | 2025年第36卷第20期 |
| 作者： | 张春梅；唐丽燕；王晓宇；王兴榆；刘晶晶；李青苗 |
| AUTHORS： | ZHANG Chunmei，TANG Liyan，WANG Xiaoyu，WANG Xingyu，LIU Jingjing，LI Qingmiao |
| 关键字： | 中药饮片；医保；药品目录；管理现状 |
| KEYWORDS： | Chinese herbal piece； healthcare security； drug catalog； management status |
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