中药配方颗粒纳入医保报销政策发展脉络与内容优化建议  

Textual Analysis and Optimization Suggestions of Chinese Medicine Granules Inclusion in Health Insurance Reimbursement Policies

作　　者：张宇 郭斯伦[1] ZHANG Yu;GUO Silun(School of Humanities,Beijing University of Chinese Medicine,Beijing,China 102488)

机构地区：[1]北京中医药大学人文学院,北京102488

出　　处：《中国药业》2025年第8期11-16,共6页China Pharmaceuticals

基　　金：北京市社会科学基金决策咨询项目[21JCB112]。

摘　　要：目的为中药配方颗粒纳入基本医疗保险(简称医保)政策的完善和产业的良好均衡发展提供参考。方法梳理国家和地方层面的相关中药配方颗粒纳入医保报销政策文本,分析政策现存问题,并提出优化建议。结果中药配方颗粒两层级标准的建设均尚待完善;部分省级标准的备案进度缓慢,影响整体标准制定进度;各省(区、市)在医保支持方面的力度存在显著差异,部分省(区、市)的新政策在惠民方面的效果欠佳;对于抵制地方保护主义的政策尚不够具体明确,为集中采购政策的实施埋下隐患。结论应加快标准制定进程,以实现医保政策优势的最大化;深入进行药物基础性研究,为省级标准备案工作提供有力支持;采取综合措施,协同发力,提升政策效果;构建全过程监管机制,防控集中采购过程中可能出现的潜在风险。Objective To provide a reference for the improvement of the policy of incorporating traditional Chinese medicine(TCM)formula granules into the basic medical insurance(hereinafter referred to as medical insurance)and balanced development of the industry.Methods The relevant policy texts on the inclusion of TCM formula granules in medical insurance reimbursement at the national and local levels were sorted out.Existing problems in the policies were analyzed,and optimization suggestions were put forward.Results The construction of the two-tier standards for TCM formula granules still needs to be improved.The filing progress of some provincial standards is slow,affecting the overall standard-setting process.There are significant differences in the intensity of medical insurance support among various provinces(autonomous regions and municipalities directly under the central government).The new policies in some provinces have poor effects in benefiting the people.The policies to resist local protectionism are not yet specific and clear enough,leaving potential risks for the implementation of the centralized procurement policy.Conclusion The standard-setting process should be accelerated to maximize the advantages of medical insurance policies.In-depth basic research on drugs should be carried out to provide strong support for the filing work of provincial standards.Comprehensive measures should be taken to work in concert to enhance the policy effects.A whole-process supervision mechanism should be constructed to prevent and control potential risks that may arise during the centralized procurement process.

关 键 词：中药配方颗粒 医保报销 政策文本分析 发展脉络 优化建议 

分 类 号：R95[医药卫生—药学]