目的: 本文基于纵向视角,梳理9版《国家医保药品目录》关于中成药和中药饮片的目录变化内容及特点,以期为中医药医保政策的制定与完善提供参考。方法: 主要基于文献研究法对相关重要政策文件进行梳理,以及采用描述性分析方法,对历版《国家医保药品目录》中的西药、中成药、中药饮片调整情况进行对比分析。结果: 中成药在目录中的数量呈上升趋势,但增速有所放缓,其年平均增长率为10.66%,超过了西药。截至2023年,目录中中成药数量与第一版相比增加701种,增长率高达112.70%;在甲类药品的占比方面,西药始终高于中成药,两者之间的差距逐年缩小;协议期内谈判药品中的中成药数量持续增加,但占比不足;在中成药的分类中,内科用药的占比最大;中药饮片的管理从排除法转变为准入法,确保了各地区用药的公平性。结论: 纵向分析表明,我国中成药、中药饮片的药品数量和结构的调整更趋合理,中成药数量增长明显,充分体现出医保制度对中医药支持力度不断加大。

Objective: Based on the longitudinal perspective, this paper organizes and analyzes the contents and characteristics of the changes within the nine editions of the National Healthcare Insurance Drug Catalog on proprietary Chinese medicine and Chinese herbal medicine decoction pieces, offering insights for the development and enhancement of healthcare insurance policies concerning Chinese medicine. Methods: The documentary analysis method was mainly used to analyze the relevant important policy documents. Descriptive analysis was adopted to compare and analyze the adjustments of western medicines, proprietary Chinese medicine and Chinese herbal medicine decoction pieces in the National Healthcare Insurance Drug Catalog over the past years. Results: The number of proprietary Chinese medicines in the catalog showed an upward trend, but the growth rate slowed down, with an average annual growth rate of 10.66%, which exceeded that of western medicines. By 2023, the number of proprietary Chinese medicines in the catalog has increased by 701 compared with the first edition, with an increase rate of 112.70%. In terms of the proportion of Class A drugs, western medicine was always higher than proprietary Chinese medicines, but the gap between the two is narrowing year by year. The number of proprietary Chinese medicines during the agreement period of negotiated drugs continued to increase, although the proportion was insufficient. In the classification of proprietary Chinese medicines, internal medicine medications accounted for the largest proportion. The management of Chinese herbal medicine decoction pieces has shifted from an exclusion regulation to an admission regulation, ensuring the fairness of medication in various regions. Conclusion: The longitudinal analysis shows that the adjustment of the number and structure of proprietary Chinese medicine and Chinese herbal medicine decoction pieces is more reasonable, and the number of proprietary Chinese medicines has increased significantly, which fully reflects the increasing support of the healthcare insurance system for Chinese medicine.