本文通过系统梳理各省份医用耗材除外收费管理相关政策文本与实践案例,对全国医用耗材除外收费管理模式展开历史脉络梳理、现状特征分析与未来发展展望。研究结果显示：在管理模式演进方面,既往各省份以“除外内容”为核心管理框架,结合地方实际需求进行政策适配,但省际间同一医用耗材的除外收费管理标准存在差异;在“技耗分离”改革落地阶段,随着相关立项指南的实施,全国初步形成三类管理模式,分别为“平移指南配套可收费耗材”“编制可单独收费耗材目录（清单）”“落实国家非基本物耗清单”,三类模式依次呈现“稳健过渡”“体系优化”“一步到位”的实践特征。同时,研究发现少数基本物耗的收费边界与收费属性仍需进一步明确。基于上述研究结论,本文建议优先按“先平移—后衔接—再微调”的工作逻辑,分阶段稳妥推进全国医用耗材除外收费管理规范化进程,并同步建立健全除外收费耗材动态调整机制,为提升医用耗材收费管理效能、平衡多方利益提供实践参考。

This article systematically reviews the policy texts and practical cases related to the management of excluded medical consumable charge across various provinces. It conducts a historical analysis and examines current characteristics and future development prospects of management models for excluded medical consumable charge in China. The research shows that in terms of the evolution of management models, each province has used "excluded content" as the core management framework in the past, and adapted policies based on local practical needs. However, there are differences in the management standards for excluding charges for the same medical consumables among provinces. During the implementation of the “separation of technology and consumable” reform and the introduction of relevant guides for project initiation, three management models have been initially formed nationwide, namely supporting chargeable consumables for the guides, compiling a catalog (list) of separately chargeable consumables, and implementing the national nonbasic material consumption list. These three models, in order, show the practical characteristics of steady transition, system optimization, and one-step implementation. At the same time, research has found that the boundaries and attributes of charging for a few basic consumables still need to be further clarified. Based on those findings, this paper recommends that we advance the national standardized management of excluded medical consumable charge in a phased and prudent manner, following the operational logic of “transition first, integration next, followed by fine-tuning”. Concurrently, we should establish and refine a dynamic adjustment mechanism for excluded consumable charge, in order to provide practical guidance for enhancing the efficiency of medical consumable charge management and balancing the interests of multiple stakeholders.