医疗服务价格项目立项指南（以下简称“立项指南”）是以服务产出为导向对现行医疗服务价格项目的规范整合,也是对医疗服务计价规则的全面更新。本研究在回顾国家对医疗收费规则政策要求的基础上,梳理了立项指南计价说明、使用说明中的计价规则设置及其变化,发现立项指南以正面清单、负面清单清楚界定了收费边界,对医疗收费规则顶层设计和应用场景提出了全新要求。用足用好立项指南收费规则的政策建议包括：结合立项指南要素重大变化,更新国家和省级医疗收费审核监管规则库,建立医嘱和价格项目匹配关系,将收费规则嵌入信息系统,筑牢监管防线。

The medical service price item initiation guideline (hereinafter referred to as the item initiation guideline) is not only a standardized integration of the current medical service price items oriented towards service output, but also a comprehensive update of the medical service pricing rules. Based on a review of the national policy requirements for medical charging rules, this study analyzed the pricing rule settings and their changes in the pricing explanations and usage instructions of the item initiation guidelines. The study found that the item initiation guidelines clearly defined the charging boundaries through positive and negative lists, and put forward new requirements for the top-level design and application scenarios of medical charging rules. Policy suggestions for making full and effective use of charging rules in item initiation guidelines include updating the national and provincial versions of medical charge regulation and supervision rule databases according to significant changes in the elements of item initiation guidelines, establishing a matching relationship between medical orders and price items, embedding charging rules into information systems, and strengthening the supervision line of defense.