目的:构建适用于省级医保准入决策的中药饮片综合价值评价指标体系,为规范省级中药饮片医保准入管理提供循证工具。方法:综合运用政策文献研究与实地调研,构建初始评价框架;采用德尔菲法对全国15名专家开展两轮咨询,筛选并确定评价指标;运用层次分析法计算指标权重;在省级中药饮片医保目录调整工作中开展实证研究,检验指标体系的可行性。结果:构建了包含5个一级指标（药学价值20.62%、临床价值22.29%、经济价值18.96%、传承价值19.16%、社会价值18.96%）和12个二级指标（涵盖药材来源记载、临床有效性和必需性、医保预算影响等）的评价体系。两轮专家咨询问卷回收率均为100%,专家权威系数为0.896,表明专家积极性与权威性较高,研究结果可靠。结论:该指标体系体现中药饮片多维价值特征,紧扣省级医保目录调整的现实需求与证据要求,在省级实证应用中展现出良好的区分效度与可操作性,初步验证了其可行性,可为各省级医保部门开展中药饮片准入评审提供决策参考。

Objective:The paper scientifically constructs a comprehensive value evaluation index system for Traditional Chinese Medicine (TCM) decoction pieces tailored for provincial medical insurance access decisions, thereby providing an evidence-based tool to standardize and strengthen the administrative access management of provincial TCM decoction pieces. Methods:An initial comprehensive value evaluation framework was developed through policy and literature review combined with field research. Two-round Delphi method was employed to consult 15 national experts to screen and finalize the evaluation indicators. The analytic hierarchy process was used to calculate the weights of indicators at each level. Based on the constructed indicator system, an empirical study was conducted in the adjustment of a provincial TCM decoction pieces medical insurance list to test the feasibility of the indicator system. Results:An evaluation system was established, comprising 5 first-level indicators: Pharmaceutical Value (20.62%), Clinical Value (22.29%), Economic Value (18.96%), Heritage Value (19.16%), and Social Value (18.96%). It also includes 12 second-level indicators, such as Documentation of Medicinal Material Origin, Clinical Effectiveness and Necessity, and Budget Impact on Medical Insurance. The questionnaire response rate for the two rounds was 100%, and the expert authority coefficient was 0.896, indicating high levels of expert engagement and authority, thus ensuring the reliability of the results. Conclusion:The index system developed in this study not only reflects the multidimensional value of TCM decoction pieces, but also closely aligns with the practical needs and evidence requirements of provincial medical insurance list adjustments. In provincial-level empirical applications, it has demonstrated good discriminant validity and operability, preliminarily verifying its feasibility. It can serve as a decision-making reference for provincial healthcare security administrations in conducting access review of TCM decoction pieces.