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.
Key words
provincial medical insurance access /
TCM decoction pieces /
comprehensive value evaluation /
indicator system /
Delphi method
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References
[1] 国家医保局,人力资源社会保障部.关于印发《国家基本医疗保险、生育保险和工伤保险药品目录》以及《商业健康保险创新药品目录(2025年)》的通知:医保发〔2025〕 33号[EB/OL]. (2025-12-5)[2026-3-23].https://www.gov.cn/zhengce/zhengceku/202512/content_7050533.htm.
[2] 国家医疗保障局.基本医疗保险用药管理暂行办法(国家医疗保障局令第1号)[EB/OL]. (2020-07-30)[2025-11-19].https://www.nhsa.gov.cn/art/2020/7/31/art_37_3387.html.
[3] 张春梅,唐丽燕,王晓宇,等.我国医保药品目录中药饮片管理现状分析[J].中国药房,2025, 36(20):2495-2501.
[4] 郭凌云,李瑞锋,马爽.纵向视角下我国中成药和中药饮片医保药品目录管理研究[J].中国医疗保险,2024(03):44-50.
[5] 国家医保局,财政部,国家税务总局.关于做好2023年城乡居民基本医疗保障工作的通知:医保发〔2023〕24号[EB/OL].(2023-07-28)[2025-11-19].https://www.nhsa.gov.cn/art/2023/7/28/art_53_11109.html.
[6] 国家卫生健康委办公厅.药品临床综合评价管理指南(2021年版试行):国卫办药政〔2021〕16号[Z].2021.
[7] 孙振球. 医学综合评价方法及其应用[M].北京:化学工业出版社,2006:185.
[8] 黄竹航,张丽珍,赵新华.Delphi法在流行病学研究中的应用现状[J].中国公共卫生管理,2011,27(5):459-461.
[9] 姚振阁,周佳薇,陆梦依,等.基于德尔菲法构建真实世界证据评价体系[J].中国循证医学杂志,2024,24(10):1156-1161.
[10] 赵锐,胡若飞,石秀园,等.我国药品临床综合评价全面质量管理体系的构建[J].中国药房,2022,33(12):1409-1414+1429.
[11] 谭婧,熊益权,黄诗尧,等.用于药品临床价值和经济价值评价的真实世界数据关键技术考量[J].中国循证医学杂志,2024,24(05):516-522.
[12] Jiao B.Estimating the Potential Benefits of Confirmatory Trials for Drugs with Accelerated Approval: A Comprehensive Value of Information Framework[J]. Pharmacoeconomics, 2023, 41(12): 1617-1627.
[13] Angelis A, Kanavos P.Multiple Criteria Decision Analysis (MCDA) for evaluating new medicines in Health Technology Assessment and beyond: The Advance Value Framework[J]. Soc Sci Med, 2017, 188: 137-156.
[14] Jin X Y, Su C G, Zhang J L, et al.A comprehensive value evaluation index system for provincial medical insurance access to traditional Chinese medicine preparations in medical institutions[J]. Integrative Medicine Research, 2026, 15(2): 101258.
