Analysis of hospitalization costs for a TCM-advantaged disease under DRG payment reform: a case study of Xiang Bi
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective This study aims to analyze the composition, temporal trends, and influencing factors of hospitalization costs for “Xiang Bi” (cervical spondylosis), a TCM-advantaged disease category, against the background of ongoing DRG payment reform and the deepening of policies supporting TCM, so as to provide empirical evidence for improving medical insurance payment mechanisms that align with the characteristics of TCM. Methods A total of 1,046 inpatients discharged with a diagnosis of Xiangbi between January 1, 2023, and December 31, 2025, from a tertiary TCM hospital in Z province were selected. Data were collected from the first pages of medical records and detailed medical insurance settlement records. Descriptive analysis, Mann–Whitney U test, Kruskal–Wallis H test, and generalized linear models were used to statistically analyze the composition, annual changes, and influencing factors of hospitalization costs. Results Patients hospitalized with Xiangbi were predominantly young and middle-aged women, and the application rate of TCM characteristic techniques reached 94.0%. From 2023 to 2025, the average total hospitalization cost per visit decreased from 10,610.66 yuan to 7,273.65 yuan, showing a continuous downward trend during the three-year study period. The proportion of TCM treatment costs rose from 22.22 to 32.46%, becoming the dominant cost component, while the proportions of diagnostic tests, Western medicine, and consumables decreased to 18.79, 6.56, and 13.58%, respectively. The generalized linear model revealed that length of stay (Wald χ 2 = 117.860, p < 0.001), year (Wald χ 2 = 10.859, p = 0.004), age group (Wald χ 2 = 23.799, p = 0.001), application of TCM characteristic techniques (Wald χ 2 = 7.240, p = 0.007), use of hospital-prepared TCM preparations (Wald χ 2 = 9.302, p = 0.002), and use of TCM diagnostic and therapeutic equipment (Wald χ 2 = 7.539, p = 0.006) were independent influencing factors of hospitalization costs. Conclusion During the implementation of the DRG payment reform, a year-by-year decreasing trend in the total hospitalization costs for Xiangbi was observed, with the cost structure showing an optimized trend driven by TCM techniques and a compressed proportion of drugs and consumables. TCM characteristic techniques exhibited potential advantages in cost containment; however, factors such as length of stay and age still significantly affected the cost level. It is recommended that length of stay be adopted as a core control target, incentive mechanisms reflecting the labor value of TCM characteristic techniques be refined, differentiated tiered payment strategies be established, and multicenter, long-term cost evaluation studies be advanced. Nevertheless, because this study lacked control data from before the reform, the changes observed cannot be directly attributed to the DRG reform. Future research should incorporate quasi-experimental designs such as interrupted time series or difference-in-differences analyses for verification. This study is intended to provide a descriptive basis and generate hypotheses for future causal inference research, rather than to serve as a substitute for rigorous policy-effect evaluation.
Source: Frontiers in Public Health
Authors: Xihao Zhang, Ke Ding, Yue Lv, Wei Zhang
Institution: Gansu University of Traditional Chinese Medicine
Language: English
Subfield: Finance
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223103487