Unpacking the Cost Implications of Diagnosis-Related Groups Reform for Lumbar Disc Herniation Patients in Chinese Medicine: A Closer Look at Evidence from China

Unpacking the Cost Implications of Diagnosis-Related Groups Reform for Lumbar Disc Herniation Patients in Chinese Medicine: A Closer Look at Evidence from China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unpacking the Cost Implications of Diagnosis-Related Groups Reform for Lumbar Disc Herniation Patients in Chinese Medicine: A Closer Look at Evidence from China Mengen Chen, Yuhan Wang, Jing Yu, Shiji Xia, Xiaoxi Zhang, Yan Wang, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5354926/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Lumbar disc herniation (LDH) presents a significant economic burden globally, worsening in China due to an aging population. Traditional Chinese Medicine (TCM) offers effective treatment options for LDH, making its integration with Diagnosis-Related Groups (DRG) payment reform crucial for reducing medical costs and enhancing healthcare quality. Methods We analyzed data from hospitalized patients at Qingyang City Hospital of Chinese Medicine, Gansu Province, from 2017 to 2022. Univariate analysis was conducted to examine changes in patient demographics before and after the DRG reform. A single group interrupted-time series (ITS) model was used to compare key indicators of medical costs and length of stay pre- and post-reform. Results A total of 2,857 LDH patients were included in the study. Pre-DRG reform, 1,294 patients were recorded, with males comprising 46.06% and a mean age (SD) of 58.29(14.22) years. Post-DRG reform, 1,563 patients were observed, with males accounting for 40.88% and a mean age (SD) of 60.64 (14.25) years. No significant differences were found in nationality, marital status, use of Chinese medicine diagnostic and therapeutic equipment, use of Chinese medicine diagnostic and treatment techniques or diagnosis and treatment based on Chinese medicine evidence (P>0.05). However, significant differences were noted in sex, age, visit times, admission pathways, admission disease status, complications and comorbidities, and surgeries and operations (P<0.05). Post-reform, average monthly hospitalization cost decreased by CNY 36.78 (β1+β3=-36.78, P<0.05), Chinese medicine cost fell by CNY 8.87 (β1+β3=-8.87, P<0.05), and Western medicine cost dropped by CNY 31.68 (β1+β3=-31.68, P<0.05). While the rising trend in diagnosis cost was curtailed, both medical services cost and TCM treatment cost increased, with the length of stay remaining stable. Conclusions The DRG reform is associated with lower hospitalization cost and reduced costs for both Chinese medicine and Western medicine. However, its impact on overall medical services cost, diagnosis cost, TCM treatment cost, and length of stay is limited. Future DRG reform should leverage the distinctive advantages of TCM, enhance the payment system, improve treatment outcomes, and further reduce healthcare costs while shortening hospitalization times. LDH DRG Qingyang City Hospitalization cost Chinese medicine hospitals Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Low back pain is one of modern society's most common orthopedic conditions[ 1 ]. Currently, over 600 million people suffer from low back pain worldwide, and this number is projected to exceed 800 million by 2050[ 2 – 4 ]. According to the Global Burden of Disease study, low back pain ranks among the top causes of disability globally, with long recovery times that impose a significant economic burden on patients and their families[ 5 , 6 ]. LDH has emerged as a primary contributor to low back pain, leg pain, and mobility impairments[ 7 , 8 ], with its incidence climbing each year due to an aging population, evolving work patterns, lifestyle shifts, and increasingly sedentary behavior[ 9 , 10 ]. Research from countries such as the United States[ 11 , 12 ], the United Kingdom[ 13 ], Brazil[ 14 ], New Zealand[ 15 ], and Spain underscores the substantial healthcare burden posed by LDH[ 16 , 17 ]. Given China's large population and accelerating aging process, healthcare costs associated with LDH are expected to continue rising soon. TCM demonstrates unique advantages in treating LDH. It utilizes various modalities, including acupuncture, tuina (Chinese massage), herbal medicine, and moxibustion. By adopting a holistic approach and differential diagnosis, TCM effectively alleviates pain and enhances the body’s self-repair capabilities[ 18 , 19 ]. Furthermore, exercises such as Tai Chi and Wuqinxi have demonstrated significant effectiveness in preventing low back pain, as highlighted in several studies[ 20 , 21 ]. In contrast, conventional treatments like medication and surgery often carry numerous complications and side effects[ 22 – 24 ]. TCM’s conservative, non-surgical methods typically result in fewer complications and better recovery outcomes[ 25 – 28 ]. Reforming the DRG payment system in Chinese medicine hospitals to harness TCM strengths can significantly reduce hospitalization cost and length of stay for LDH patients, making this an important practical consideration. DRG introduced by Fetter et al. in the 1980s, classify cases based on similarities in clinical processes and resource consumption[ 29 ]. DRG has been adopted by various countries[ 30 – 34 ] for its benefits in hospital management and healthcare costs, achieving notable results[ 31 , 35 – 37 ]. China began researching DRG in the 1980s and implemented several regional pilot schemes, including Beijing-Diagnosis-Related Groups (BJ-DRG) and Chinese-Diagnosis-Related Groups (CN-DRG). To address rising healthcare costs, China launched the national China Healthcare Security Diagnosis Related Groups (CHS-DRG) pilot scheme in 2019, with a mandate for full implementation in hospitals by 2025[ 38 , 39 ]. As a vital part of healthcare in China, the reform of DRG payment systems in Chinese medicine hospitals is important, particularly for LDH, a condition where TCM shows distinct advantages. This study focuses on LDH patients at Qingyang City Hospital of Chinese Medicine, Gansu Province, examining the impact of DRG payment reform on healthcare-related costs and length of stay. The findings aim to provide insights for Chinese health policymakers to advance DRG reforms, leveraging TCM's strengths to alleviate the economic burden of diseases like LDH in China. Materials and methods Data sources Data were sourced from the Gansu Provincial Health and Health Commission, covering case records from January 2017 to June 2022 for Qingyang City Hospital of Chinese Medicine. Inclusion criteria included TCM diagnosis code International Classification of Disease (ICD)-10 M51.202 and TCM coding BNS150 (1995 version) or A03.06.04.06.01 (2021 version). Exclusion criteria involved length of stay less than 1 day or greater than 90 days, zero hospitalization cost, and logically inconsistent visit information, resulting in a final dataset of 2,857 valid cases. The data were regularly validated and cleaned by qualified personnel, ensuring reliable quality for analysis. The dataset encompasses patient demographics, including sex, age, and marital status, alongside medical information including visit times, surgeries and operations, complications and comorbidities, medical costs, and length of stay. To evaluate the impact of DRG reform on medical costs and length of stay for LDH patients in Chinese medicine hospitals, our study employed a quasi-experimental ITS model for data analysis. As one of the pioneering tertiary Chinese medicine hospitals in Northwest China to implement DRG payment reform, this research is instrumental in advancing DRG reimbursement systems in the TCM sector. Statistical analysis To address healthcare economic costs, we used 2016 as the base year and adjusted relevant costs based on the Consumer Price Index (CPI) for healthcare in Gansu Province from 2017 to 2022, minimizing potential biases in the study. It is worth highlighting that Qingyang City in Gansu Province, began trial implementation of the DRG reimbursement system in October 2019. Thus, the period from January 2017 to September 2019 was defined as the pre-reform phase, while October 2019 to June 2022 was the post-reform phase. Next, we compared the basic characteristics of patient visits before and after the DRG reform. For normally distributed numerical variables, paired sample t-tests were used, reporting data as means and standard deviations. For non-normally distributed numerical variables, we applied the Wilcoxon rank-sum test, expressing results in median and quartiles. Categorical variables were analyzed using chi-square tests, with frequencies and percentages reported. Moreover, we utilized an ITS model—commonly applied in public health policy research[ 40 – 42 ]—to analyze key healthcare indicators for patients with LDH in Chinese medicine hospitals. This analysis included hospitalization cost, medical service cost, diagnostic cost, TCM treatment cost, Chinese medicine cost, Western medicine cost, and length of stay. This approach enabled a detailed exploration of changes in these indicators before and after the DRG reform, with the model equation used represented by the following: $$\:{\:Y}_{t}={\beta\:}_{0}+{\beta\:}_{1}{T}_{t}+{\beta\:}_{2}{X}_{t}+{\beta\:}_{3}{X}_{t}{T}_{t}+{\epsilon\:}_{t}$$ In this equation, \(\:{Y}_{t}\) is the dependent variable (the primary outcome), \(\:{\beta\:}_{0}\) is the intercept, \(\:{\beta\:}_{1}\) reflects the pre-reform trend, \(\:{\beta\:}_{2}\) indicates the level change at the reform, and \(\:{\beta\:}_{3}\) represents the difference in slopes between the post-reform and pre-reform periods, with the post-reform slope being the sum of \(\:{\beta\:}_{1}\) and \(\:{\beta\:}_{3}\) . \(\:{T}_{t}\) denotes the time series spanning January 2017 to June 2022, with T ranging from 1 to 66. Interaction terms include \(\:{X}_{t}{T}_{t}\) , \(\:\:Z{T}_{t}\) , \(\:Z{X}_{t}\) , and \(\:Z{X}_{t}{T}_{t}\) , while \(\:{\epsilon\:}_{t}\) denotes random error. To address the skewed distributions of healthcare costs and length of stay, we selected the median values for each month as the data for the interrupted time series analysis, ensuring the rigor of the analysis. A schematic of the model is shown in Fig. 1. We used the Cumby-Huizinga tests to assess the autocorrelation of the dependent variable and adjusted calculations using the 'lag (#)' command along with the Newey-West method[ 43 – 45 ]. All statistical analyses were conducted using Excel 2019, SPSS 26.0, and Stata 15.0, with a significance level set at α = 0.05. Results General information of LDH hospitalized patients in Qingyang City Hospital of Chinese Medicine in pre- and post-DRG reform. We included a total of 2,857 LDH patients in our analysis. Before the implementation of the DRG reform, there were 1,294 cases, with 46.06% of the patients being male and an average age ( SD ) of 58.29 (14.22) years. Following the DRG reform, the sample comprised 1,563 cases, with a male proportion of 40.88% and an average age ( SD ) of 60.64 (14.25) years. Further demographic details are provided in Table 1. As shown in Table 1, there were no statistical differences in nationality, marital status, use of Chinese medicine diagnostic and treatment techniques, use of Chinese medicine diagnostic and treatment techniques, diagnosis and treatment based on Chinese medicine evidence, and hospitalization cost among LDH patients pre- and post-DRG reforms ( P >0.05), but there were significant differences in sex, age, visit times, admission pathways, admission disease status, complications and comorbidities, surgeries and operations, medical services cost, diagnosis cost, TCM treatment cost, Chinese medicine cost, Western medicine cost and length of stay among LDH patients pre- and post-DRG reforms ( P <0.05). Results of ITSA of DRG reform on LDH patients' healthcare-related costs in Qingyang City Hospital of Chinese Medicine We performed Cumby-Huizinga autocorrelation tests on hospitalization cost, medical service cost, diagnostic cost, TCM treatment cost, Chinese medicine cost, and Western medicine cost. The results indicated that hospitalization cost, TCM treatment cost, and Chinese medicine cost exhibited no autocorrelation. However, diagnostic cost and Western medicine cost may demonstrate first-order autocorrelation, while medical service cost could indicate second-order autocorrelation, as summarized in Table 2. To ensure the robustness of our interrupted time-series analysis, we employed the 'lag (1) ' or 'lag (2)' command to adjust for autocorrelation effects in the medical costs analysis. Before the DRG reform at Qingyang City Hospital of Chinese Medicine, hospitalization cost exhibited a significant upward trajectory, with an average monthly increase of CNY 43.49 (β₁=43.49, P 0.05). Following the reform, however, cost demonstrated a pronounced downward trend, decreasing by an average of CNY 36.78 per month (β₁+β₃=-36.78, P <0.05). Comprehensive results are presented in Table 3, and the corresponding trend changes are illustrated in Figure 2. In terms of medical services cost, the pre-reform trend was not significant (β₁=-2.76, P >0.05). Nevertheless, during the reform, there was a substantial increase of CNY 361.98 (β₂=361.98, P 0.05), as detailed in Table 3 and depicted in Figure 3. Regarding diagnosis cost, a clear upward trend was evident before the reform, with an average monthly increase of CNY 26.16 (β₁=26.16, P <0.05). During the reform, diagnosis cost significantly decreased by CNY 307.11 (β₂=-307.11, P 0.05), as outlined in Table 3 and shown in Figure 4. Concerning TCM treatment cost, there was a notable increase before the reform, averaging CNY 39.04 per month (β₁=39.04, P <0.05). Following a significant decrease of CNY 466.54 during the reform (β₂=-466.54, P <0.05), the cost rebounded, displaying a clear upward trend post-reform, with an average increase of CNY 50.08 (β₁+β₃=50.08, P 0.05). However, during the reform, the cost rose significantly by CNY 142.27 (β₂=142.27, P <0.05), while post-reform expenses revealed a significant downward trend, decreasing by an average monthly of CNY 8.87 (β₁+β₃=-8.87, P <0.05), as presented in Table 3 and illustrated in Figure 6. Finally, Western medicine cost showed a significant downward trend before the reform, decreasing by an average of CNY 9.93 (β₁=-9.93, P 0.05). However, the cost exhibited a marked downward trend, with an average monthly decrease of CNY 31.68 (β₁+β₃=-31.68, P <0.05) post-reform, which was notably more pronounced than the pre-reform trend. Detailed results can be found in Table 3, with trend changes depicted in Figure 7. Results of ITSA of DRG reform on length of stay in Qingyang City Hospital of Chinese Medicine We conducted a Cumby-Huizinga autocorrelation test on the length of stay, which revealed no evidence of autocorrelation, as presented in Table 4. This finding underscores the stability of the data regarding length of stay. Pre-DRG reform, the trend in length of stay was not statistically significant, with a coefficient of β₁=-0.03 ( P >0.05). This lack of significance indicates that there were no noteworthy changes in the average length of stay during this period. Similarly, the analysis of length of stay during the reform period also yielded insignificant results (β₂=0.27, P >0.05), and post-reform trends remained unremarkable, as reflected in the combined coefficient (β₁+β₃=-0.02, P >0.05). Detailed results are provided in Table 5, and the corresponding trend changes are illustrated in Figure 8, further emphasizing the consistency of length of stay across the study periods. Discussion We are the first to investigate the effects of the DRG reform on medical costs and length of stay for LDH patients in Chinese medicine hospitals. This study provides valuable insights into the ongoing reforms of DRG payment systems in TCM. Our univariate analysis revealed differences in patient characteristics before and after the reform, including sex, age, visit times, admission pathways, admission disease status, complications and comorbidities, and surgeries and operations. Post-reform, there was an increase in female patients, older patients, those admitted through other pathways, and patients with defined disease status, complications and comorbidities, and surgical needs. Notably, the proportion of patients admitted through other pathways and those with repeated hospitalizations also increased, suggesting that the reform measures have successfully attracted more patients and fostered repeat admissions to the hospital. The higher number of patients with defined disease status aligns with the reform's objective of improving diagnostic precision. Additionally, the increase in patients with complications and operations needs suggests a rise in case complexity, potentially leading to higher reimbursement standards, which benefits the hospital departments during cost settlement. The results from our interrupted time-series analysis indicate a significant downward trend in hospitalization cost, Chinese medicine cost, and Western medicine cost following the DRG reform. While the rising trend in diagnostic cost before the reform was curtailed, overall medical service cost increased post-reform, alongside a marked rise in TCM treatment cost. It is noteworthy that hospitalization cost for LDH patients changed significantly after the DRG reform, demonstrating a marked decrease that aligns with findings from various other studies [46-48]. Certainly, the component costs of hospitalization, including those for Chinese and Western medicine, have concurrently declined alongside the overall reduction in hospitalization cost. However, diagnostic cost and medical service cost were higher post-reform than before, indicating that Chinese hospitals are leveraging their unique strengths by providing more specialized services to address patient needs. This aligns with the Chinese government's objectives for DRG reform in TCM. Interestingly, the length of stay for LDH patients did not decrease following the DRG reform, which stands in contrast to findings from several other studies[33, 49-51]. What’s more, previous studies suggest that length of stay is a critical factor influencing hospitalization cost, implying that a significant cost reduction should typically accompany shorter stay[52-54]. The absence of a reduction in length of stay, despite the cost reduction, may be related to the unique characteristics of TCM treatment, which often has a slower onset of effects and fewer side effects. The majority of TCM treatment occurs in the initial days of hospitalization, suggesting that later cost may be lower, making it challenging to significantly reduce recovery times through DRG payment reforms alone. However, integrating and standardizing TCM treatment methods, along with reducing medication usage, could help achieve the goal of lowering hospitalization cost. In conclusion, the reform of DRG payment system in TCM has a substantial impact on controlling overall medical costs for LDH patients, although its effectiveness in reducing the length of stay remains limited. Future refinements of the DRG payment system should account for the distinctive characteristics of TCM, optimizing treatment methods and enhancing the quality of healthcare. Establishing a unique and effective reimbursement framework for TCM will further reduce patient treatment cost and length of stay, ultimately benefiting a greater number of patients. Limitations Our study focused on LDH patients at Qingyang City Hospital of Chinese Medicine. Although the sample size is limited, it is noteworthy that this hospital was among the first in Western China to implement DRG reforms in TCM, which lends a degree of representativeness to our findings. Nevertheless, the research lacks specific indicators related to the quality of healthcare and treatment outcomes. Therefore, future studies should aim to establish relevant metrics that assess the impact of DRG reform on treatment results for LDH patients. This limitation is partly attributed to the underdeveloped medical record systems in Chinese medicine hospitals. However, as hospital information systems and the scope of diagnostic and treatment services continue to evolve, these challenges can be effectively addressed. Conclusions DRG reform is associated with lower hospitalization cost, as well as reduced costs for both Chinese and Western medicine among LDH patients in Chinese medicine hospitals. However, it does not correlate with reductions in medical services cost, diagnostic cost, TCM treatment cost, or length of stay. While the reform effectively leverages the unique strengths of TCM to alleviate the economic burden of illness, there is a need to deepen institutional reforms and enhance the quality and content of medical services, with the goal of further reducing healthcare costs and shortening hospitalization durations. Abbreviations LDH Lumbar Disc Herniation TCM Traditional Chinese Medicine DRG Diagnosis-Related Group ITS Interrupted Time-series BJ-DRG Beijing-Diagnosis Related Groups CN-DRG Chinese-Diagnosis-Related Groups CHS-DRG China Healthcare Security Diagnosis-Related Groups ICD International Classification of Diseases CPI Consumer Price Index CNY Chinese Yuan Declarations Acknowledgments The authors would like to acknowledge the Gansu Provincial Health and Wellness Commission for data support for our study. Authors’ contributions MC, YY, SX, and JYY participated in data collection and collation. MC, YY, YW, JY, YHW, XZ, and ZW participated in the method design, analyzed data, and drafted the initial manuscript. MC, JW, FK, TC, XJ, HS, GW, and HH participated in text-checking correction and helped to draft the manuscript. ZW and JYY oversaw and provided input on all aspects of manuscript writing and the final analytical plan. All the authors read and approved the final manuscript. Funding This study was supported by the State Administration of Traditional Chinese Medicine (SACM) (Grant NO. ZYZB-2023-435 and NO. GZY-FJS-2022-045). Availability of data and materials Datasets used or analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate The need for informed consent was waived by the Beijing University of Chinese Medicine Ethics Committee (BUCM-1002600). All methods were carried out in accowing relevant guidelines and regulations. Since research data comes from a government agency database without critical private information about individuals for our study, we believed that no official ethics approval should be sought for this study according to Measures for the Ethical Review of Biomedical Research Involving Humans by China’s National Health and Family Planning Commission in 2016. Consent for publication Not applicable. Competing interests Not applicable. Author details 1 School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 102400, China 2 School of Management, Beijing University of Chinese Medicine, Beijing 102400, China 3 Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing 100053, China 4 School of Health Management, Gansu University of Chinese Medicine, Lanzhou 730000, China 5 Gansu Health and Population Development Research Center, Gansu Provincial Health and Wellness Commission, Lanzhou 730000, China 6 School of Public Health, Lanzhou University, Lanzhou 730000, China 7 National Institute of Chinese Medicine Development and Strategy, Beijing 102400, China References Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J et al : What low back pain is and why we need to pay attention . Lancet 2018, 391 (10137):2356-2367. 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Bernal JL, Cummins S, Gasparrini A: Interrupted time series regression for the evaluation of public health interventions: a tutorial . Int J Epidemiol 2017, 46 (1):348-355. Linden A: Conducting interrupted time-series analysis for single- and multiple-group comparisons . Stata Journal 2015, 15 (2):480-500. Baum C, Schaffer M: ACTEST: Stata module to perform Cumby-Huizinga general test for autocorrelation in time series . Mark Schaffer 2015. Linden A: A comprehensive set of postestimation measures to enrich interrupted time-series analysis . Stata Journal 2017, 17 (1):págs. 73-88. Lin K, Li Y, Yao Y, Xiong Y, Xiang L: The impact of an innovative payment method on medical expenditure, efficiency, and quality for inpatients with different types of medical insurance: evidence from a pilot city, China . Int J Equity Health 2024, 23 (1):115. Wang S, Wu N, Wang H, Zhang X, Li F, Wang X, Wang W: Impacts of a new diagnosis-related group point payment system on children's medical services in China: Length of stay and costs . Int J Health Plann Manage 2024, 39 (2):432-446. Liu Y, Du S, Cao J, Niu H, Jiang F, Gong L: Effects of a Diagnosis-Related Group Payment Reform on Length and Costs of Hospitalization in Sichuan, China: A Synthetic Control Study . Risk Manag Healthc Policy 2024, 17 :1623-1637. Chen YJ, Zhang XY, Yan JQ, Xue T, Qian MC, Ying XH: Impact of Diagnosis-Related Groups on Inpatient Quality of Health Care: A Systematic Review and Meta-Analysis . Inquiry 2023, 60 :469580231167011. Hamada H, Sekimoto M, Imanaka Y: Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan . Health Policy 2012, 107 (2-3):194-201. Wu Y, Fung H, Shum HM, Zhao S, Wong EL, Chong KC, Hung CT, Yeoh EK: Evaluation of Length of Stay, Care Volume, In-Hospital Mortality, and Emergency Readmission Rate Associated With Use of Diagnosis-Related Groups for Internal Resource Allocation in Public Hospitals in Hong Kong . JAMA Netw Open 2022, 5 (2):e2145685. Chen M, Kong F, Su B, Wei X, Yang J: Factors Influencing Hospitalization Cost for Diabetic Patients in Traditional Chinese Medicine Hospitals in Qingyang City, China . Int J Environ Res Public Health 2022, 19 (21). Hou HJ, Cong TZ, Cai Y, Ba YH, Chen ME, Yang JY, Luo ZH: Influencing factors of hospitalization cost of hypertension patients in traditional Chinese medicine hospitals . Front Public Health 2024, 12 :1329768. Chen M, Yang J, Hou H, Zheng B, Xia S, Wang Y, Yu J, Wu G, Sun H, Jia X, et al : Analysis of factors influencing hospitalization cost of patients with distal radius fractures: an empirical study based on public traditional Chinese medicine hospitals in two cities, China . BMC Health Serv Res 2024, 24 (1):605. Tables Tables 1 to 5 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Data.xls Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5354926","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":372718505,"identity":"fce141c3-51a0-4c6b-bd23-81515c07055e","order_by":0,"name":"Mengen Chen","email":"","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mengen","middleName":"","lastName":"Chen","suffix":""},{"id":372718506,"identity":"fa56823a-3bcd-4ec2-9951-f7891682cddf","order_by":1,"name":"Yuhan Wang","email":"","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yuhan","middleName":"","lastName":"Wang","suffix":""},{"id":372718507,"identity":"8e2446f9-6712-43e8-b3cf-9d4b6a78be10","order_by":2,"name":"Jing Yu","email":"","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Yu","suffix":""},{"id":372718508,"identity":"85e7f8a1-1703-4241-9bfe-64530525a79e","order_by":3,"name":"Shiji Xia","email":"","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shiji","middleName":"","lastName":"Xia","suffix":""},{"id":372718509,"identity":"84e82ac8-1afb-4126-a5ef-f14c729f18a3","order_by":4,"name":"Xiaoxi Zhang","email":"","orcid":"","institution":"Beijing University of Chinese 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Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xuan","middleName":"","lastName":"Jia","suffix":""},{"id":372718513,"identity":"7f0dda95-1906-47d9-b914-4dab06c7c4d3","order_by":8,"name":"Henong Sun","email":"","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Henong","middleName":"","lastName":"Sun","suffix":""},{"id":372718514,"identity":"cf5e3bd2-7052-428b-938c-7727c1ec9c32","order_by":9,"name":"Guoping Wu","email":"","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Guoping","middleName":"","lastName":"Wu","suffix":""},{"id":372718515,"identity":"709abf9e-0bde-47ab-b69b-c5ebe8927c57","order_by":10,"name":"Jiayi Wang","email":"","orcid":"","institution":"Gansu University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jiayi","middleName":"","lastName":"Wang","suffix":""},{"id":372718516,"identity":"def95cf8-e5c8-4314-b537-e99d784d65e7","order_by":11,"name":"Tianzhen Cong","email":"","orcid":"","institution":"Gansu University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tianzhen","middleName":"","lastName":"Cong","suffix":""},{"id":372718517,"identity":"e1696bc5-de96-4a35-94ad-f04df9d73e77","order_by":12,"name":"Fanxin Kong","email":"","orcid":"","institution":"Gansu Provincial Health and Wellness Commission","correspondingAuthor":false,"prefix":"","firstName":"Fanxin","middleName":"","lastName":"Kong","suffix":""},{"id":372718518,"identity":"b3ba5fc4-9d02-4414-b85e-ce9779e746d9","order_by":13,"name":"Haojia Hou","email":"","orcid":"","institution":"Gansu University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Haojia","middleName":"","lastName":"Hou","suffix":""},{"id":372718519,"identity":"cd5a1433-3cc9-4d90-a6b4-3916b22cffd6","order_by":14,"name":"Jingyu Yang","email":"","orcid":"","institution":"Gansu University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jingyu","middleName":"","lastName":"Yang","suffix":""},{"id":372718520,"identity":"959761cf-62b2-4160-aaee-0e74b99f8922","order_by":15,"name":"Zhiwei Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYBACNv7GhgMfKmrk+NmbDxCnhU/icOPDGWeOGUv2HEsgToscQ3qzMWcbc+KGGTkGRDqM4WCbNGMbW+IGiZyPN94w2MnpNhDSwtzYJl1wTsZ4O8/bzZZzGJKNzQ4QY8uMMjbZne2526R5GA4kbiOsJbFNmoeNmXHDgZxnRGtpNuZpY1bccCKHjUgtEgfhgWxsOceACL/I97c/gEXlwxtvKuzkCGpBARI8REYNshZSdYyCUTAKRsGIAACntUZyto9YnQAAAABJRU5ErkJggg==","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Zhiwei","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-10-29 14:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5354926/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5354926/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69950295,"identity":"9f395a7b-32e0-494a-8273-e6c58f9be002","added_by":"auto","created_at":"2024-11-27 02:10:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37062,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic diagram of ITSA model\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/9e6d5612837768d29caca77c.png"},{"id":69950752,"identity":"896f8f10-4444-46a6-91fb-531ebabb2b0f","added_by":"auto","created_at":"2024-11-27 02:18:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":67684,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in hospitalization cost for LDH patients pre- and post-DRG reform\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/25c1af71633ab1ff143bb8dc.png"},{"id":69950302,"identity":"fd1b0c3b-3667-4de5-958d-b551fe60569d","added_by":"auto","created_at":"2024-11-27 02:10:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":62337,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in medical services cost for LDH patients pre- and post-DRG reform.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/90f15543f84691419765cbea.png"},{"id":69950297,"identity":"959059be-b14d-4de2-a320-575dd2f992b3","added_by":"auto","created_at":"2024-11-27 02:10:02","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":63839,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in diagnosis cost for LDH patients pre- and post-DRG reform\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/7e90cde877425860325a06a0.png"},{"id":69950301,"identity":"7ff5955d-4e78-4613-b102-16c01bb5bfc3","added_by":"auto","created_at":"2024-11-27 02:10:02","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":67265,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in TCM treatment cost for LDH patients pre- and post-DRG reform\u003c/p\u003e","description":"","filename":"Fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/a4b8ebd90487656e69c5a839.png"},{"id":69950754,"identity":"26e14c23-fc61-42d9-bc36-01646def9a02","added_by":"auto","created_at":"2024-11-27 02:18:02","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":64757,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in Chinese medicine cost for LDH patients pre- and post-DRG reform.\u003c/p\u003e","description":"","filename":"Fig6.png","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/18125bf9c5217799910bc9f2.png"},{"id":69950755,"identity":"6ad589a4-b509-4669-b92a-ceb793be84b7","added_by":"auto","created_at":"2024-11-27 02:18:02","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":65847,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in Western medicine cost for LDH patients pre- and post-DRG reform\u003c/p\u003e","description":"","filename":"Fig7.png","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/d23f37b0db72a4aa03010052.png"},{"id":69951566,"identity":"139cac7a-3a9f-41db-a0ff-b5cf9dbb9140","added_by":"auto","created_at":"2024-11-27 02:26:02","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":58170,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in length of stay for LDH patients pre- and post-DRG reform\u003c/p\u003e","description":"","filename":"Fig8.png","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/4867917c7e97cb87a6355f1a.png"},{"id":74540799,"identity":"63c7f1ea-ff2d-4b2d-b907-8931bad19efd","added_by":"auto","created_at":"2025-01-23 09:17:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3798714,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/eb1dddfa-51e5-4930-9672-4e61b91278c9.pdf"},{"id":69950304,"identity":"05a11f91-9f10-4410-924d-7ee1a090bb8a","added_by":"auto","created_at":"2024-11-27 02:10:02","extension":"xls","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":960512,"visible":true,"origin":"","legend":"","description":"","filename":"Data.xls","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/d98ecbe0408fc7c84f0d63d4.xls"},{"id":69950296,"identity":"a5a8e823-0ca0-4beb-a8e8-3e640997898e","added_by":"auto","created_at":"2024-11-27 02:10:02","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":43831,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5354926/v1/76e9f9ac1f9b16de11c119d5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unpacking the Cost Implications of Diagnosis-Related Groups Reform for Lumbar Disc Herniation Patients in Chinese Medicine: A Closer Look at Evidence from China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLow back pain is one of modern society's most common orthopedic conditions[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Currently, over 600\u0026nbsp;million people suffer from low back pain worldwide, and this number is projected to exceed 800\u0026nbsp;million by 2050[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. According to the Global Burden of Disease study, low back pain ranks among the top causes of disability globally, with long recovery times that impose a significant economic burden on patients and their families[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. LDH has emerged as a primary contributor to low back pain, leg pain, and mobility impairments[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], with its incidence climbing each year due to an aging population, evolving work patterns, lifestyle shifts, and increasingly sedentary behavior[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Research from countries such as the United States[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], the United Kingdom[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], Brazil[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], New Zealand[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and Spain underscores the substantial healthcare burden posed by LDH[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Given China's large population and accelerating aging process, healthcare costs associated with LDH are expected to continue rising soon.\u003c/p\u003e \u003cp\u003eTCM demonstrates unique advantages in treating LDH. It utilizes various modalities, including acupuncture, tuina (Chinese massage), herbal medicine, and moxibustion. By adopting a holistic approach and differential diagnosis, TCM effectively alleviates pain and enhances the body\u0026rsquo;s self-repair capabilities[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Furthermore, exercises such as Tai Chi and Wuqinxi have demonstrated significant effectiveness in preventing low back pain, as highlighted in several studies[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In contrast, conventional treatments like medication and surgery often carry numerous complications and side effects[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. TCM\u0026rsquo;s conservative, non-surgical methods typically result in fewer complications and better recovery outcomes[\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Reforming the DRG payment system in Chinese medicine hospitals to harness TCM strengths can significantly reduce hospitalization cost and length of stay for LDH patients, making this an important practical consideration.\u003c/p\u003e \u003cp\u003eDRG introduced by Fetter et al. in the 1980s, classify cases based on similarities in clinical processes and resource consumption[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. DRG has been adopted by various countries[\u003cspan additionalcitationids=\"CR31 CR32 CR33\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] for its benefits in hospital management and healthcare costs, achieving notable results[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. China began researching DRG in the 1980s and implemented several regional pilot schemes, including Beijing-Diagnosis-Related Groups (BJ-DRG) and Chinese-Diagnosis-Related Groups (CN-DRG). To address rising healthcare costs, China launched the national China Healthcare Security Diagnosis Related Groups (CHS-DRG) pilot scheme in 2019, with a mandate for full implementation in hospitals by 2025[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. As a vital part of healthcare in China, the reform of DRG payment systems in Chinese medicine hospitals is important, particularly for LDH, a condition where TCM shows distinct advantages.\u003c/p\u003e \u003cp\u003eThis study focuses on LDH patients at Qingyang City Hospital of Chinese Medicine, Gansu Province, examining the impact of DRG payment reform on healthcare-related costs and length of stay. The findings aim to provide insights for Chinese health policymakers to advance DRG reforms, leveraging TCM's strengths to alleviate the economic burden of diseases like LDH in China.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eData sources\u003c/h2\u003e\n \u003cp\u003eData were sourced from the Gansu Provincial Health and Health Commission, covering case records from January 2017 to June 2022 for Qingyang City Hospital of Chinese Medicine. Inclusion criteria included TCM diagnosis code International Classification of Disease (ICD)-10 M51.202 and TCM coding BNS150 (1995 version) or A03.06.04.06.01 (2021 version). Exclusion criteria involved length of stay less than 1 day or greater than 90 days, zero hospitalization cost, and logically inconsistent visit information, resulting in a final dataset of 2,857 valid cases.\u003c/p\u003e\n \u003cp\u003eThe data were regularly validated and cleaned by qualified personnel, ensuring reliable quality for analysis. The dataset encompasses patient demographics, including sex, age, and marital status, alongside medical information including visit times, surgeries and operations, complications and comorbidities, medical costs, and length of stay.\u003c/p\u003e\n \u003cp\u003eTo evaluate the impact of DRG reform on medical costs and length of stay for LDH patients in Chinese medicine hospitals, our study employed a quasi-experimental ITS model for data analysis. As one of the pioneering tertiary Chinese medicine hospitals in Northwest China to implement DRG payment reform, this research is instrumental in advancing DRG reimbursement systems in the TCM sector.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eTo address healthcare economic costs, we used 2016 as the base year and adjusted relevant costs based on the Consumer Price Index (CPI) for healthcare in Gansu Province from 2017 to 2022, minimizing potential biases in the study. It is worth highlighting that Qingyang City in Gansu Province, began trial implementation of the DRG reimbursement system in October 2019. Thus, the period from January 2017 to September 2019 was defined as the pre-reform phase, while October 2019 to June 2022 was the post-reform phase.\u003c/p\u003e\n \u003cp\u003eNext, we compared the basic characteristics of patient visits before and after the DRG reform. For normally distributed numerical variables, paired sample t-tests were used, reporting data as means and standard deviations. For non-normally distributed numerical variables, we applied the Wilcoxon rank-sum test, expressing results in median and quartiles. Categorical variables were analyzed using chi-square tests, with frequencies and percentages reported. Moreover, we utilized an ITS model\u0026mdash;commonly applied in public health policy research[\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e]\u0026mdash;to analyze key healthcare indicators for patients with LDH in Chinese medicine hospitals. This analysis included hospitalization cost, medical service cost, diagnostic cost, TCM treatment cost, Chinese medicine cost, Western medicine cost, and length of stay. This approach enabled a detailed exploration of changes in these indicators before and after the DRG reform, with the model equation used represented by the following:\u003c/p\u003e\n \u003cdiv id=\"Equa\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e$$\\:{\\:Y}_{t}={\\beta\\:}_{0}+{\\beta\\:}_{1}{T}_{t}+{\\beta\\:}_{2}{X}_{t}+{\\beta\\:}_{3}{X}_{t}{T}_{t}+{\\epsilon\\:}_{t}$$\u003c/div\u003e\n \u003c/div\u003e\n \u003cp\u003eIn this equation, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{Y}_{t}\\)\u003c/span\u003e\u003c/span\u003e is the dependent variable (the primary outcome), \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{0}\\)\u003c/span\u003e\u003c/span\u003e is the intercept, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{1}\\)\u003c/span\u003e\u003c/span\u003e reflects the pre-reform trend, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{2}\\)\u003c/span\u003e\u003c/span\u003e indicates the level change at the reform, and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{3}\\)\u003c/span\u003e\u003c/span\u003e represents the difference in slopes between the post-reform and pre-reform periods, with the post-reform slope being the sum of \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{1}\\)\u003c/span\u003e\u003c/span\u003e and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}_{3}\\)\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{T}_{t}\\)\u003c/span\u003e\u003c/span\u003e denotes the time series spanning January 2017 to June 2022, with T ranging from 1 to 66. Interaction terms include \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{X}_{t}{T}_{t}\\)\u003c/span\u003e\u003c/span\u003e,\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\:Z{T}_{t}\\)\u003c/span\u003e\u003c/span\u003e, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:Z{X}_{t}\\)\u003c/span\u003e\u003c/span\u003e, and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:Z{X}_{t}{T}_{t}\\)\u003c/span\u003e\u003c/span\u003e, while \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\epsilon\\:}_{t}\\)\u003c/span\u003e\u003c/span\u003e denotes random error. To address the skewed distributions of healthcare costs and length of stay, we selected the median values for each month as the data for the interrupted time series analysis, ensuring the rigor of the analysis. A schematic of the model is shown in Fig. 1.\u003c/p\u003e\n \u003cp\u003eWe used the Cumby-Huizinga tests to assess the autocorrelation of the dependent variable and adjusted calculations using the \u0026apos;lag (#)\u0026apos; command along with the Newey-West method[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e]. All statistical analyses were conducted using Excel 2019, SPSS 26.0, and Stata 15.0, with a significance level set at \u0026alpha;\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eGeneral information of LDH hospitalized patients in Qingyang City Hospital of Chinese Medicine in pre- and post-DRG reform.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe included a total of 2,857 LDH patients in our analysis. Before the implementation of the DRG reform, there were 1,294 cases, with 46.06% of the patients being male and an average age (\u003cem\u003eSD\u003c/em\u003e) of 58.29 (14.22) years. Following the DRG reform, the sample comprised 1,563 cases, with a male proportion of 40.88% and an average age (\u003cem\u003eSD\u003c/em\u003e) of 60.64 (14.25) years. Further demographic details are provided in Table 1.\u003c/p\u003e\n\u003cp\u003eAs shown in Table 1, there were no statistical differences in nationality, marital status, use of Chinese medicine diagnostic and treatment techniques, use of Chinese medicine diagnostic and treatment techniques, diagnosis and treatment based on Chinese medicine evidence, and hospitalization cost among LDH patients pre- and post-DRG reforms (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05), but there were significant differences in sex, age, visit times, admission pathways, admission disease status, complications and comorbidities, surgeries and operations, medical services cost, diagnosis cost, TCM treatment cost, Chinese medicine cost, Western medicine cost and length of stay among LDH patients pre- and post-DRG reforms (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults of ITSA of DRG reform on LDH patients\u0026apos; healthcare-related costs in\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eQingyang City Hospital of Chinese Medicine\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed Cumby-Huizinga autocorrelation tests on hospitalization cost, medical service cost, diagnostic cost, TCM treatment cost, Chinese medicine cost, and Western medicine cost. The results indicated that hospitalization cost, TCM treatment cost, and Chinese medicine cost exhibited no autocorrelation. However, diagnostic cost and Western medicine cost may demonstrate first-order autocorrelation, while medical service cost could indicate second-order autocorrelation, as summarized in Table 2. To ensure the robustness of our interrupted time-series analysis, we employed the \u0026apos;lag (1) \u0026apos; or \u0026apos;lag (2)\u0026apos; command to adjust for autocorrelation effects in the medical costs analysis.\u003c/p\u003e\n\u003cp\u003eBefore the DRG reform at Qingyang City Hospital of Chinese Medicine, hospitalization cost exhibited a significant upward trajectory, with an average monthly increase of CNY 43.49 (\u0026beta;₁=43.49, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Conversely, during the reform, fluctuations in hospitalization cost were not statistically significant (\u0026beta;₂=-333.52, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). Following the reform, however, cost demonstrated a pronounced downward trend, decreasing by an average of CNY 36.78 per month (\u0026beta;₁+\u0026beta;₃=-36.78, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Comprehensive results are presented in Table 3, and the corresponding trend changes are illustrated in Figure 2.\u003c/p\u003e\n\u003cp\u003eIn terms of medical services cost, the pre-reform trend was not significant (\u0026beta;₁=-2.76, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). Nevertheless, during the reform, there was a substantial increase of CNY 361.98 (\u0026beta;₂=361.98, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), while post-reform changes remained insignificant (\u0026beta;₁+\u0026beta;₃=-3.26, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05), as detailed in Table 3 and depicted in Figure 3.\u003c/p\u003e\n\u003cp\u003eRegarding diagnosis cost, a clear upward trend was evident before the reform, with an average monthly increase of CNY 26.16 (\u0026beta;₁=26.16, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). During the reform, diagnosis cost significantly decreased by CNY 307.11 (\u0026beta;₂=-307.11, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), yet the\u0026nbsp;post-reform trend was again not significant (\u0026beta;₁+\u0026beta;₃=-3.66,\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026gt;0.05), as outlined in Table 3 and shown in Figure 4.\u003c/p\u003e\n\u003cp\u003eConcerning TCM treatment cost, there was a notable increase before the reform, averaging CNY 39.04 per month (\u0026beta;₁=39.04, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Following a significant decrease of CNY 466.54 during the reform (\u0026beta;₂=-466.54, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), the cost rebounded, displaying a clear upward trend post-reform, with an average increase of CNY 50.08 (\u0026beta;₁+\u0026beta;₃=50.08, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), as detailed in Table 3 and represented in Figure 5.\u003c/p\u003e\n\u003cp\u003eChinese medicine cost exhibited no significant trend before the reform (\u0026beta;₁=-3.96, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). However, during the reform, the cost rose significantly by CNY 142.27 (\u0026beta;₂=142.27, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), while post-reform expenses revealed a significant downward trend, decreasing by an average monthly of CNY 8.87 (\u0026beta;₁+\u0026beta;₃=-8.87, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), as presented in Table 3 and illustrated in Figure 6.\u003c/p\u003e\n\u003cp\u003eFinally, Western medicine cost showed a significant downward trend before the reform, decreasing by an average of CNY 9.93 (\u0026beta;₁=-9.93, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Changes during the reform were not statistically significant (\u0026beta;₂=-41.39, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). However, the cost exhibited a marked downward trend, with an average monthly decrease of CNY 31.68 (\u0026beta;₁+\u0026beta;₃=-31.68, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05) post-reform, which was notably more pronounced than the pre-reform trend. Detailed results can be found in Table 3, with trend changes depicted in Figure 7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults of ITSA of DRG reform on length of stay in\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eQingyang City Hospital of Chinese Medicine\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a Cumby-Huizinga autocorrelation test on the length of stay, which revealed no evidence of autocorrelation, as presented in Table 4. This finding underscores the stability of the data regarding length of stay.\u003c/p\u003e\n\u003cp\u003ePre-DRG reform, the trend in length of stay was not statistically significant, with a coefficient of \u0026beta;₁=-0.03 (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). This lack of significance indicates that there were no noteworthy changes in the average length of stay during this period.\u003c/p\u003e\n\u003cp\u003eSimilarly, the analysis of length of stay during the reform period also yielded insignificant results (\u0026beta;₂=0.27, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05), and post-reform trends remained unremarkable, as reflected in the combined coefficient (\u0026beta;₁+\u0026beta;₃=-0.02, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). Detailed results are provided in Table 5, and the corresponding trend changes are illustrated in Figure 8, further emphasizing the consistency of length of stay across the study periods.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe are the first to investigate the effects of the DRG reform on medical costs and length of stay for LDH patients in Chinese medicine hospitals. This study provides valuable insights into the ongoing reforms of DRG payment systems in TCM. Our univariate analysis revealed differences in patient characteristics before and after the reform, including sex, age, visit times, admission pathways, admission disease status, complications and comorbidities, and surgeries and operations. Post-reform, there was an increase in female patients, older patients, those admitted through other pathways, and patients with defined disease status, complications and comorbidities, and surgical needs. Notably, the proportion of patients admitted through other pathways and those with repeated hospitalizations also increased, suggesting that the reform measures have successfully attracted more patients and fostered repeat admissions to the hospital. The higher number of patients with defined disease status aligns with the reform's objective of improving diagnostic precision. Additionally, the increase in patients with complications and operations needs suggests a rise in case complexity, potentially leading to higher reimbursement standards, which benefits the hospital departments during cost settlement.\u003c/p\u003e\n\u003cp\u003eThe results from our interrupted time-series analysis indicate a significant downward trend in hospitalization cost, Chinese medicine cost, and Western medicine cost following the DRG reform. While the rising trend in diagnostic cost before the reform was curtailed, overall medical service cost increased post-reform, alongside a marked rise in TCM treatment cost. It is noteworthy that hospitalization cost for LDH patients changed significantly after the DRG reform, demonstrating a marked decrease that aligns with findings from various other studies\u0026nbsp;[46-48]. Certainly, the component costs of hospitalization, including those for Chinese and Western medicine, have concurrently declined alongside the overall reduction in hospitalization cost. However, diagnostic cost and medical service cost were higher post-reform than before, indicating that Chinese hospitals are leveraging their unique strengths by providing more specialized services to address patient needs. This aligns with the Chinese government's objectives for DRG reform in TCM.\u003c/p\u003e\n\u003cp\u003eInterestingly, the length of stay for LDH patients did not decrease following the DRG reform, which stands in contrast to findings from several other studies[33, 49-51]. What’s more, previous studies suggest that length of stay is a critical factor influencing hospitalization cost, implying that a significant cost reduction should typically accompany shorter stay[52-54]. The absence of a reduction in length of stay, despite the cost reduction, may be related to the unique characteristics of TCM treatment, which often has a slower onset of effects and fewer side effects. The majority of TCM treatment occurs in the initial days of hospitalization, suggesting that later cost may be lower, making it challenging to significantly reduce recovery times through DRG payment reforms alone. However, integrating and standardizing TCM treatment methods, along with reducing medication usage, could help achieve the goal of lowering hospitalization cost.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the reform of DRG payment system in TCM has a substantial impact on controlling overall medical costs for LDH patients, although its effectiveness in reducing the\u0026nbsp;length of stay remains limited. Future refinements of the DRG payment system should account for the distinctive characteristics of TCM, optimizing treatment methods and enhancing the quality of healthcare. Establishing a unique and effective reimbursement framework for TCM will further reduce patient treatment cost and length of stay, ultimately benefiting a greater number of patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study focused on LDH patients at Qingyang City Hospital of Chinese Medicine. Although the sample size is limited, it is noteworthy that this hospital was among the first in Western China to implement DRG reforms in TCM, which lends a degree of representativeness to our findings. Nevertheless, the research lacks specific indicators related to the quality of healthcare and treatment outcomes. Therefore, future studies should aim to establish relevant metrics that assess the impact of DRG reform on treatment results for LDH patients. This limitation is partly attributed to the underdeveloped medical record systems in Chinese medicine hospitals. However, as hospital information systems and the scope of diagnostic and treatment services continue to evolve, these challenges can be effectively addressed.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDRG reform is associated with lower hospitalization cost, as well as reduced costs for both Chinese and Western medicine among LDH patients in Chinese medicine hospitals. However, it does not correlate with reductions in medical services cost, diagnostic cost, TCM treatment cost, or length of stay. While the reform effectively leverages the unique strengths of TCM to alleviate the economic burden of illness, there is a need to deepen institutional reforms and enhance the quality and content of medical services, with the goal of further reducing healthcare costs and shortening hospitalization durations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLDH Lumbar Disc Herniation\u003c/p\u003e\n\u003cp\u003eTCM Traditional Chinese Medicine\u003c/p\u003e\n\u003cp\u003eDRG Diagnosis-Related Group\u003c/p\u003e\n\u003cp\u003eITS Interrupted Time-series\u003c/p\u003e\n\u003cp\u003eBJ-DRG Beijing-Diagnosis Related Groups\u003c/p\u003e\n\u003cp\u003eCN-DRG Chinese-Diagnosis-Related Groups\u003c/p\u003e\n\u003cp\u003eCHS-DRG China Healthcare Security Diagnosis-Related Groups\u003c/p\u003e\n\u003cp\u003eICD International Classification of Diseases\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCPI Consumer Price Index\u003c/p\u003e\n\u003cp\u003eCNY Chinese Yuan\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the Gansu Provincial Health and Wellness Commission for data support for our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMC, YY, SX, and JYY participated in data collection and collation. MC, YY, YW, JY, YHW, XZ, and ZW participated in the method design, analyzed data, and drafted the initial manuscript. MC, JW, FK, TC, XJ, HS, GW, and HH participated in text-checking correction and helped to draft the manuscript. ZW and JYY oversaw and provided input on all aspects of manuscript writing and the final analytical plan. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the State Administration of Traditional Chinese Medicine (SACM) (Grant NO. ZYZB-2023-435 and NO. GZY-FJS-2022-045).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDatasets used or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe need for informed consent was waived by the Beijing University of Chinese Medicine Ethics Committee (BUCM-1002600). All methods were carried out in accowing relevant guidelines and regulations. Since research data comes from a government agency database without critical private information about individuals for our study, we believed that no official ethics approval should be sought for this study according to Measures for the Ethical Review of Biomedical Research Involving Humans by China\u0026rsquo;s National Health and Family Planning Commission in 2016.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003eSchool of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 102400, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003eSchool of Management, Beijing University of Chinese Medicine, Beijing 102400, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e Guang\u0026apos;anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing 100053, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e School of Health Management, Gansu University of Chinese Medicine, Lanzhou 730000, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e5\u0026nbsp;\u003c/sup\u003eGansu Health and Population Development Research Center, Gansu Provincial Health and Wellness Commission, Lanzhou 730000, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e6\u0026nbsp;\u003c/sup\u003eSchool of Public Health, Lanzhou University, Lanzhou 730000, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e7\u0026nbsp;\u003c/sup\u003eNational Institute of Chinese Medicine Development and Strategy, Beijing 102400, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, 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\u003cstrong\u003e12\u003c/strong\u003e:1329768.\u003c/li\u003e\n \u003cli\u003eChen M, Yang J, Hou H, Zheng B, Xia S, Wang Y, Yu J, Wu G, Sun H, Jia X,\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eAnalysis of factors influencing hospitalization cost of patients with distal radius fractures: an empirical study based on public traditional Chinese medicine hospitals in two cities, China\u003c/strong\u003e. \u003cem\u003eBMC Health Serv Res\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e24\u003c/strong\u003e(1):605.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"LDH, DRG, Qingyang City, Hospitalization cost, Chinese medicine hospitals","lastPublishedDoi":"10.21203/rs.3.rs-5354926/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5354926/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLumbar disc herniation (LDH) presents a significant economic burden globally, worsening in China due to an aging population. Traditional Chinese Medicine (TCM) offers effective treatment options for LDH, making its integration with Diagnosis-Related Groups (DRG) payment reform crucial for reducing medical costs and enhancing healthcare quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe analyzed data from hospitalized patients at Qingyang City Hospital of Chinese Medicine, Gansu Province, from 2017 to 2022. Univariate analysis was conducted to examine changes in patient demographics before and after the DRG reform. A single group interrupted-time series (ITS) model was used to compare key indicators of medical costs and length of stay pre- and post-reform.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 2,857 LDH patients were included in the study. Pre-DRG reform, 1,294 patients were recorded, with males comprising 46.06% and a mean age (SD) of 58.29(14.22) years. Post-DRG reform, 1,563 patients were observed, with males accounting for 40.88% and a mean age (SD) of 60.64 (14.25) years. No significant differences were found in nationality, marital status, use of Chinese medicine diagnostic and therapeutic equipment, use of Chinese medicine diagnostic and treatment techniques or diagnosis and treatment based on Chinese medicine evidence (P\u0026gt;0.05). However, significant differences were noted in sex, age, visit times, admission pathways, admission disease status, complications and comorbidities, and surgeries and operations (P\u0026lt;0.05). Post-reform, average monthly hospitalization cost decreased by CNY 36.78 (β1+β3=-36.78, P\u0026lt;0.05), Chinese medicine cost fell by CNY 8.87 (β1+β3=-8.87, P\u0026lt;0.05), and Western medicine cost dropped by CNY 31.68 (β1+β3=-31.68, P\u0026lt;0.05). While the rising trend in diagnosis cost was curtailed, both medical services cost and TCM treatment cost increased, with the length of stay remaining stable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe DRG reform is associated with lower hospitalization cost and reduced costs for both Chinese medicine and Western medicine. However, its impact on overall medical services cost, diagnosis cost, TCM treatment cost, and length of stay is limited. Future DRG reform should leverage the distinctive advantages of TCM, enhance the payment system, improve treatment outcomes, and further reduce healthcare costs while shortening hospitalization times.\u003c/p\u003e","manuscriptTitle":"Unpacking the Cost Implications of Diagnosis-Related Groups Reform for Lumbar Disc Herniation Patients in Chinese Medicine: A Closer Look at Evidence from China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-27 02:09:57","doi":"10.21203/rs.3.rs-5354926/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"56d6dab4-1917-48ae-9eb2-e802ebf8322c","owner":[],"postedDate":"November 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-11T08:23:56+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-27 02:09:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5354926","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5354926","identity":"rs-5354926","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}