Research On The Treatment Costs Of TCM Advantage Diseases In Beijin

Objective:The dominant diseases of traditional Chinese medicine(TCM)are an important part of the revitalization and development of TCM,which is of great significance for the world to understand the value of TCM.At present,the research on the dominant diseases of TCM mainly focuses on the concept definition,selection method and clinical practice.Under the guidance of value medicine,it is particularly urgent to answer and sort out the current situation and characteristics of the curative care expenditure(CCE)of the dominant diseases of TCM from the perspective of health costs.Under the background of the revitalization and development of TCM,this study will take Beijing as an example to collect large sample data from medical institutions and management departments at different levels,and use big data to study the CCEs of the consensus dominant diseases of TCM from the perspective of health costs.Method:Firstly,based on System of Health Accounts 2011(SHA2011)accounting and analysis framework,the CCE accounting and analysis framework of dominant diseases of TCM was constructed from single,two and three dimensions respectively.Then,the analysis database of the CCE of dominant diseases of TCM was constructed through data collation,the CCE of dominant diseases of TCM was calculated macroscopically,the overall scale of the cost was analyzed,and the financing structure of the CCE of dominant diseases was analyzed in multiple dimensions.Furthermore,statistical methods were used to compare the cost differences between TCM hospitals and general hospitals,as well as the cost differences between TCM participation and non-participation,and to explore the TCM participation rate of dominant diseases and its influencing factors.Finally,according to the data volume,disease characteristics and research needs,three typical diseases were selected,and the data mining method was used to compare and analyze the cost differences of dominant diseases in different service functions,different medical institutions and people with different characteristics,so as to excavate the cost characteristics of typical diseases.Consult experts in clinical and health economics to interpret and discuss the findings.Results:(1)From the perspective of total CCE,the CCE of dominant diseases of TCM in Beijing increased from 23.187 billion yuan to 27.818 billion yuan from 2016 to 2019,with an average annual growth rate of 6.26%.The proportion of the cost of dominant diseases of TCM in the total CCE remained stable at about 14%.From the perspective of financing structure,the proportion of public financing,social medical insurance and voluntary financing for the CCEs of local TCM patients in Beijing was higher than that of Beijing as a whole,while the proportion of family health expenditure was lower than that of Beijing in total.From the perspective of cost distribution,the cost of local and external patients mainly contributed to tertiary hospitals,and the cost of external patients contributing to tertiary hospitals is higher than that of local patients.The expenses of foreign medical treatment and local patients are mostly concentrated in diseases that are mainly Western medicine and supplemented by Chinese medicine;Overall,the proportion of expenses for men is higher than for women;The cost of treatment for local and foreign patients is concentrated in the age of 55-69.(2)From the point of view of the average total hospital expenses,the average total hospital expenses of patients with dominant diseases in TCM hospital in general hospital was higher than that in TCM hospital;The total cost of 55%of TCM dominant diseases in TCM hospital is higher than that in general hospital.As to the cost structure,the proportion of consumables in general hospital is higher than that in TCM hospital.From the perspective of TCM participation,the total hospitalization cost of patients with dominant diseases under the participation of Chinese patent medicine was higher,while the total hospitalization cost of patients under the participation of Chinese herbal decoction was lower.The participation rate of Chinese patent medicine was higher among patients with dominant diseases,accounting for about 50%,while the participation rate of Chinese herbal decoction was lower.The main influencing factors of TCM participation rate were hospital level,hospital category,age and length of stay.(3)From the cost characteristics of typical diseases,the cost of dominant diseases was concentrated in some diseases which accounted for a relatively high proportion.Typical studies can be carried out according to the characteristics of different diseases and policy needs.Take lung cancer,cerebral infarction,coronary heart disease angina for example:the participation rate of Chinese patent medicine in lung cancer patients is about 50%,while the participation rate of Chinese herbal decoction is low,the hospitalization cost of lung cancer patients is higher when Chinese patent medicine is involved,and the hospitalization cost is lower when Chinese herbal decoction is involved.Cerebral infarction patients were grouped by DRG,and four classification nodes were selected by decision tree model according to the priority,which were hospitalization days,hospital level,consumables cost and hospital type respectively.A total of 19 case combinations were obtained,and 1.4%of the total cases exceeded the cost control limit.Compared with the basic treatment of Western medicine,the curative effect of Chinese medicine in the treatment of angina pectoris of coronary heart disease is better,and the cost effect of Chinese medicine in the treatment of angina pectoris of coronary heart disease in the middle stage is the best.Conclusion:(1)At present,the treatment cost of dominant diseases of TCM in Beijing has increased year by year,accounting for 14%of the total disease treatment costs,accounting for a certain scale in the overall disease treatment costs.The financing structure of local patients is more reasonable,and the financing structure of Chinese medicine hospitals still has room for improvement;The treatment costs of advantageous diseases mainly flow to high-level hospitals,and the siphon effect of patients coming to Beijing for medical treatment is more obvious,so it is necessary to increase support for advantageous diseases of TCM and enhance the scientific and rationality of TCM compensation.It is necessary to promote the construction of a high-quality and efficient service system for advantageous diseases of TCM,improve the service capacity of advantageous diseases of TCM at the grassroots level,and promote the expansion of high-quality resources of TCM;It is also necessary to strengthen the role of two-way referral and linkage of secondary hospitals,and promote the balanced regional layout of TCM resources;Cooperation and co-construction of medical alliances should be strengthened to return tertiary hospitals to functional positioning;It is necessary to improve the health service capacity of the dominant diseases of Chinese medicine in the whole life cycle of the population to meet the growing demand of the people for Chinese medicine.(2)On the whole,the average total inpatient cost of TCM dominant diseases in TCM hospitals is lower than that of general hospitals,and 45%of the diseases in TCM hospitals have lower costs than general hospitals,and the cost structure of TCM hospitals reflects the characteristics of TCM diagnosis and treatment.In the future,the training of non-TCM physicians in TCM medical activities should be strengthened to increase the participation of TCM.The gradual inclusion of Chinese medicines in the medical insurance catalogue should be strengthened,and the prices of included Chinese medicines should be monitored;The quality control of the whole production process of traditional Chinese medicines should be strengthened,and the research on comprehensive evaluation methods,Quality evaluation and precision drug use of traditional Chinese medicines should be strengthened to ensure the exertion of advantageous effects;We should actively promote the comprehensive reform of the field of Chinese medicine,continue to improve the price formation mechanism of Chinese medicine services,and appropriately increase the price of medical services that reflect the value of Chinese medicine technology and labor;It is necessary to promote the implementation of payment according to the type of disease for the dominant diseases of TCM,gradually standardize the behavior of doctors,guide hospitals to actively control costs,and improve the quality of medical care,so that the price of TCM services can truly reflect its medical value.(3)The dominant diseases of TCM were concentrated in the diseases with higher contribution degree.Taking lung cancer as an example,the participation rate of prescription drugs is relatively high,while the participation rate of TCM decoction pieces is relatively low.Therefore,further studies can be conducted on how to strengthen the participation of TCM in the treatment of dominant diseases in the future,so as to reasonably control health costs and reduce the economic burden of patients.Taking cerebral infarction as an example,decision tree model is an effective grouping method,which can classify patients with dominant diseases of TCM according to the influencing factors of resource consumption,and provide reference for the reform of medical insurance payment method in TCM field.Taking angina pectoris of coronary heart disease as an example,the real-world data can be used to mine and study the cost effect of TCM in the treatment of dominant diseases.In the future,we can make use of the real-world data to carry out further research on the dominant diseases of TCM.