Objective: The paper analyzes the impact of the implementation of approval guidelines for traditional Chinese medicine (TCM) medical service price on inpatient diagnosis and treatment behavior in TCM hospitals, providing a reference for better adapting to these guidelines and optimizing hospital resource allocation. Methods: Based on medical insurance settlement data from March to June, 2025 at a tertiary TCM hospital in Guangzhou City, with the guideline implementation in April 2025 as the intervention point, Stata was used to draw box plots for comparative analysis of the number of cases, actual settlement scores, length of hospital stay, number of surgical procedures, and total expenses. Results: After implementing the guidelines, repetitive procedures for mild cases decreased, inpatient diagnosis and treatment services became more standardized, and resource input for severe and chronic consumptive cases increased significantly. The structure of medical expenses showed a differentiated pattern of "fewer mild cases, more severe cases". Conclusion: The implementation of approval guidelines for TCM medical service price effectively curbed over-treatment of mild cases, guided hospitals to allocate more resources to severe and complex cases, and promoted the standardization of inpatient diagnosis and treatment services in TCM hospitals. It had a positive effect on optimizing the cost structure and improving the efficiency of medical insurance fund utilization. Future studies should incorporate long-term observational data to compare clinical outcome indicators and further assess the systemic impact after guideline implementation.
Key words
medical service price project /
approval guidelines /
traditional Chinese medicine hospital /
diagnosis and treatment behavior
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