{
  "abstract": "Background: China’s DRG/DIP payment reform has strengthened prospective case-based reimbursement, but conventional grouping metrics may not fully capture the patient-perceived and TCM-specific value of Traditional Chinese Medicine (TCM) for TCM-advantage diseases.\n\nObjective: This study evaluated whether outcome-based payment for TCM-advantage diseases improved patient-centered public value compared with conventional DRG/DIP payment.\n\nMethods: A multicenter, mixed-methods quasi-experimental study was conducted using medical insurance settlement data, discharge abstracts, electronic medical records, patient questionnaires, and semi-structured interviews. The administrative cohort included 7,985 inpatient cases across five TCM-advantage disease cohorts, and the patient-reported component included 545 questionnaires. Ten stakeholders were interviewed to contextualize the quantitative findings. A Patient-Centered Public Value Index (PCPVI) was constructed across five dimensions and analyzed using propensity score matching and difference-in-differences estimation.\n\nResults: Outcome-based payment was associated with a 4.85-point increase in the PCPVI (95% CI: 3.32 to 6.38; p < 0.001). It was also associated with reductions of 520 RMB in total hospitalization expenditure and 300 RMB in out-of-pocket payment per admission. The reimbursement ratio and TCM treatment cost proportion increased by 2.40 and 4.90 percentage points, respectively. The insurance fund payment estimate was −130 RMB (95% CI: −361 to 101; p = 0.270), and the EQ-5D-5L estimate was 0.021 (95% CI: −0.001 to 0.043; p = 0.061). Neither was statistically significant. No statistically significant differences were detected in 30-day readmission or in-hospital complications. Patient satisfaction and perceived insurance benefit were higher in the outcome-based payment group.\n\nConclusion: In the Taiyuan study setting, outcome-based payment was associated with better financial protection, a higher PCPVI and more favorable patient experience. Increased TCM expenditure share indicates a change in service composition, rather than direct evidence of TCM-specific therapeutic efficacy. Effects on generic health-related quality of life, insurance fund payment and short-term safety outcomes remain uncertain. Longer follow-up and external validation are needed before drawing conclusions about fund sustainability or transferability.",
  "abstract_shown": true,
  "affiliations": [
    "School of Management, Shanxi Medical University",
    "School of Health Services and Management, Shanxi University of Chinese Medicine"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Zhongyang Pei"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Anxia Hu"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhiguang Duan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/974y09sdjfbye.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1902781",
  "fulltext_url": null,
  "id": "974y09sdjfbye",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1902781/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2003|Healthcare Systems and Reforms"
    ]
  ],
  "openalex": "W7223107356",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1902781/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/974y09sdjfbye.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:24Z",
      "native_id": "10.3389/fpubh.2026.1902781",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1902781/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2296-2565",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Aligning insurance payment with public value: outcome-based payment for traditional Chinese medicine advantage diseases under China’s DRG/DIP reform",
  "title_text": "Aligning insurance payment with public value: outcome-based payment for traditional Chinese medicine advantage diseases under China’s DRG/DIP reform",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:24Z",
  "url": "https://research.draconitic.com/paper/974y09sdjfbye",
  "venue": "Frontiers in Public Health",
  "versions": []
}