Cervical Spondylosis Costs Fell as TCM Spending Rose in One Hospital

Average hospitalization costs for cervical spondylosis at a tertiary Grade A traditional Chinese medicine hospital in eastern China fell from 10,610.66 yuan per visit in 2023 to 7,273.65 yuan in 2025, according to an observational study of 1,046 admissions. The share of spending attributed to TCM treatment rose from 22.22% to 32.46% over the same period, while the proportions devoted to Western medicine and consumables declined. The researchers said the pattern coincided with a more TCM-centered cost structure and lower drug and consumable expenditure, but emphasized that the single-site data could not establish that DRG payment reform caused the changes.

The study examined “Xiang Bi,” the TCM disease category used for cervical spondylosis, using medical-record front pages and detailed medical-insurance settlement records from the hospital’s Department of Orthopedics and Traumatology. Eligible patients were discharged between January 1, 2023, and December 31, 2025, and had received TCM or integrated TCM and Western medicine treatment. Z Province introduced diagnosis-related group, or DRG, payment in 2020, and full coverage had been achieved for eligible inpatient institutions by the end of 2023. The study window therefore fell within the post-full-implementation phase of the payment system. However, the analysis included neither a pre-reform control series nor a comparison hospital.

Patients were predominantly women and young or middle-aged adults. Females accounted for 606 of 1,046 patients, or 57.9%, and 71.8% were between 31 and 60 years old. The 41–50 age group was the largest, with 275 patients, or 26.3% of the cohort. Admissions increased from 212 in 2023 to 312 in 2024 and 522 in 2025, while 970 patients, or 92.7%, stayed between one and 13 days. Nearly all patients entered through outpatient services, and 1,030, or 98.5%, received integrated TCM and Western treatment. TCM characteristic techniques were used in 94.0% of admissions, hospital-prepared TCM preparations in 82.5%, and TCM diagnostic and therapeutic equipment in 71.5%.

Cost composition changed alongside the overall bill. TCM treatment became the largest cost category in 2024 and represented 32.46% of spending in 2025. Diagnostic and examination costs declined from 20.20% of the total in 2023 to 18.79% in 2025. Consumables showed the largest proportional decrease, falling from 20.48% to 13.58%, while Western medicine declined from 9.46% to 6.56%. Other categories, including comprehensive medical services, Chinese herbal medicine, rehabilitation, and remaining expenses, occupied comparatively small and relatively stable shares of the total.

Length of hospital stay was the strongest factor associated with costs in the multivariable analysis. Patients staying one to 13 days had a mean cost of 7,297.03 yuan, compared with 20,246.30 yuan for stays of at least 14 days. After adjustment through a generalized linear model using a Gamma distribution and log link, the estimated cost multiplier for the shorter-stay group was 0.392, indicating predicted costs about 61% lower than those for the reference group of stays lasting at least 14 days. The association was highly statistically significant, with a Wald chi-square value of 117.860 and p<0.001. Admission year, age group, use of TCM characteristic techniques, use of hospital-prepared TCM preparations, and use of TCM diagnostic and therapeutic equipment were also independent correlates of cost.

The adjusted estimates separated the model associations from the raw group comparisons. Use of TCM characteristic techniques was associated with a 22.7% lower predicted cost relative to non-use, with a multiplier of 0.773 and p=0.007. TCM diagnostic and therapeutic equipment was associated with a 13.6% lower predicted cost, with a multiplier of 0.864 and p=0.006. Hospital-prepared TCM preparations, in contrast, were associated with a 20.2% higher predicted cost, with a multiplier of 1.202 and p=0.002. Patients admitted in 2023 had an estimated cost 35.5% higher than those admitted in 2025, whereas the adjusted estimate for 2024 did not differ significantly from the 2025 reference. Age group was also associated with cost overall, with a Wald chi-square value of 23.799 and p=0.001.

The investigators used Mann–Whitney U tests and Kruskal–Wallis H tests for initial comparisons because total hospitalization costs were markedly right-skewed. Costs ranged from 316.33 yuan to 60,591.01 yuan, with a mean of 8,237.90 yuan and a standard deviation of 7,277.18 yuan. The final model included 13 independent variables, encoded as 20 degrees of freedom, and the authors reported adequate fit without obvious overdispersion: the deviance-to-degrees-of-freedom ratio was 0.327 and the Pearson chi-square-to-degrees-of-freedom ratio was 0.490. An omnibus likelihood-ratio test indicated that the variables collectively accounted for significant cost variation, with chi-square equal to 298.113, 20 degrees of freedom, and p<0.001. These findings describe adjusted associations within this hospital and do not show that any particular TCM technique or pathway produces a clinical benefit.

Several results differed between unadjusted and adjusted analyses. Marital status was associated with cost in the univariate comparison but was not significant after other variables were included. TCM diagnostic and therapeutic equipment showed the opposite pattern: its unadjusted association was not significant, while it became an independent correlate in the final model. The authors proposed possible explanations involving confounding, interactions, or differences in case complexity, including the possibility that patients receiving equipment also received more comprehensive TCM care. They explicitly described these interpretations as speculative because no formal interaction or mediation analyses were performed. Sex, number of hospitalizations, medical-payment type, admission route, treatment category, and discharge method were not independently associated with costs in the final model.

The findings have substantial limits for policy interpretation. The hospital was a high-level TCM institution in an economically developed eastern province, and its admission patterns, clinical pathways, reimbursement rates, and cost mix may differ from those of other regions or primary-level facilities. The available records did not include disease severity, comorbidity scores, functional recovery, patient satisfaction, readmission rates, or other clinical outcomes. Consequently, the study cannot determine whether lower spending was accompanied by equivalent or better care, nor can it assess cost-effectiveness or net clinical benefits. The lack of pre-reform control data and a comparison institution also prevents the annual decline from being attributed directly to DRG reform. The authors characterize the results as a descriptive basis for hypotheses and future causal inference rather than a rigorous evaluation of the reform’s effect.

For future research, the team proposes multicenter studies covering different regions, hospital levels, and institution types, along with longer follow-up and stronger quasi-experimental designs such as interrupted time-series or difference-in-differences analyses. Linking claims and cost records with detailed clinical information could support an evaluation framework combining costs and efficacy. The study’s clearest descriptive result is that lower average cervical spondylosis hospitalization bills coincided with a larger TCM share of expenditure and smaller proportions for Western medicines and consumables, while longer hospital stays remained strongly associated with higher costs. Whether that pattern reflects payment incentives, changes in clinical practice, patient case mix, or other factors remains unresolved and requires comparisons across institutions and time.

Subject of Research: Hospitalization cost trends and cost determinants for cervical spondylosis in a Chinese TCM hospital

Article Title: Analysis of hospitalization costs for a TCM-advantaged disease under DRG payment reform: a case study of Xiang Bi

Article References: Zhang, X., Ding, K., Lv, Y., & Zhang, W. (2026). Analysis of hospitalization costs for a TCM-advantaged disease under DRG payment reform: a case study of Xiang Bi. Frontiers in Public Health, 14, Article 1902363. https://doi.org/10.3389/fpubh.2026.1902363

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1902363

Keywords: cervical spondylosis, hospitalization costs, DRG payment reform, traditional Chinese medicine, medical insurance, cost composition, length of stay, observational study, health economics, Analysis, hospitalization, costs