Objective:Constructing and exploring the spatial association mechanism of the efficiency of Urban and Rural Residents' Basic Medical Insurance(URRBMI)across provincial regions is of great significance for promoting regional insurance development and constructing a unified national healthcare system.Methods:Using the super-efficiency SBM model and the modified gravity model to build a spatial association network of URRBMI fund operational efficiency from 2020 to 2022.The network structure and driving(actors are analyzed using social network analysis.Results:The spatial association network of URRBMI efficiency exhibits a highly interconnected structure characterized by bilateral reciprocity,triadic closure,and stability,with the network in 2022 being the most compact and showing decreasing internal disparities.It is organized into four major blocks led by the"Beijing-Shanghai-Jiangsu"Region.The spatial association mechanism is driven by three core factors:"geographical proximity,insurance fund pressure,coordination of medical and financial resources".Conclusion:It is suggested to further leverage the role of key provinces,optimize the allocation of medical and financial resources,and enhance the efficiency of insurance management.

Objective:Constructing and exploring the spatial association mechanism of the efficiency of Urban and Rural Residents' Basic Medical Insurance(URRBMI)across provincial regions is of great significance for promoting regional insurance development and constructing a unified national healthcare system.Methods:Using the super-efficiency SBM model and the modified gravity model to build a spatial association network of URRBMI fund operational efficiency from 2020 to 2022.The network structure and driving(actors are analyzed using social network analysis.Results:The spatial association network of URRBMI efficiency exhibits a highly interconnected structure characterized by bilateral reciprocity,triadic closure,and stability,with the network in 2022 being the most compact and showing decreasing internal disparities.It is organized into four major blocks led by the"Beijing-Shanghai-Jiangsu"Region.The spatial association mechanism is driven by three core factors:"geographical proximity,insurance fund pressure,coordination of medical and financial resources".Conclusion:It is suggested to further leverage the role of key provinces,optimize the allocation of medical and financial resources,and enhance the efficiency of insurance management.

Objective:It aims to examine the effects of the employee medical insurance outpatient mutual assistance on medical insurance costs for patients with diabetes mellitus,offering insights for optimizing outpatient insurance policies and chronic disease management strategies.Methods:Outpatient cost settlement data of urban employees with diabetes mellitus in Lanzhou from 2022 to 2023 was collected.Univariate analysis and interrupted time-series models were used to compare relevant medical insurance cost indicators before and after the reform.Results:The inpatient data of 765 730 diabetes mellitus patients were included in the study,and male patients account for 62.67％.After the reform,average per-visit pooling fund expenditure,average per-visit individual payment expenditures,average per-visit personal account expenditure,average per-visit eligible expense amount,average per-visit total fund payment,and the average per-visit proportion of basic medical pooling payments were decreased(P＜0.05).Moreover,average per-visit pooling fund expenditure,average per-visit individual account expenditure,average per-visit cash payment,average per-visit eligible expense amount,average per-visit total fund payment,and the average per-visit proportion of basic medical pooling payments showed a notable declining trend post-reform(P＜0.05).In contrast,the per-visit fully out-of-pocket expenditure exhibited no significant change before and after the reform(P＞0.05).Conclusion:The reform of the employee medical insurance outpatient mutual assistance system has alleviated the economic burden of disease for diabetic patients and improved the efficiency of medical insurance fund utilization,but it reduced the proportion of basic medical pooling payments.It is recommended to continuously refine the outpatient medical insurance payment system,strengthen supervision of medical expenses and service quality,and balance patient benefits with fund pressure to enhance chronic disease outpatient benefits.

Objective:It aims to examine the effects of the employee medical insurance outpatient mutual assistance on medical insurance costs for patients with diabetes mellitus,offering insights for optimizing outpatient insurance policies and chronic disease management strategies.Methods:Outpatient cost settlement data of urban employees with diabetes mellitus in Lanzhou from 2022 to 2023 was collected.Univariate analysis and interrupted time-series models were used to compare relevant medical insurance cost indicators before and after the reform.Results:The inpatient data of 765 730 diabetes mellitus patients were included in the study,and male patients account for 62.67％.After the reform,average per-visit pooling fund expenditure,average per-visit individual payment expenditures,average per-visit personal account expenditure,average per-visit eligible expense amount,average per-visit total fund payment,and the average per-visit proportion of basic medical pooling payments were decreased(P＜0.05).Moreover,average per-visit pooling fund expenditure,average per-visit individual account expenditure,average per-visit cash payment,average per-visit eligible expense amount,average per-visit total fund payment,and the average per-visit proportion of basic medical pooling payments showed a notable declining trend post-reform(P＜0.05).In contrast,the per-visit fully out-of-pocket expenditure exhibited no significant change before and after the reform(P＞0.05).Conclusion:The reform of the employee medical insurance outpatient mutual assistance system has alleviated the economic burden of disease for diabetic patients and improved the efficiency of medical insurance fund utilization,but it reduced the proportion of basic medical pooling payments.It is recommended to continuously refine the outpatient medical insurance payment system,strengthen supervision of medical expenses and service quality,and balance patient benefits with fund pressure to enhance chronic disease outpatient benefits.

Objective:To analyze the impact of DRG payment method reform on hospitalization costs and structure in traditional Chinese medicine hospitals.Methods:Using the cost data of hospitalized patients from 2017 to 2022 for public traditional Chinese medicine hospitals in Qingyang and Tianshui,descriptive statistics and two groups interrupted time-series models were implemented to compare the changes before and after DRG payment method reform.Results:DRG payment method reform had no effective impact on the secondary traditional Chinese medicine hospital's average hospitalization costs,average Chinese medicine costs,and average western medicine costs(P＞0.05),but the average proportion of western medicine costs showed an obvious downward trend after the reform(β9=-0.19,P＜0.01).DRG payment method reform resulted in tertiary traditional Chinese medicine hospitals turning to obvious decreasing trends in average hospitalization costs,average Chinese medicine costs,and average western medicine costs(P＜0.05),while the pre-reform decreasing trends in the average proportion Chinese medicine costs share of both secondary and tertiary traditional Chinese medicine hospitals were curbed in the post-reform period.Conclusion:DRG payment method reform had effectively controlled hospitalization costs,Chinese medicine costs,and western medicine costs of tertiary traditional Chinese medicine hospitals,while the cost control of secondary traditional Chinese medicine hospitals has been ineffective,probably contributing to the enhancement of the use of Chinese medicine and the average proportion of Chinese medicine costs.DRG payment method reform for Chinese medicine should strengthen the supervision of costs,actively utilize the advantages of the characteristics of Chinese medicine,and promote the differentiated reform of traditional Chinese medicine hospitals.

Objective To quantitatively evaluate the synergy level of Traditional Chinese Medicine(TCM)"three-medical"and advance TCM revitalization and healthcare reform.Methods Sort out the quantitative evalution indictors of the"three-medical"in TCM based on policy texts.Policy-derived evaluation indicators were refined through the Delphi method.The composite system synergy degree model was applied to calculate subsystem order degrees and overall synergy degrees across seven national TCM reform demonstration zones.Results From 2021 to 2023:the mean value of the orderliness of the TCM medical system in the 7 demonstration areas increased from 0.31 to 0.72,the orderliness of the TCM health insurance increased from 0.23 to 0.74,and the orderliness of the Herbal System increased from 0.34 to 0.70.From 2022 to 2023,the average value of synergy between medical and health insurance systems in the field of Chinese medicine in 7 demonstration areas grew from 0.17 to 0.29.The synergy between medical and pharmaceutical systems in the field of Chinese medicine grows from 0.19 to 0.31.The synergy between pharmaceutical and health insurance system in the field of Chinese medicine increased from 0.17 to 0.27.The overall synergy of the"three-medical"system of TCM increased from 0.19 to 0.36.Conclusion The degree of orderliness of the"three-medical"systems of TCM is gradually rising,showing a relatively good development trend in orderliness.The degree of synergy among the"three-medical"total systems of TCM is on the rise,but is still at the level of moderate synergy or below.

Objective:To analyze the impact of DRG payment method reform on hospitalization costs and structure in traditional Chinese medicine hospitals.Methods:Using the cost data of hospitalized patients from 2017 to 2022 for public traditional Chinese medicine hospitals in Qingyang and Tianshui,descriptive statistics and two groups interrupted time-series models were implemented to compare the changes before and after DRG payment method reform.Results:DRG payment method reform had no effective impact on the secondary traditional Chinese medicine hospital's average hospitalization costs,average Chinese medicine costs,and average western medicine costs(P＞0.05),but the average proportion of western medicine costs showed an obvious downward trend after the reform(β9=-0.19,P＜0.01).DRG payment method reform resulted in tertiary traditional Chinese medicine hospitals turning to obvious decreasing trends in average hospitalization costs,average Chinese medicine costs,and average western medicine costs(P＜0.05),while the pre-reform decreasing trends in the average proportion Chinese medicine costs share of both secondary and tertiary traditional Chinese medicine hospitals were curbed in the post-reform period.Conclusion:DRG payment method reform had effectively controlled hospitalization costs,Chinese medicine costs,and western medicine costs of tertiary traditional Chinese medicine hospitals,while the cost control of secondary traditional Chinese medicine hospitals has been ineffective,probably contributing to the enhancement of the use of Chinese medicine and the average proportion of Chinese medicine costs.DRG payment method reform for Chinese medicine should strengthen the supervision of costs,actively utilize the advantages of the characteristics of Chinese medicine,and promote the differentiated reform of traditional Chinese medicine hospitals.

Objective To measure the policy synergy of the"Three Medical"policies in Traditional Chinese Medicine across 7 national TCM Comprehensive Reform Pilot Zones,providing a scientific basis for policy optimization.Methods Utilizing text mining techniques to explore the focus of the"Three Medical"policies in 80 TCM comprehensive reform construction plans,and employing the PMC index model to evaluate their vertical policy synergy,while using the coupling synergy model to measure their horizontal synergy.Results The overall policy synergy of the"Three Medical"policies in the sample regions has a mean value of 0.52.Specifically,the policy synergy between TCM healthcare and herbal medicine policies has a mean value of 0.60,between TCM healthcare and health insurance policies has a mean value of 0.57,and between herbal medicine and health insurance policies has a mean value of 0.47.The mean policy difference between provinces and cities in the sample regions is 0.023,and between cities and counties is 0.010.Conclusion The"Three Medical"policies in the sample regions are in a state of reluctant synergy.Among the"Three Medical"system,the policy synergy is highest between TCM healthcare and herbal medicine,followed by TCM healthcare and health insurance,with the lowest being between herbal medicine and health insurance.Additionally,the policy synergy between"Three Medical"policies at the city-county level is higher than at the province-city level.There is a continued need to optimize the horizontal and vertical policy synergy of policies at different levels within the comprehensive reform policies of TCM in the TCM Comprehensive Reform Pilot Zones.

Objective To quantitatively evaluate the synergy level of Traditional Chinese Medicine(TCM)"three-medical"and advance TCM revitalization and healthcare reform.Methods Sort out the quantitative evalution indictors of the"three-medical"in TCM based on policy texts.Policy-derived evaluation indicators were refined through the Delphi method.The composite system synergy degree model was applied to calculate subsystem order degrees and overall synergy degrees across seven national TCM reform demonstration zones.Results From 2021 to 2023:the mean value of the orderliness of the TCM medical system in the 7 demonstration areas increased from 0.31 to 0.72,the orderliness of the TCM health insurance increased from 0.23 to 0.74,and the orderliness of the Herbal System increased from 0.34 to 0.70.From 2022 to 2023,the average value of synergy between medical and health insurance systems in the field of Chinese medicine in 7 demonstration areas grew from 0.17 to 0.29.The synergy between medical and pharmaceutical systems in the field of Chinese medicine grows from 0.19 to 0.31.The synergy between pharmaceutical and health insurance system in the field of Chinese medicine increased from 0.17 to 0.27.The overall synergy of the"three-medical"system of TCM increased from 0.19 to 0.36.Conclusion The degree of orderliness of the"three-medical"systems of TCM is gradually rising,showing a relatively good development trend in orderliness.The degree of synergy among the"three-medical"total systems of TCM is on the rise,but is still at the level of moderate synergy or below.

Objective To measure the policy synergy of the"Three Medical"policies in Traditional Chinese Medicine across 7 national TCM Comprehensive Reform Pilot Zones,providing a scientific basis for policy optimization.Methods Utilizing text mining techniques to explore the focus of the"Three Medical"policies in 80 TCM comprehensive reform construction plans,and employing the PMC index model to evaluate their vertical policy synergy,while using the coupling synergy model to measure their horizontal synergy.Results The overall policy synergy of the"Three Medical"policies in the sample regions has a mean value of 0.52.Specifically,the policy synergy between TCM healthcare and herbal medicine policies has a mean value of 0.60,between TCM healthcare and health insurance policies has a mean value of 0.57,and between herbal medicine and health insurance policies has a mean value of 0.47.The mean policy difference between provinces and cities in the sample regions is 0.023,and between cities and counties is 0.010.Conclusion The"Three Medical"policies in the sample regions are in a state of reluctant synergy.Among the"Three Medical"system,the policy synergy is highest between TCM healthcare and herbal medicine,followed by TCM healthcare and health insurance,with the lowest being between herbal medicine and health insurance.Additionally,the policy synergy between"Three Medical"policies at the city-county level is higher than at the province-city level.There is a continued need to optimize the horizontal and vertical policy synergy of policies at different levels within the comprehensive reform policies of TCM in the TCM Comprehensive Reform Pilot Zones.