The choice of treatment mode is related to the patient, sometimes influenced by the doctor and the type of disease. Regarding the situation of using TCM in different groups of geriatric inpatients with chronic diseases, our results indicate that the possibility of TCM treatment in female inpatients with chronic diseases was higher than that in male. On the one hand, it may be affected by the patient's preference for medical treatment. In 2016, the results of the national survey on health care literacy of TCM shown that female pay more attention to health care issues of TCM in life than male[18]. Chung's study found that women were more likely to choose TCM for treatment of diseases[19]. On the other hand, it may be related to the distribution of dominant diseases in TCM. According to the survey of the predominant diseases of TCM, the predominant diseases of TCM are distributed in internal, external, gynecology, pediatrics, orthopedics, ophthalmology, otolaryngology[20]. If female with chronic diseases suffer from gynecological diseases at the same time, doctors are more likely to choose TCM for treatment.
Our study also found that taking the group of 60-69 y as a reference, the elderly were more likely to receive TCM treatment. This may be related to the trust of TCM. The affirmation and trust of the efficacy of TCM is the key factor affecting the residents' consumption behavior of TCM[21]. Qiu's research shown that age has the greatest influence on the factors of trust and seeking medical treatment,and the elderly have greater trust in TCM, and they are more likely to use TCM for treatment[22]. In our study, patients who have undergone surgery were less likely to use TCM. This may be the reason that surgical patients must be fasting before and after surgery, and also can not take oral TCM.
From the comparison of various institutions, the possibility of TCM treatment in general hospitals was lower than other institutions. Differences in the allocation of TCM resources among different types of institutions may lead to this situation. Cai's results shown that the number of TCM doctors was an important factor affecting the provision of TCM services by institutions[23]. In 2018, the proportion of TCM physicians in general hospitals (7.23%) in Hunan province was lower than in TCM hospitals (48.11%), community health service centers (18.28%), and township health centers (14.18%). Western doctor does not have the legal prescription right of Chinese herbal medicine, so the utilization rate of TCM was lower in general hospitals with less doctors of TCM.
In our study, compared with the self-financed patient group, the possibility of TCM treatment in groups of urban employees, urban and rural residents, work injury insurance, public health care, and other medical insurance types were higher.This may be the effect of medical insurance on the compensation of TCM services. Patients with chronic diseases who need to be hospitalized are in serious condition. Some studies have shown that under the hypothesis of severe chronic disease, patients are more inclined to choose western medical services and willingness to pay low-cost medical treatment[24]. In recent years, China has formulated a series of policies and measures to promote the role of TCM in disease treatment. The Chinese medicine law of the people's Republic of China, which came into effect in 2017, clearly stipulates that governments at or above the county level should include eligible TCM decoction pieces, proprietary TCM, and TCM preparations in medical institutions into the basic medical insurance fund payment scope[25]. At present, there are 1,321 kinds of Chinese patent medicines, and 892 kinds of TCM decoction pieces have been included in the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalogue"[26]. Medical insurance not only increases the willingness of patients to use TCM services through economic means, but also increases the enthusiasm of medical institutions to provide TCM services.
The length of stay, the cost of medicine, Totalexp, and OOPs are often used as indicators to evaluate the patient's hospitalization burden[27][28][29]. Ji Conghua's study concluded that patients using TCM were higher than the western medicine group in terms of length of stay, total cost of hospitalization of medicines, etc[30]. In our study, we found that for geriatric inpatients with chronic congenital malformations, deformities, and chromosomal abnormalities, the difference in hospitalization days between the group of TCM user and the TCM nousers group was not significant. For digestive diseases, the cost of medicines in the TCM users group was lower than that in the TCM nousers group. For patients with different types of diseases and symptoms, the means of TCM treatment of digestive system diseases are not necessarily all drug treatment, but also Taiji, dietotherapy, acupuncture, massage, which may explain why the drug cost of TCM nousers group was lower[31]. Although the Totalexp level of the TCM users group for most diseases were higher than those of TCM nousers group, the OOPs in TCM users group was lower than that of TCM nousers group. This may be related to the health insurance reimbursement policy. When the national basic medical insurance pays the expenses of Chinese patent medicine and Western medicine, it is divided into class A and class B. The expenses incurred by using class a drugs and Chinese herbal pieces included in the medical insurance shall be paid in full by the medical insurance fund[32]. Among the drugs included in the drug catalog of national basic medical insurance, 1134 kinds (51.24%) of TCM and 398 kinds (30.11%) of Western medicine can be fully paid by the fund. Only less than 40 kinds of Chinese herbal pieces have not been included in the scope of fund payment. The number of Western medicines not included in the fund is far more than that.
Regarding the relationship between the use of TCM treatment and the length of stay, previous research conclusions are not completely consistent. The results of Wang's study showed that the length of stay with TCM treatment was longer[33]. Li found that the combined treatment of ischemic stroke with TCM and west medicine can reduce the length of stay[34]. Our results shown that the Ptcm was negatively related to the length of stay for inpatient treatment of various chronic diseases for geriatric. We did not distinguish between specific diseases, so we are not sure whether there is such a correlation between the Ptcm and the length of stay for each disease. It should be noted that the severity of the illness is the most important factor affecting the length of stay[35]. Since we did not obtain information about the condition, we cannot rule out the increase in the Ptcm caused by the degree of the disease, which also affected the length of stay.
Concerning the impact of Ptcm on the cost of medicines and Totalexp, previous studies have shown that the cost of medicines decreases as Ptcm increases[36]. The higher Ptcm, the lower Totalexp[37]. We have found that Ptcm was not necessarily related to Totalexp of geriatric inpatients with chronic diseases. For certain diseases, the cost of medicines and Totalexp may increase with the increase in Ptcm, such as tumors, blood and hematopoietic organ diseases and certain diseases involving immune mechanisms, endocrine, nutritional and metabolic diseases, mental and behavioral disorders, eye and appendage disorders, urogenital diseases. On the one hand, it may be determined by the natural characteristics of the disease species. Taking geriatric inpatients with cancer as an example, their disease severity is relatively high. Many patients were treated with TCM for symptomatic treatment in the later stage because of unsatisfactory effect after previous repeated treatment. The treatment characteristics of the disease are long hospital stays, high proportion of drugs, and high total cost of a single hospital stay. On the other hand, it may be affected by the degree of illness. Some patients are hospitalized in critical condition. Doctors often choose west medicine such as infusion to control their condition at first[38]. After patient's condition improves, TCM could be need to take for a long time. Although the cost of hospitalization of certain diseases will increase with the increase of Ptcm, Ptcm was negatively related to OOPs. It shows that the higher Ptcm, the smaller the burden on patients.
According to the relationship between Ptcm for various diseases, the cost of medicines, and the cost of hospitalization,We believe that the use of TCM for the treatment of geriatric chronic diseases respiratory system, digestive system, ear diseases, nervous system are relatively cost-effective. The higher the Ptcm, the lower the cost of medicines and Totalexp, and the lower OOPs. The use of TCM for the treatment of chronic circulatory diseases and ophthalmic diseases, although the cost of medicine is higher, but Totalexp and the OOPs decrease with the increase of Ptcm.
To our knowledge, this is the first comprehensive report on the use and cost of TCM in geriatric inpatients with chronic diseases. In this study, not only the situation of using TCM were analyzed from the perspective of gender, age, institution, and insurance status, but also the relationship between the Ptcm and the cost of hospitalization and personal burden of various geriatric chronic patients were discussed. However, It is undeniable that our research still has two limitations. First, the data we obtained only reflects a single cost and cannot reflect the annual cost and burden level of geriatric inpatients with chronic diseases. In addition, due to space limitations, there is a lack of research on the path of Ptcm affects hospitalization costs.