Abstract:Objective:To develop an operational global-budget estimation framework for tightly County Medical Communities(CMCs)that balances equity and incentives.Methods:The budget-setting practices was reviewed to promote a two-step framework combining non-negotiable factors and negotiable factors.Using medical insurance settlement and statistical data,rolling forecasts,and compare errors against benchmark models were conducted.Results:In most years,the fitting error at Tightly Integrated County CMC level stays within 5%.Conclusion:A tiered calculation and decision-making framework incorporating non-negotiable factors,negotiable factors,and annual rolling adjustments should be adopted to advance the refined regional total budget reforms.This framework will enhance the linkage between healthcare institutions'quality performance and surplus incentives,driving a coordinated shift in payment methods from a"cost-control-oriented"approach to a"cost control+quality improvement"model.

Abstract:Objective:To examine long-term trends in the disease burden of five major brain-related diseases(stroke,mental disorders,neurological diseases,brain cancer,and encephalitis)in China in the context of the implementation of the National Fitness Policy,and to assess the association between the China's National Fitness Policy and changes in the burden of brain-related diseases.Methods:Global Burden of Disease data for China from 1990 to 2021 were analyzed,with 1995,2009,and 2014 identified as key policy intervention points.Segmented regression time series models were applied,incorporating counterfactual analysis and sensitivity testing to examine changes in age-standardized mortality rates,incidence rates,and disability-adjusted life year rates before and after policy implementation.Results:The overall burden of the targeted brain conditions showed a sustained decline.Marked reductions were observed in the burden of stroke and encephalitis,while improvements in mental disorders and other neurological conditions were relatively limited.The policy's influence was primarily reflected in persistent improvements over time,with the 2009-2014 period emerging as a pivotal window,suggesting a synergistic effect between the China's National Fitness Policy and concurrent institutional reforms such as healthcare reform.Conclusion:The temporal alignment between the National Fitness Policy and declining burdens of brain related diseases disorders suggests a potential policy effect,while not establishing a definitive causal link.Future research should incorporate attributable burden models and longitudinal individual-level data to further elucidate mechanisms of policy impact,including exploration of policy interactions and population-level heterogeneity in health responses.These efforts will provide robust empirical support for evidence-based policymaking and the construction of the Healthy China.

Abstract:Objective:To analyze the principal-agent dilemma under Diagnosis Related Groups/Diagnosis-Intervention Packet(DRG/DIP),propose an incentive-compatible mechanism and nudge design guided by value-based healthcare.Methods:Based on principal-agent theory,a doctor behavior model is constructed.By integrating incentive compatibility and nudge theory,a multi-party governance mechanism is proposed,which includes clinical decision support,performance evaluation,medical insurance payment adjustments,and social supervision.The doctor behaviors are analyzed under four scenarios:simple cost control,decision reminders,regulatory evaluation,and information disclosure.Results:Simple cost control cannot ensure service quality.The decision reminder mechanism reduces the cost of high-value services.The regulatory evaluation mechanism optimizes the benefit structure through economic incentives.The information disclosure system forms an implicit reputation constraint.Through multi-party governance,a positive cycle of"medical service quality,patient volume,revenue"is achieved,suppressing malpractice.Conclusion:The DRG/DIP prepaid system needs to balance cost control and value goals through an incentive-compatible mechanism.By integrating pre-event reminders,mid-event interventions,and post-event evaluations,a full-cycle strategy is proposed to promote medical insurance payment reform guided by value-based healthcare.

Abstract:The risk control and management of economic operation in public hospitals is essential for ensuring public welfare and achieving high-quality development,representing financing supervision.From the dimension of operational balance dilemmas under government regulation,resource allocation challenges amid industry competition,governance capability deficiencies in independent operations,and management tool ineffectiveness in the face of market failures.Taking Shanghai municipal hospitals as an example,the article summarizes and analyzes innovative practices such as budget-guided constraints,economic operation analysis,cost accounting control,information platform support,and the appointment of chief accountants.It outlines the implementation path for hospital economic operation risk prevention and control based on meso-level governance.It suggests that the economic operational risk management in public hospitals should align with their institutional mechanisms and operational characteristics,and should strengthen exploration in areas such as the application of management accounting tools,the use of digital and intelligent technologies,and the standardization of accounting information.

Abstract:Objective:From a dual embeddedness perspective,it examines how business-finance integration helps public hospitals balance public welfare with economic efficiency,facilitating their transition from extensive to refined and efficiency-oriented management.Methods:Based on qualitative analysis of national-level policy texts and typical cases,it identifies the"policy-institutional"and"operational-management"dual embeddedness structures formed by business-finance integration in public hospitals.Using a four-dimensional embedding framework,it evaluates the effectiveness of integrating business and financial operations in achieving balanced development of public welfare and economic efficiency within public hospitals.Results:Three identified challenges to its development are a"policy-cognition gap","structural-cultural lag",and institutional erosion.Conclusion:It is recommended to foster an institutional symbiosis by building value consensus,humanizing lean tools,and improving compensation mechanisms,so as to promote the balance between public welfare and economic benefits from a passive equilibrium towards prioritising economic benefits.It provides a practical and theoretical framework for transitioning public hospitals from extensive to high-quality,refined management.

Abstract:Objective:With the continuous strengthening of the trend of population migration and the continuous improvement of the pooling level of medical insurance,it has become an important proposition to narrow the policy differences of contribution years in different areas and improve the equity of the insured's treatment.The current status of contribution years of Urban Employee Basic Medical Insurance(UEBMI)was analyzed to provide reference for improving the relevant policies.Methods:Through policy analysis,the current status of contribution years was summarized.Literature analysis and expert investigation were used to study how to set the type and value of contribution years.Results:The policy of contribution years were quite different among regions,and it was necessary to formulate unified standards.The accumulated contribution years were more reasonable and universal on the type selection,which were policy-oriented and less difficult to promote.On the value setting,5 first-level influencing factors and 21 secondary influencing factors were extracted.In the first-level factors,the fund operation was most important;while in the secondary factors,the per capita income level,average premium base,contributor percentage and premium ratio were in the forefront.Conclusion:The contribution years play an important role in strengthening policy convergence,encouraging insurance payment and ensuring fund security in UEBMI.It was suggested to unify the policy of contribution years,give priority to the accumulated contribution years,and set the value according to multiple influencing factors.

Abstract:Objective:To understand the interpersonal interactions and work performance of family doctor team members,analyze associated factors and causal pathways,and propose improvement strategies.Methods:From December 2023 to January 2024,the questionnaire survey was conducted among members of family doctor teams in 10 community health service centers in Zhengzhou.Data were analyzed using parametric tests and structural equation modeling.Results:A total of 207 valid questionnaires were collected.The mean interpersonal interaction score was(110.60±10.27)points,with 85.08%response rate;the total work performance score was(48.13±5.36)points,with 87.51%response rate.Significant differences in interpersonal interaction were observed across job types,employment forms,and years of service(P＜0.05);significant differences in work performance were found based on weekly home visit frequency(P＜0.001).According to the study result of the structural equation modeling,the standardized direct path coefficient between interpersonal interaction and work performance among family doctor team members was β=0.62(P＜0.001),indicating good model fit.Conclusion:Both interpersonal interaction and work performance among family doctor team members were at relatively high levels,with interpersonal interaction significantly and positively predicting work performance.It is recommended to promote synergistic improvement in both areas by addressing job type,employment status,years of service,and frequency of home visits so as to promote the integrated promotion of interpersonal interaction and job performance.

Abstract:Objective:To investigate the status of geriatric healthcare services in Haikou for the enhancement of service delivery,so as to provide evidence for promoting the health service level of the elderly.Methods:A multistage random sampling design was utilized in the field investigations.Anderson's Model was constructed to analyze the influencing factors on the medical service ubtilization among elderly in Haikou.Univariate analyses employed Pearson's chi-square tests,while multivariate analyses were performed via logistic regression modeling.Results:Multivariate logistic regression analysis revealed that lack of a spouse and experience with online medicine purchasing were influencing factors for outpatient service utilization among elderly patients(P＜0.05).Current alcohol consumption,lack of exercise,and chronic disease status were influencing factors for inpatient service utilization among elderly patients(P＜0.05).Conclusion:It is needed to pay attention to the elderly individuals without spouses,those with experiences in online medicine purchasing,current alcohol drinkers,those who do not exercise,and those with chronic diseases.It is needed to meet the healthcare needs and enhance their utilization of medical services.

Abstract:Objective:It introduces the dynamic medical insurance copayment ratio into the tripartite evolutionary game framework of"government subsidies,hospital construction,patient adoption".An evolutionary game model is constructed to evaluate the impact of the"subsidy-copayment-regulation"policy mix on system equilibrium convergence.Methods:Based on replicator dynamics and data from Sample Hospital,MATLAB R2023b software simulations and sensitivity analyses were conducted.Results:The system converges to(1,1,1)only when three conditions are simultaneously satisfied:the government's welfare increment exceeds expenditures,hospitals'net returns from telemedicine surpass those of traditional services,and patients'net utility is greater than their copayment cost.Among single policy tools,dynamic adjustment of the copayment ratio exerts the most significant effect on convergence speed.Among combined schemes,the"moderate subsidy+moderate copayment+moderate regulation"configuration achieves the best performance.Conclusion:A tripartite policy framework of"fiscal guidance,insurance adjustment,regulatory support"should be established,with particular emphasis on the dynamic adjustment of the copayment ratio.Phased policy optimization is recommended to enhance the efficiency and adaptability of telemedicine promotion,thereby providing empirical evidence for policy design.

Abstract:Objective:To examine the coordination between health status and health investment among Chinese residents,including its degree,patterns,and spatial distribution,so as to propose strategies for coordinated development.Methods:Based on the provincial panel data of residents'health and health investment in China from 2013 to 2022,the analysis was conducted using the combination weighting method,coupling coordination model,cluster analysis,and spatial autocorrelation.Results:From 2013 to 2022,the coupling coordination degree of the two systems increased from 0.58 to 0.70,achieving a positive transition from barely coordinated to moderately coordinated;the four types of coordination patterns were low-low type,low health-high investment,high health-low investment,and high-high type;the coupling coordination degree of the two systems shows a random distribution globally(P＞0.05),while locally it is mainly clustered in the"high-high"pattern,with Guangdong and Hainan being clustered in"high-low"and"low-high"areas.Conclusion:The coupling coordination between the two systems shows an upward trend,the coordination pattern exhibits a gradient distribution,and the spatial heterogeneity pattern displays a high-to-low trend from east to west,with global randomness and local order.

Abstract:Objective:To explore the impact of medical security levels and capital market performance on the prices of commonly used retail drugs under the market-driven price comparison mechanism,and to provide empirical evidence and suggestions for improving the formation mechanism of retail drug prices and optimizing price regulation.Methods:The chained Fisher's index was calculated using the price data of commonly used retail drugs in the"Medical Insurance Price Pass"mini-program of Shenzhen from December 2023 to February 2025.The Lasso regression model was used to screen the variables of medical security levels and capital market performance,and the Ridge regression model was employed to study the correlation between the price index and each variable.Results:The number of participants in basic medical insurance,the total outpatient volume of public hospitals,and the trading volume of the CSI All Share Health Care Index were negatively correlated with the price index,while the number of participants in maternity medical insurance and the trading amount of the CSI All Share Health Care Index were positively correlated with the price index.Conclusion:Continuously deepen the three-dimensional coordination of"system-market-technology"to promote the transformation of drug price governance from passive response to active regulation.

Abstract:Objective:To provide references and implications for China's drug reimbursement decision-making by analyzing the setting and application of cost-effectiveness thresholds.Methods:A literature review method was employed to examine the establishment of cost-effectiveness thresholds and their application patterns in decision-making for health technology assessment and drug reimbursement management in representative countries,including the UK.,US.,Germany,and Japan.Results:Through analyzing the application of cost-effectiveness thresholds in different countries'decision-making mechanisms,significant discrepancies were identified in pharmacoeconomic practices,with no single"perfect"model or unified standard available for direct adoption.Conclusion:In 2025,China will launch its first commercial health insurance list for innovative drugs,primarily focusing on high-value innovative medicines that go beyond the scope of"basic coverage".However,since the funding for this list will come from commercial health insurance,the application of pharmacoeconomic evaluations and the setting of cost-effectiveness thresholds will need to be redefined in accordance with the shifting decision-making objectives.Therefore,China should continue to investigate the application patterns of cost-effectiveness threshold in decision-making that align with its health insurance system,thereby further enhancing the scientific rationality of medical and healthcare reimbursement decisions and improving the efficiency of healthcare resource allocation.

Abstract:Objective:To evaluate the implementation effects of the diagnosis and treatment before payment policy based on the practice in Xiamen.Methods:The effect model of Evert Vedung public policy assessment is applied to construct a policy evaluation framework and conduct evaluation and analysis.Results:The policy was appropriately formulated and effectively implemented,which improved patient medical treatment efficiency,reduced economic burden,and enhanced medical experiences.However,it also increased the financial risks and economic operation pressure of hospitals.Meanwhile,there were issues such as low popularity of credit-based medical treatment and expected slowdown in the refund of advance payments.Conclusion:The policy has basically achieved its set policy goals and played a positive role in promoting public hospitals to return to their public welfare nature,building harmonious doctor-patient relationships.It is recommended that the government fully exercise its responsibility and primary role,while medical institutions effectively implement adjustments to response strategies and enhance management practices to further maximize the policy effectiveness.

Abstract:Objective:It analyzes the operational performance of internet-based medical service models for oncology specialties in a public hospital,to provide a scientific basis for evaluating the service delivery capacity and resource utilization of healthcare.Methods:Employing a non-randomized cross-over design for pre-post departmental comparisons and dual-operating-model cross-validation,the GROW model was utilized to calculate and analyze key economic growth factors of internet healthcare services—including total revenue,gain,revisit rate,and value retention—to evaluate the market adaptability of different operational models.Results:It showed that the"centralized scheduling model"achieved an increase of 5 373 cases in service volume and a size of 3.581 million yuan in total internet-based medical revenue.Gain power is the dominant driving factor in thoracic surgery and oncological surgery(63.3%,62.9%),while both gain power and value power exhibit driving characteristics(50.3%,50.4%)in respiratory medicine.Oncology medicine is primarily value-driven(124.1%).Conclusion:Department-level internet operation strategies exhibit distinct characteristics in adaptability.

Abstract:Objective:To evaluate the cost-utility of repetitive Transcranial Magnetic Stimulation(rTMS)combining with Denepezil for Alzheimer's Disease(AD)treatment and provide scientific evidence for clinical decision-making.Methods:Based on clinical trial data,a cost-utility analysis was conducted collecting direct medical costs,direct non-medical costs,and indirect costs of rTMS treatment Combined with Donepezil.Health utility values were assessed using Mini-Mental State Examination(MMSE)conversion formula.The Incremental Cost-Utility Ratio(ICUR)was calculated with sensitivity analysis performed.Results:Total cost of rTMS combined treatment for AD was 404 421.5 yuan with incremental health utility of 0.47.The ICUR was below three times Gross Domestic Product(GDP)threshold,indicating cost-effectiveness compared to traditional therapy.Sensitivity analysis showed transition probability of mild AD is the key parameter influencing this ratio.However,the results remain robust even when this parameter fluctuates within a reasonable range.Conclusion:The combination of rTMS and donepezil demonstrates economic feasibility in treating Alzheimer's disease and significantly improves patient health utility scores.Its clinical implementation is recommended.

Abstract:Objective:It aims to introduce the Agent-Based Modeling simulation method in an innovative manner,develop a scientific sound modeling framework,and provide support for optimizing critical illness insurance policies for urban and rural residents.Methods:Using data from a province as variable parameters,a virtual simulation environment was developed on the NetLogo modeling platform from the dimensions of fund raising,fund utilization,and fund settlement.Results:Increasing the pooling ratio of the basic employee medical insurance fund to 2%renders the balance rate of critical illness insurance positive.The implementation of segmented reimbursement substantially reduces patients'out-of-pocket expenses,with an average reduction of approximately 629 yuan(12.55%).When commercial insurance companies adopt a 3%profit-loss ratio combined with a 50%additional risk-sharing ratio,the loss difference between the two parties is only 1 807 yuan.Conclusion:Based on the actual circumstances of a province,it designed policy schemes and conducted simulations that effectively target financing channel expansion,reimbursement method adjustment,and risk-sharing mechanisms,while identifying and predicting the equilibrium point in stakeholder games,thereby providing evidence for the optimization of critical illness insurance policies.

Abstract:Under the strong support of Shanghai Shenkang Hospital Development Center,the sample hospital,in response to the current problems existing in the budget management practice,closely focuses on the effectiveness of resource allocation as the core.Based on its own business characteristics,a new system of resource allocation budget management is constructed by strengthening the effectiveness of budget control,establishing a cultural value orientation,enhancing the intensity of budget assessment,and paying attention to the control of its process,achieving a leapfrog transformation from extensive allocation to precise resource allocation.Practice has proved that this system can effectively enhance the scientific nature of budget preparation,optimize operational efficiency and pay attention to the control of costs and expenses.Further research also indicates that the budget management supported by sample hospital leaders,the participation of clinical departments,and the integration of information construction are the key elements for the implementation of this system.It provides replicable experiences and practical references for achieving quality improvement and efficiency enhancement while promoting the refined management of hospitals.

Abstract:Objective:To summarize the current status,difficulty and problems of international medical services in Shanghai's public hospitals,propose health economics optimization strategies,and provide references for improving operational efficiency of international medical services in public hospitals.Methods:A questionnaire survey was conducted among Shanghai public hospitals,field research was carried out in pilot public general hospitals,and case analysis was performed on a public hospital of Shanghai.Results:The branding of international medical tourism services needs clarification,pricing and reimbursement mechanisms for service packages require optimization,a unified information platform for commercial insurance settlements needs improvement.Conclusion:It is recommended that regulatory authorities may consider taking the lead in establishing a multi-stakeholder collaborative governance mechanism to enhance specialized service branding and explore a unified commercial insurance settlement platform.Hospitals should optimize international medical service systems and processes,refine pricing mechanisms to strengthen competitiveness,and improve collaboration with international health insurers to streamline payment procedures.

Abstract:Healthy rural construction necessitates the strengthening of the talent foundation at the grassroots level of the medical sector.However,at present,32.5%of grassroots healthcare personnel are shouldering 51.8%of the clinical consultation workload,highlighting a prominent supply-demand imbalance.Moreover,while there has been a"counter-trend growth"in medical students'employment at the grassroots level,this remains more of a"situation"rather than a stable"trend".It integrates the"supply-demand-management"framework from health economics with social identity theory to construct a four-dimensional driving model encompassing"demand,policy,individual,and society"to decode the underlying mechanism.Specifically,on the demand side,the"supply-demand gap"acts as a driving force.On the policy side,"job establishment,remuneration,and career development"provide guarantees.At the individual level,there are two pathways:"passive avoidance"and"active identification",with the latter demonstrating a higher retention rate.On the social side,the"cognitive-evaluative-supportive"chain reduces psychological costs.It proposes facilitating transformations at both the demand and policy ends to promote a trend of medical students'grassroots employment,thereby providing talent support for healthy rural construction.

Abstract:Objective:To estimate and analyze the avoidable hospitalization costs and influencing factors for diabetes patients in Ningxia,provide countermeasures and suggestions for related policies.Methods:The"SHA 2011"accounting method was used to calculate and analyze the total amount and composition of avoidable hospitalization costs for diabetes patients in Ningxia.The two-level logistic model was constructed to analyze the relationship among the occurrence of avoidable hospitalization,individual characteristics and county health care resourcing.Results:In 2024,the total expenditures of avoidable hospitalization for diabetes were 279 million yuan in Ningxia,accounting for 1.78％of the total hospitalization costs.About 72.84％of avoidable hospitalization costs for diabetes occurred in general hospitals.Age,male gender,other ethnicities,medical insurance payment methods,occupation,and admission pathways were identified as major factors influencing avoidable hospitalizations among diabetes patients.The higher the number of doctors and beds per 1 000 rural population in township health centers(OR=0.943,0.866),the lower the likelihood of avoidable hospitalization for patients would be.Conclusion:The avoidable hospitalization of diabetes is widespread and the cost scale is large in Ningxia.It is recommended to take multiple measures to improve the accessibility and quality of primary health care services.