Abstract:Objective:To summarize practical experiences in addressing healthcare resource shortages in economically underdeveloped regions and to propose a novel theoretical framework for county-level healthcare governance systems.Methods:Applying the seamless governance theory,it analyzes the implementation of the new-round medical reform in Sangzhi County through the dimensions of organizational structure,interest coordination,and information sharing.Results:The"seamless"healthcare consortium model in Sangzhi County centers on organizational integration,interest coordination,and information convergence.It unifies county-township-village tertiary medical resources through the"Eight Unifications"approach,breaking down administrative barriers.The model enhances resource allocation and fund efficiency via a"four-medical synergy".Intelligent platforms and telemedicine technologies enable data interoperability,improving service continuity and precision.Post-reform indicators show the county's hospitalization rate increased from 84.6%in 2019 to 91.5%in 2024,with medical insurance funds transforming from deficit to a cumulative surplus of 577 million yuan.Conclusion:The Sangzhi County"seamless"healthcare consortium model demonstrates a viable pathway for resource-constrained regions by integrating institutional innovation with technological empowerment,offering a new theoretical framework for analyzing county-level healthcare governance systems.

Abstract:Objective:To analyze the influencing factors of asset-liability ratios and medical surplus rates in urban public hospitals,providing a basis for optimizing operational management.Methods:Utilizing data from urban public hospitals in Guangdong from 2019 to 2023,a two-way fixed effects model was constructed for empirical analysis.Results:It is showed that 44%of urban public hospitals reported medical losses,42.10%of hospitals had liability ratios＞40%,and some facing insolvency.Fiscal subsidies significantly reduced asset-liability ratios in secondary and tertiary hospitals,but showed no significant impact on medical surplus rates.Management capability emerged as a core factor influencing medical surplus rates:tertiary hospitals are influenced by material costs per hundred yuan of medical income and outpatient visits;secondary hospitals are affected by personnel expenditure ratio,medical revenue per employee,and average salary per staff member;primary hospitals are influenced by medical revenue per employee and medical income per hundred yuan of fixed assets.Conclusion:To enhance the financial performance of urban public hospitals,it is essential for the government to assist in resolving historical debts and improving categorized and tiered subsidy policies.Meanwhile,the hospitals themselves must strengthen the application of budget management tools and place emphasis on managing areas such as the cost of medical supplies,labor expenses,and the operational efficiency of fixed assets.

Abstract:Objective:Promoting the continuous optimization of the outpatient mutural-aid program aid system for employee medical insurance.Methods:Grounded in the implementation of the outpatient mutual-aid reform for employee medical insurance in Shandong Province,three adjustment scenarios for general outpatient benefits were designed under the policy of"compensation exchange and fund transfer".A comparative analysis was then conducted through simulation modeling to evaluate the scale of pooled fund expenditure and its utilization efficiency.Results:With a pooled fund expenditure of 130.78 billion CNY,Plan Ⅰ would alleviate immediate fiscal pressure,but demonstrates poor efficiency in translating funds into accessible benefits.With an expenditure of 151.33 billion CNY,Plan C would push the fund utilization rate beyond the 100%threshold,posing a significant risk of insolvency.Requiring an expenditure of 141.85 billion CNY for a 95.23%utilization rate,Plan Ⅱ strikes a superior balance between meeting healthcare needs and ensuring fund sustainability,while also offering the distinct advantages of a seamless policy transition and the lowest implementation costs.Conclusion:Plan Ⅱ is recommended as a baseline model.Core parameters such as the deductible threshold and reimbursement rate should be scientifically calibrated.This should be complemented by the enhancement of intelligent monitoring capabilities,in order to provide a sustainable and operable pathway for advancing the reform of the coordinated outpatient coverage system.

Abstract:Objective:To retrospectively analyze the relationship between the clinical value and treatment costs of innovative anticancer drugs.Methods:For all exclusive new anticancer drugs not included in China's National Reimbursement Drug List(NRDL)from 2017 to 2023,multiple linear regression was employed to explore the association between the treatment costs and clinical value.Results:A total of 92 eligible drugs were analyzed,of which 74 were included in NRDL.Linear egression showed that the progression-free survival hazard ratio was positively correlated with pre-negotiation annual treatment costs,and greater PFS benefits were associated with higher costs(β=-1.01,P=0.009).Overall survival benefits and safety were not correlated with costs.Robustness analyses confirmed the relationship between clinical value and costs remained consistent before and after negotiation.Conclusion:In recent years,the clinical value of innovative anticancer drugs launched in China has been positively correlated with their costs.Price negotiation significantly reduced treatment costs while the positive association between clinical value and costs remained unchanged.

Abstract:In terms of financial support and compensation for hospitals,the dual-track framework of"finance+medical insur-ance"adopted by China and Germany.Based on the comparative perspective of China and Germany,it systematically analyzes the financial compensation system and mechanism of German hospitals.Through the comparative analysis of the system design,deci-sion-making basis and fund supervision of these two countries,it systematically summarizes the experiences and practices of the German financial subsidy compensation system,and provides references for the reform and improvement of the financial investment and compensation mechanism of public hospitals in China.

Abstract:The reform of healthcare payment systems,particularly through Diagnosis-Related Groups(DRG)/Diagnosis-Intervention Package(DIP),seeks to enhance the efficiency of medical resource allocation by establishing evidence-based pricing mechanisms.General equilibrium theory serves as a foundational framework for understanding price formation and systemic equilibrium.However,structural characteristics inherent to healthcare markets,including pronounced information asymmetry,principal-agent dilemmas,and regulatory constraints,expose critical limitations in applying equilibrium-based paradigms.Combining policy practice and theoretical models,it systematically analyzes the applicability and boundaries of the general equilibrium theory in the formation of DRG/DIP disease prices,and proposes improvement paths such as dynamic adjustment mechanisms and policy coordination.

Abstract:Objective:To investigate the alienation patterns of workplace violence in healthcare under digital transformation within the interwoven virtual and physical spaces,and provide theoretical perspectives for understanding the emerging form of violence and supports evidence-based intervention strategies.Methods:Semi-structured interviews were conducted with 38 management department heads from seven Grade Ⅲ-A hospitals in Harbin.Through literature review,the concept of digital workplace violence in healthcare(DPVH)was defined,and digital behavioral economics theory was applied to analyze perpetrator behaviors.Results:The core characteristics of medical digital violence were clarified,demonstrating broader dissemination and deeper societal impact.Key drivers identified through the theoretical framework include limited rational decision-making,digital behavior dependency,virtual identity identification,and herd behavior among perpetrators.The study also elucidated the path of interperpetrator reinforcement and violence spillover into physical spaces.Conclusion:Medical digital violence represents a new high-risk form of violence in the digital era.Digital behavioral economics provides an effective theoretical framework for understanding its generation and diffusion mechanisms.Future comprehensive governance should integrate digital behavior facilitation,privacy protection,and big data prediction technologies to maintain healthcare market equilibrium and harmonious doctor-patient relationships.

Abstract:The adjustment of medical service prices is crucial to the allocation of medical resources and the health rights of the public.Currently,three key problems exist in the dynamic adjustment of medical service prices:firstly,the technical methods for price adjustment are unclear,with complex cost accounting,insufficient scientificity of models,and failure to effectively consider dynamic factors such as price fluctuations and medical insurance policies;secondly,the policy system is imperfect,lacking quanti-tative standards in regulations,with poor coordination among departments and a lack of long-term effectiveness in the adjustment mechanism;thirdly,the supporting platforms are inadequate,with low data quality and lagging information systems,affecting the scientific nature of decision-making.To address these issues,improvements should be made in four aspects:improving the cost ac-counting system to clarify real costs and highlight the value of technical labor;introducing technologies such as machine learning to optimize price adjustment models;improving the dynamic mechanism to conduct regular evaluations and publicize adjustment pro-cesses;and increasing investment in information system construction to strengthen data mining and information sharing among de-partments,thereby promoting the high-quality development of the medical industry.

Abstract:Objective:To resolve institutional conflicts between financial supervision compliance and medical risk control in public hospital asset management under the"Healthy China"strategy.Methods:A five-dimensional synergistic mechanism of"integrating dynamic balancing,three-tier decision-making,lifecycle risk control,and scenario-based protocols for emergency procurement,equipment maintenance,and supply disposal"was constructed by collaborative governance theory.Results:Operational systems is constructed,including creating a clinical-priority rapid-response channel for emergency procurement while concurrently strengthening post-event financial oversight,implementing a dynamic reallocation mechanism for equipment maintenance budgets based on medical risk levels,formulating a public reserve equipment inventory management system alongside cost-sharing protocols.Conclusion:The Mechanism provides a systematic approach for balancing asset security,cost efficiency,and medical quality during public hospital reform,which could support the high-quality development practices for public hospitals under the new medical reform.

Abstract:Objective:To study the difference in the choice of professional position and quality investment before and after the payment reform of Diagnosis Related Group(DRG)and Diagnosis Intervention Packet(DIP),and analyze the theoretical mechanism and realization path of the promotion of graded diagnosis and treatment from payment method reform.Methods:Applying the theory of industrial organization in economic theory,a model of location-quality competition is established.Results:The payment reform of DRG and DIP provides incentive to other level hospitals that compete with tertiary grade A hospital to attract more patients through enhancing quality investment,and meanwhile to mitigate the quality competition through differentiated development in professional position.Conclusion:Appropriately designing the DRG and DIP,hospitals'quality investment will be higher and the functional positions will be closer to the social optimum than before the reform,which helps promote the implementation of graded diagnosis and treatment.

Abstract:Objective:To analyze the current status and challenges of inter-institutional price comparisons for urban medical service items,and to propose targeted optimization strategies to support the adjustment of urban medical service pricing.Methods:Based on City H and the"Medical Service Price Standards(Offical List)",price comparisons of medical institutions were analyzed.T-tests,ANOVA,and Bonferroni tests were applied to compare the price comparison relationship of the total differences and group differences.Results:Significant differences were observed across service categories(P＜0.05).Items offered by both municipal and district institutions had lower comparison levels(P＜0.01).Similarly,services available at both district and primary levels showed lower levels than those only at the district level or not implemented(P＜0.01).Conclusion:Price comparisons lack stability,and primary care pricing remains weak.Hierarchical differences across service categories persist,and unimplemented items are often overlooked in pricing decisions.

Abstract:Objective:To analyze the effects of the employee medical insurance outpatient mutual assistance system implement on medical and pharmaceutical costs between traditional Chinese medicine(TCM)and non-TCM hospitals.Methods:Using medical insurance settlement data for hypertensive outpatients in Lanzhou from 2022 to 2023,univariate analysis and interrupted time-series models were implemented to compare changes before and after the implement.Results:In TCM hospitals,there were statistically significant differences in the average per-visit costs of Western medicines,Chinese herbal medicines,and medical service items before and after the implement(P＜0.05).Additionally,the average per-visit total medical costs,Chinese herbal medicine cost,and medical service item cost all showed a significant downward trend after the implement(P＜0.05).In non-TCM hospitals,the differences in the average per-visit total medical costs,Western medicine cost,proprietary Chinese medicine cost and other items before and after the implement were statistically significant(P＜0.05).Furthermore,the average per-visit total medical costs,Western medicine cost,and proprietary Chinese medicine cost showed a significant downward trend after the implement(P＜0.05).Conclusion:The employee medical insurance outpatient mutual assistance system has had a positive impact on controlling medical and pharmaceutical costs in both types of hospitals,with non-TCM hospitals showing better cost control outcomes.However,the control of certain cost components in both types of hospitals still requires further improvement.It is essential to continuously refine the employee medical insurance outpatient mutual assistance system,promote multi-stakeholder collaborative governance,and implement differentiated payment strategies to enhance the level of outpatient benefit protection.

Abstract:Objective:To explore the different impacts of the Outpatient Mutual-Aid Security(OMAS)system on the medical-seeking pattern and cost burden of retired and employed workers.Methods:Based on the outpatient chronic and special disease settlement data of employees'basic medical insurance in Lanzhou from January 2020 to March 2025,a two-group interrupted time-series model was used to assess the effect of the policy in terms of three dimensions:hierarchical diagnosis and treatment,cost burden reduction,and release of the demand for medical care.Results:After the implementation of the OMAS policy,the average monthly decrease in the grade of medical institutions visited by retired workers was 0.003 grade(P＜0.05),the average monthly decline in the amount of cash payment was 0.71 yuan(P＜0.05),and the average monthly increase in the number of visits to medical institutions was 25.40(P＜0.05);the average monthly increase in the number of visits to medical institutions for employed workers was 5.66(P＜0.05).The changes in the grade of medical institutions visited,and the amount of cash payment were insignificant(P＞0.05).Conclusion:The OMAS policy has begun to show results in promoting hierarchical diagnosis and treatment,reducing the cost burden and releasing the demand for medical care,with retired workers being the greater beneficiaries of the reform.In the future,it is necessary to further refine the existing policy and optimize the policy implementation mechanism to consolidate the effectiveness of the reform.

Abstract:Objective:To analyze the coordination between medical service prices and economic development level in China,so as to provide references for promoting the coordinated development of regional medical service prices and economic development.Methods:Selecting the GDP data of 31 provinces in China spanning the years 2012 to 2022,coupling coordination degree model and Dagum Gini coefficient were comprehensively used to analyze the coordination and development characteristics between medical service prices and economic development level.Results:The coupling and coordination degree of the whole country and the three major regions have been gradually improved;the average Gini coefficient within the region is ranked as follows:Eastern(0.126)＞Western(0.077)＞Central(0.065);the average Gini coefficient between regions is ranked as follows:Eastern-Western(0.187)＞Eastern-Central(0.143)＞Central-Western(0.093).Conclusion:Although the coordination between medical service prices and economic development level in China has been gradually improved,the overall coordination level is still relatively low,with significant regional and inter regional differences.Regional development policies should be formulated according to local conditions,inter-connectivity should be strengthened and promoted the coupling coordination between medical service prices and economic development level.

Abstract:Objective:To explore a cost management model integrating Activity-Based Costing(ABC)and Diagnosis-Related Groups(DRGs)driven by the goals of value-based healthcare.Methods:Based on case analysis,Yibin Hospital Affiliated to Children's Hospital of Chongqing Medical University were selected as the study subject.The ABC-DRGs cost management method was implemented to establish a more comprehensive DRG cost management system.Results:DRG cost accounting was conducted for the pediatric appendicitis case group at the hospital from January to December 2024.Compared with traditional cost accounting methods,cost differences were effectively identified,enabling precise targeting of key cost-control areas.Conclusion:The innovative application of Activity-Based Costing in DRG-based value-based healthcare can help public hospitals effectively achieve the goals of"improving quality,reducing costs,and increasing efficiency",thereby providing patients with high-value medical services.

Abstract:Exercise-based intervention serves as a cost-effective approach for chronic disease management,with extensive international experience in integrating healthcare and physical activity services.The US.integrates medical and fitness resources through medical fitness centers;the UK.implements dual prescriptions(combining medication and exercise)via general practitioner referrals;Australia demonstrates significant cost-effectiveness by incorporating accredited exercise physiologists into Medicare coverage;Germany employs evidence-based programs to enable precise interventions and reduce readmission rates;and Japan establishes a complementary model combining commercial and welfare-based services.By examining institutional frameworks and practical pathways across these countries,it summarizes their experiences in key aspects of efficiency in health resource integration,cost-effectiveness optimization mechanisms,and medical fitness platform development.It is recommended that China should prioritize building an economically efficient chronic disease exercise intervention system centered on a referral mechanism,explore insurance coverage for exercise prescriptions,gradually establish medical fitness centers and community intervention stations,and clarify professional qualification certifications.

Abstract:Objective:Taking Province A's Huimin Insurance as a case,it aimed to assess the effects of inclusive commercial health insurance on anti-tumor drug use following their inclusion in China National Reimbursement Drug List(NRDL),so as to provide evidence for relevant policy decision.Methods:Monthly procurement data for 30 new anti-tumor drugs were collected from public tertiary hospitals in Province A.A two-group,two-stage interrupted time series(ITS)analysis was employed to evaluate the effects of Huimin Insurance on medical institution coverage and procurement volume.Results:During the Huimin Insurance implementation period,both coverage rate and procurement volume were significantly higher for drugs covered by Huimin Insurance compared to those not covered(P＜0.01).The coverage rate and procurement volume further increased in the early post-national negotiation access period for Huimin Insurance-covered drugs.Conclusion:Huimin Insurance and the National Drug Negotiation access exhibited a synergistic effect,promoting earlier adoption and accelerated clinical use of covered anti-tumor drugs.It is recommended to enhance value communication for innovative drugs,optimize Huimin Insurance drug selection criteria,and establish a shared drug use data mechanism between"Huimin Insurance and the National Health Insurance".

Abstract:Using the theory of comprehensive budget management,it discusses the difficulties in the core aspects of asset allocation in public hospitals from the perspective of fiscal budget control,such as budgeting,procurement,contracts,and payments.The analysis found that the annual budget formulation and operational strategy formulation are not synchronized,the new asset allocation budget formulation is too specific,and the budget adjustment process is cumbersome,affecting budget implementation rate;the management of surplus funds for asset allocation procurement needs to be paid attention to and discussed;there are internal control risks in the management of medical consumables and might affect the procurement cost.A mutually compatible medium and long-term strategy and financial budget should be formed,and it is recommended that the purchase of assets with special funds should be included in the scope of the new asset allocation budget and given appropriate asset allocation budget adjustment rights to public hospitals.Meanwhile,it is necessary to optimize the management process of medical consumables.

Abstract:Objective:Based on the Advocacy Coalition Framework,a dynamic adaptation model of cataract health policy changes and multi-subject collaborative governance is constructed,and the dynamic adaptation path of multi-subject collaborative governance and the policy suggestions for continuously improving patients'sense of health gain in the process of cataract health policy change are discussed.Methods:Through the hybrid research method of Advocating Coalition Framework model and policy tracking data,the dynamic adaptation process of multi-subject governance behavior in cataract health policy changes is explored,and the evolution path and logic of the two subsystems are revealed.Results:Cataract health policy has achieved a policy upgrade from"basic vision"to"inclusive quality"driven by external events and internal alliances of policy systems.In this process,the collaborative governance behavior of multiple subjects has gone through three stages of development,showing the dynamic adaptability of multiple subjects in policy changes,the gradual improvement characteristics of China's health policy formulation,and the continuous improvement of patients'sense of gain.Suggestion:(1)Optimizing the structure of the medical and health service system and improve service efficiency;(2)establishing an interest coordination mechanism for the"healthcare,medical insurance,and medicine system"linkage and leverage policy synergies;(3)building a hierarchical response policy supply system to meet diverse needs;(4)establishing a collaborative regulation mechanism between quality and price to promote innovation and optimization.

Abstract:Objective:To summarize the international experience of Generative AI in pharmacoeconomics and evidence generation for health technology assessment,and to provide a reference for the rational use of Generative AI in pharmacoeconomic evidence generation in China.Methods:The position statements and working reports on the rational application of Generative AI published by National institute for Health and Care Excellence(NICE)and International Society for Pharmacoeconomic and Outcomes Research(ISPOR)in the UK were reviewed to conduct a comparative analysis of the similarities and differences in the value and risks generated by generative artificial intelligence in evidence generation,as well as the methods of quality control.Results:NICE paid more attention to the application of Generative AI to the whole process of evidence generation,affirmed its value of improving the automation of the model,and emphasized that the quality control of the generated evidence should pay attention to external supervision and its own autonomy.ISPOR focuses on the application of Generative AI to the core link of pharmacoeconomic evidence generation,affirming that it brings simple and efficient value points to evidence generation,and advocates that the quality control of generated evidence should start from the technology of model training itself.Both of them attach great importance to the risks brought by Generative AI in the generation of evidence from the perspective of security,equity,and transparency.Conclusion:In order to promote the high quality and efficiency of the generated evidence in the field of pharmacoeconomics in China,suggestions are put forward to control the transparency of model algorithms,guard against the risk of data pollution,and improve the quality of training data when applying Generative AI in the field of pharmacoeconomics in China.