Abstract:Objective:To evaluate the economic effects of the implementation of Special Outpatient Chronic Diseases(SPOCD)in urban and rural resident basic medical insurance on middle-aged and elderly hypertensive patients in Heilongjiang.Methods:Based on the mixed cross-sectional data of Basic Medical Insurance claims for Outpatient Unified Accounts in Heilongjiang from 2022 to 2023,generalized linear regression was used to measure the impact of SPOCD on the total medical expenses,out-of-pocket expenses,fund expenditures and medical saving account expenditures of hypertensive patients for outpatient and inpatient services.Results:The total outpatient medical expenses,total fund expenditures and individual saving account expenses of the patients who enjoyed the program benefits were 3.03,3.97 and 1.40 times of those who didn't enjoy the benefits,respectively.For inpatient services,program benefits only have a significant impact on the out-of-pocket expenses(P＜0.05).Compared with those who did not enjoy the benefits,the out-of-pocket expenses of patients who enjoyed the benefits decreased by 54%.The robustness checks were consistent with the benchmark regressions.The results of heterogeneity test showed that there were heterogeneities in gender,age,work type and time in the effects of SPOCD on variables in outpatient.Conclusion:The economic effect of SPOCD on middle-aged and elderly patients with hypertension existed,and it induced ex-post moral hazard.In order to achieve the goal of chronic disease prevention and control,it is necessary to further explore the connection with other programs,and accelerate the refined benefit designs.

Abstract:Based on a comprehensive review of Artificial Intelligenc(AI)technology applications in public hospital financial management,the article concludes that AI can be effectively deployed across four core scenarios:budget management,cost management,financial early warning systems,and financial process automation.By leveraging data to empower these functions,AI enhances the precision and efficiency of financial management.By scientifically planning the implementation path for AI technology and refining supporting mechanisms,the value of AI in financial management can be fully realized.It will significantly enhance the financial control capabilities of public hospitals,providing robust support for the high-quality development of their financial management systems.

Abstract:Objective:To analyze the medical insurance payment,costs and profits of non-governmental hemodialysis centers in 23 provinces(autonomous regions and municipalities)in China,and to put forward reasonable suggestions for precise medical insurance cost control and optimization of cost management in non-public hemodialysis centers.Methods:A stratified random sampling method was used to investigate 215 non-governmental hemodialysis centers in 23 provinces(autonomous regions and municipalities)in China.Descriptive statistics and multifactorial analysis of variance were employed to analyze data on medical insurance payment,costs,and profits.Results:There were inter-regional differences in medical insurance payment among the surveyed non-public hemodialysis centers.The costs of the centers were mainly composed of consumables,human resources,and operation and management,with an average net profit rate of 9.30%.The number of patients undergoing dialysis had a significant impact on the profits of the centers.Conclusion:Non-governmental hemodialysis centers generally exhibit low profitability and high dependence on medical insurance payments.It is recommended to complement the payment standard for independent hemodialysis centers so as to incentivize the high-development of hemodialysis centers;adjust fee structures based on actual treatment costs to enable precise cost control;optimize construction scale and strengthen refined management to effectively reduce costs and improve efficiency;encourage the development of independent hemodialysis centers to achieve benefits for both the nation and residents.

Abstract:Objective:To investigate the impact of regional innovation on medical security and its spatial effects across 31 provinces in China,providing scientific evidence for synergizing the"Healthy China"strategy with regional coordinated development.Methods:Based on provincial panel data from 2007 to 2023,the medical insurance fund expenditure was employed as a proxy for medical security.Methodologies include Moran's I tests,dual-way fixed effects models,Spatial Durbin Models(SDM)with adjacency and inverse-distance matrices,and spatial mediation models were applied to comprehensively analyze the direct effects,spatial spillover effects,and mediating pathways of regional innovation on medical security.Results:During the observation period,medical security levels in all provinces showed a fluctuating upward trend with significant regional disparities,where eastern provinces outperformed central and western regions.Regional innovation exhibited significant positive direct effects and spatial spillover effects on medical security.Regional innovation can improve medical insurance coverage by promoting growth in medical financial expenditure and the conversion of medical patents.Conclusion:Policy recommendations include deepening the synergy between regional innovation and medical security,optimizing the allocation of medical fiscal resources,accelerating the transformation of technological innovations,and narrowing regional development gaps.

Abstract:The Diagnosis-Intervention Packet(DIP)payment exerts notable effects on hospitals' economic operations.As centralized hubs of high-quality medical resources,tertiary hospitals face a functional mismatch with the provision of services for primary care diseases.By analyzing the admission and payment practices for primary care diseases in sample hospitals in Henan Province,it identifies key challenges,including inadequate alignment between healthcare payment reform policies and management systems,weak foundational capabilities in hospital health insurance informatization,and insufficient awareness of health insurance policies among medical staff.It is recommended that hospitals should strengthen communication and coordination with health insurance administration agencies to foster positive interactions between healthcare providers and insurers;continuously advance in-house health insurance informatization and enhance data governance capabilities;improve strategic awareness and innovate value-based health insurance management models.

Abstract:Objective:To analyze the experiences of implementing coverage with evidence development for cell and gene therapy products in the UK.to provide references for the future access of cell and gene therapy products in China.Methods:By systematically combing the strategies of coverage with evidence development adopted by National Health Service(NHS)in the UK.,and summarizing the four links of assessment,payment,further evidence collection and final decision-making,the implementation experience of coverage with evidence development of cell and gene therapy products was analyzed by taking the reimbursement of four typical cell gene therapy products as an example,and suggestions were made for the access of this type of products in China.Results:Access to cell and gene therapy products in the UK.is cautious,with assessment focused on clinical utility.Management access agreement is used to control the risk of overspending during specialized fund reimbursement,while a unified data collection system has been established.Conclusion:China could learn from the experience of the UK.and promote the admission of cell gene therapy products from three aspects:exploring the evidence-based reimbursement model for universal commercial medical insurance;developing a targeted data collection framework based on actual data needs;establishing a unified data collection platform to provide the support for product access decision.

Abstract:Objective:To define the concept of public value on digital supervision of medical insurance funds and to interpret its basic characteristics.Methods:Based on defining the concept of"public value"using the atomic atlas method,the formal logic definition method is used to define the"public value on digital supervision of medical insurance funds".Results:Among 47 concepts related to"public value",public,citizen,collective,and preference are the core elements;negotiation,utility,and expectation are the quasi-core elements;government,outcome,and common are the important elements;and integration,construction,and appeal are the non-important elements.The"public value on digital supervision of medical insurance fund"can be defined as"in the practice of digital supervision of the health insurance fund,citizens' value demands and expectations,and the degree of satisfaction of these demands and expectations,based on their knowledge and basic value judgments of the health insurance system and digital technology,and formed through a wide range of value-constructing mechanisms,such as social communication and political consultation."Conclusion:The public value on digital supervision of medical insurance funds has the characteristics of people-centeredness,the construction of multi-subject negotiation,and the integration of multiple value dimensions.These features together constitute the rich connotation of the public value of digital supervision of medical insurance funds,which provides a certain reference for promoting the modernization and governance of healthcare insurance and the construction of digital government.

Abstract:China's Medical Service Price(MSP)reform has entered a new phase,implementing management measures.The compilation,implementation,and coordination of MSP item guidelines and the existing contradictions and problems were reviewed.It proposes strengthening price item management in planning under the background of the new era,itemizing in the alignment particle size,and comparing prices in the same coordinate system.This can offer systematic approaches and innovative strategies for improving the quality and efficiency of deepening MSP reform.

Abstract:The release of item guide is an important content of deepening the reform of medical service prices,and it is also a major measure to unify and standardize the price of medical services.Comprehensive examination items are widely grasped and applied by the majority of hospitals and medical personnel,the degree of service homogenization is relatively high,the frequency of occurrence is high,and it plays a key role in the medical service price system and service income.On the basis of the preparation ideas,framework structure design,item elements and characteristics of the comprehensive examination item initiation guide,it reviews the main changes in the establishment of the comprehensive examination item initiation guide price item,and puts forward suggestions to accelerate the implementation of the comprehensive examination item initiation guide:promoting the docking pricing and standardized implementation of the comprehensive examination item initiation guide,and starting the dynamic adjustment of the price of diagnostic items according to the trigger mechanism.

Abstract:Objective:To analyze the overall level,structure,and regional differences of central government's health and wellness transfer payments to local governments in China,providing a basis for improving the fiscal transfer payment system.Methods:The regional differences and their changes in central government's health and wellness transfer payments to local governments were analyzed using range,standard deviation,coefficient of variation,and Kendall's coefficient of concordance.Results:From the perspective of the per capita level of central government's health and wellness transfer payments to local governments,the relative differences among provinces have shown a downward trend,but the absolute differences have expanded.Meanwhile,the absolute and relative differences in the proportion of central government's health and wellness transfer payments to local governments in total government health expenditures have remained relatively stable.The Kendall's coefficient of concordance between per capita central government's health and wellness transfer payments to local governments and per capita general public budget revenue has shown a downward trend.Conclusion:Due to the different standards for sharing the expenditure responsibilities of common fiscal matters between the central and local governments,the existence of regional differences in central government's health and wellness transfer payments to local governments is inevitable.However,within regions with similar levels of economic development,there should not be significant differences in the standards and degrees of central government's health and wellness transfer payments to local governments.Therefore,it is necessary to evaluate the current standards for the division of fiscal powers,responsibilities,and expenditure responsibilities between the central and local governments,optimize the allocation mechanism of fiscal transfer payments,control the expansion of regional differences,and improve the regular assessment mechanism for fiscal transfer payments.

Abstract:Objective:To propose policy recommendations for the compensation mechanism of high-quality development of municipal public hospitals.Methods:Taking the municipal public hospitals in Shanghai as the research object,the aspects of financial subsidies,the structure of medical service income,investment in scientific research and education,and other social compensations were examined to conduct a systematic simulation of the operation of the average municipal public hospital in Shanghai under different policy intervention scenarios.Results:If the current conditions remain unchanged,the average municipal public hospital in Shanghai will face a deficit starting in 2032,the proportion of income from examinations and laboratory tests will surpass that of medical service income in 2026 and 2031,respectively.If the hospitals follow a plan of Combination Plan 3,4,and 5,the average municipal public hospital in Shanghai will be able to break even from 2023 to 2033,and the structure of medical service income will be significantly optimized.Conclusion:To establish a new compensation mechanism for high-quality hospital development that enhances medical services,it is recommended to optimize the structure of government financial compensation,explore rational pricing strategies based on categories,increase investment in scientific research and education while paying attention to the transformation of scientific and technological achievements,expand compensation channels for public hospitals,and improve relevant laws and regulations.

Abstract:To enhance hospital operational management capability,the sample hospital initiated a financial talent development program aligned with current development needs and policy directions.This program established a talent development framework encompassing hierarchical training,employment mechanisms,and digital empowerment,forming a three-tier financial talent echelon comprising senior,intermediate,and junior professionals.It effectively facilitated the transformation of financial functions toward"strategic support,business service,risk prevention and control,and value creation".It analyzes the hospital's practical experience in financial talent development,aiming to offer insights for financial workforce development in public hospitals.These efforts synergize with the modernization of governance systems and capabilities in health economics,driving high-quality development in public healthcare institutions.

Abstract:Objective:It aims to explore the spatial heterogeneity,dynamic evolution patterns,and driving mechanisms of medical insurance fund sustainability across Chinese provinces,providing decision-making support for addressing regional development imbalances and improving collaborative governance of healthcare systems.Methods:Based on data from 31 provinces in China(2010-2023)on the accumulated balance of medical insurance funds available for payment months,the Dagum Gini coefficient decomposition method is employed to analyze regional disparity sources,combined with spatial autocorrelation analysis and the Spatial Durbin Model(SDM)to reveal spatial dependency pathways and multidimensional driving mechanisms.Results:The findings indicate a gradient disparity characterized by"high stability in the east and high heterogeneity in the west with some high-risk zone".Tibet and Gansu represent the extremes of this distribution.The regional disparity mechanism has shifted from inter-group dominance to super-variable density dominance,with the latter contributing 48.59％by 2023.Significant spatial agglomeration effects were observed(Moran's I≥0.249,P＜0.01),where economic development(total effect of regional average GDP=0.278),aging populations(total effect of the dependency ratio for the elderly=-0.324),and cross-regional healthcare utilization(total effect of cross-regional healthcare utilization=-0.223)exerted asymmetric impacts through spatial spillovers.Conclusion:The sustainability of medical insurance funds is shaped by the interplay of geographical and institutional spaces.A categorized governance framework and regional collaborative mechanisms are essential,prioritizing policy integration for economic empowerment,population regulation,and resource optimization to transition healthcare governance from"localized administration"to"regional coordination".

Abstract:With the implementation of the medical service price item guidelines in various places,it is particularly urgent to follow up the coordinated policies of consumables that can be charged separately and their medical insurance catalog access and payment management.On the basis of reviewing the management policy of medical consumables charge and medical insurance catalogue,it introduces the practice of typical provinces,including making a catalogue list of consumables that can be charged separately to patients or forming a negative list of consumables based on basic consumption;formulating a unified payment management plan for medical consumables and a catalogue of medical consumables for medical insurance in the province;innovative medical consumables clinical application item fees and medical insurance payment policy coordination.The practice of typical provinces has implications for other regions to standardize consumables charges,medical insurance catalog access and payment:combing and screening,standardizing and integrating the content of price items in different places to form a list of consumables that can be separately charged;clearly defining the scope of access and meet the conditions,and classifying the consumables that can be charged separately into the medical insurance catalogue management according to the procedures.

Abstract:Objective:To investigate the determinants of hospitalization costs for joint replacement surgeries in a tertiary public hospital in Beijing from 2011 to 2023.Methods:Structural variation degree,grey relational analysis,and multiple linear regression were applied to assess the impact of policy reforms and clinical factors.Results:Average hospitalization cost per visit decreased markedly in 2013,rose steadily to a peak in 2019,and then declined.Medical pricing policies significantly influenced both cost levels and structure.Material cost consistently showed the strongest association with total cost,while treatment cost became the second most influential factor after four rounds of price adjustments.Length of stay,number of secondary diagnoses,number of additional surgeries,number of procedures,and ICU admission had impact on the average hospitalization cost per visit,with statistical significance.Conclusion:Price adjustments for consumables and treatment services are the main drivers of average hospitalization costs for joint replacement surgeries.Further optimization of cost structures and medical service pricing is required to better reflect labor value,while the labor value is required to be promoted.The length of stay and operation amount have impact on the average hospitalization cost per visit.It is needed to focus on improving efficiency and care quality.

Abstract:Objective:To deconstruct the overall medical expense and analyze systemic characteristics of cost structure dynamics in China from the perspective of optimizing healthcare resource allocation.Methods:Utilizing hospitalization records in a sample city from 2022-2023 as the research literature,the linear regression models for different cost components was established over the two-year period within each DRG-based case group to identify statistically significant temporal trends and directional changes in cost structures.Results:Most DRG groups exhibited significant trends in at least one cost component.Notable concentration patterns emerged in medication,comprehensive care and therapeutic service costs.When evaluating structure improvement,most achieved optimized allocation in at least one major cost component.Conclusion:The sample city demonstrates continuous optimization in healthcare cost structures,yet specific cost categories and DRG groups deviated from resource allocation optimization goals.Policy interventions should prioritize granular,DRG-specific adjustments to address heterogeneous structural dynamics.

Abstract:Objective:To study the development status and characteristics of the Traditional Chinese Medicine(TCM)service capacity of primary medical institutions(referred as primary)in Beijing.Methods:The case-base aggregation method was used to analyze the total amount,distribution,and development changes of total TCM costs in primary healthcare institutions in Beijing.Results:From 2019 to 2023,the average annual growth rate of the TCM costs of primary healthcare institutions in Beijing was 10.09％,and the proportion in total TCM costs increased from 16.01％to 18.19％.The average annual growth rate of the TCM costs of community health service centers(stations)was 11.78％,but there were negative growths in outpatient departments,clinics,and village clinics.The proportion of the primary TCM costs in its health costs increased from 29.16％to 32.56％.The average annual growth rate of income from primary herbal medicines and processed Chinese medicines were 16.75％and 10.13％.Conclusion:The primary TCM undertaking has developed steadily,and Beijing should continue to guide high-quality TCM resources to sink.Multiple measures should be taken to promote the development of TCM in outpatient departments,clinics,and village clinics.The coordination between prices and medical insurance reimbursement and payment methods should be strengthened.Supervision over the quality and use of Chinese medicine should be strengthened,and the technical service capabilities of primary TCM should be enhanced.

Abstract:Objective:Based on the theoretical framework of policy innovation diffusion,it systematically explores the diffusion mechanism and core influencing factors of national regional medical centers,and reveals their internal diffusion laws and key driving factors,so as to provide theoretical basis and practical guidance for the rational expansion,precise sinking and scientific layout of high-quality medical resources.Methods:Based on the panel data related to the construction of national medical centers in 31 provincial-level administrative regions of China from 2019 to 2023,the random effect and fixed effect models were used for benchmark regression analysis,and the spatial Durbin model was innovatively introduced to explore the influencing factors and internal mechanisms of the expansion of high-quality medical resources.Results:The degree of population aging,the level of regional education development and the intensity of medical financial expenditure showed a significant positive correlation with the layout of national regional medical centers,which has become the key strategic fulcrum driving the construction of national regional medical centers.Conclusion:In order to improve the efficiency of medical resource allocation and promote the expansion and balanced distribution of high-quality resources,it is necessary to accurately meet the demand for health services brought about by the evolution of population structure,systematically promote the upgrading of national education quality,and continue to increase the allocation of financial resources in the field of medical and health care,and establish a multi-institutional collaboration mechanism to promote the integration and sharing of resources to ensure the accessibility and equitable development of medical resources.

Abstract:Objective:To assess health-related quality of life and disease burden of Chinese Phenylketonuria(PKU)patients and inform optimized management and support strategies.Methods:A cross-sectional survey is conducted to explore questionnaires.The Delphi method was applied to form a standardized questionnaire.Results:A total of 263 valid questionnaires were collected.The average patient age was 7.6 years.Younger patients reported better quality of life.Mean total medical cost per patient was 238 461.9 yuan,exceeding the 2024 national per capita disposable income.Conclusion:PKU patients are facing significant challenges in both quality of life and economic burden.

Abstract:Objective:To investigate the implementation effect of the Diagnosis-Related Group(DRG)payment reform.Methods:Taking Panzhihua City in Sichuan Province,which implemented the DRG payment reform in 2018,as the treatment group,and the remaining 20 non-pilot prefecture-level administrative regions within the province as the control group,the panel data was constructed.The Synthetic Control Method(SCM)was employed to evaluate the effects of the DRG payment reform.Results:Four years after the implementation,the inpatient diagnosis and treatment costs in Panzhihua City were approximately 1200 yuan lower,and drug costs were about 500 yuan lower than the synthetic control group.Conclusion:The DRG payment reform has led to a significant reduction in both inpatient diagnosis and treatment costs and drug expenses,effectively mitigating the rapid growth of medical insurance fund expenditures.It is recommended to leverage artificial intelligence to optimize the precision of DRG grouping,utilize the technological outreach of national medical centers,and promote synergy between the DRG payment reform and public hospital performance reform,construct a medical service payment model that"controls costs,improves quality,and promotes efficiency",thereby enhancing the effectiveness of the DRG payment reform.