15 July 2025, Volume 39 Issue 7
    

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  • Impact of DIP payment on resource allocation and medical quality—an empirical study based on disease types in performance assessments in a tertiary hospital
    LI Xiaolin, LV Hui, JIANG Hui, YANG Shujie, ZHANG Yuxi
    Soft Science of Health. 2025, 39(7): 1-4. https://doi.org/10.3969/j.issn.1003-2800.2025.07.001
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    Objective To evaluate the impact of Diagnosis-Intervention Packet (DIP) on resource allocation and medical quality. Methods The interrupted time series analysis (ITS) was employed to assess changes of disease types-related indicators in the performance assessments before and after the implementation of DIP in a tertiary hospital. Results In terms of resource allocation, in the initial phase of the implementation of DIP, the average expenditure per admission and average length of stay for each disease decreased. The average expenditure per admission for acute myocardial infarction and chronic obstructive pulmonary disease decreased by 6053.91 yuan and 4496.22 yuan respectively. The average length of stay for certain disease categories showed a significant upward trend over time (P<0.05). In terms of medical quality, in the initial phase of the implementation of DIP, in-hospital mortality rates of each disease did not increase significantly. The in-hospital mortality rates of some diseases showed a significant upward trend over time (P<0.05). Conclusions DIP initially optimizes resource allocation without compromising medical quality. However, the long-term effect of DIP is not good and it may have certain negative impacts on the control of medical expenses and medical quality, which requires further research.
  • Research on the evaluation of relevant policies on the reform of medical insurance payment methods for traditional Chinese medicine—based on the PMC-Index model
    ZHAO Zhan, BAI Jie, HE Minmei
    Soft Science of Health. 2025, 39(7): 5-10. https://doi.org/10.3969/j.issn.1003-2800.2025.07.002
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    Objective A quantitative evaluation was conducted on 33 policies related to the reform of medical insurance payment methods for traditional Chinese medicine (TCM) in China, and policy suggestions for improving the reform of medical insurance payment methods for TCM in China were proposed. Methods Text mining and PMC-Index model were used to quantitatively evaluate and analyze the relevant policy texts of medical insurance payment methods for TCM. Results The average PMC-Index of related policies of medical insurance payment methods for TCM was 6.67. Among the 33 policies, 11 policies were rated as excellent and 22 policies were rated as acceptable. In terms of the average values of each first-level indicator, scores were relatively high in aspects such as policy evaluation and policy tools as a whole. However, further optimization was needed in aspects such as policy hierarchy and policy content. Conclusions There is the certain room for improvement in the relevant policies on medical insurance payment methods for TCM. It is recommended to improve the policy level to build a cross-departmental collaborative governance mechanism; enrich the policy content and encourage distinctive and diversified payment innovation; strengthen forward-looking design and establish an evaluation and dynamic adjustment mechanism with the characteristics of traditional Chinese medicine; consolidate the foundation of guarantee and strengthen the core support of technology and talents.
  • Study on the efficiency of health expenditure of the Chinese government and its spatial spillover effects
    JIANG Chenglei, SUN Xianhong, SONG Guoqiang
    Soft Science of Health. 2025, 39(7): 11-16. https://doi.org/10.3969/j.issn.1003-2800.2025.07.003
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    Objective To study the efficiency of health expenditure in each province and its influencing factors, and explore the methods to achieve the maximum benefit of health expenditure under limited resources. Methods The three-stage Data Envelopment Analysis (DEA) framework was employed to evaluate the efficiency of health expenditure in 31 provinces across the country from 2012 to 2021. Spatial autocorrelation analysis was conducted to identify the interrelationships of the efficiency of health expenditure of each province. The spatial econometric model was used to analyze the influences of factors such as fiscal decentralization on the efficiency of government health expenditure. Results The overall efficiency value of health expenditure in China was 0.751. The Global Moran's I of the efficiency of government health expenditure was significantly positive under the 1% level. The regression coefficient of the direct effect of fiscal decentralization on the efficiency of government health expenditure was significantly negative under the 1% level, and the regression coefficient of the indirect effect was not significant. Conclusions The efficiency of government health expenditure demonstrates spatial dependency. Fiscal decentralization, per capita GDP and the unemployment rate inhibit the improvement of the efficiency of government health expenditure. Urbanization, the proportion of government health expenditure in fiscal expenditure and the low illiteracy rate promote the efficiency.
  • Research on the high-quality development of the traditional Chinese medicine health industry driven by new quality productive forces
    LI Xingchen, FAN Taotao, CHEN Xiangru, LUO Qi, ZHANG Wenlong, RAO Yuanli
    Soft Science of Health. 2025, 39(7): 17-23. https://doi.org/10.3969/j.issn.1003-2800.2025.07.004
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    New quality productive forces are an advanced form of productivity that conforms to the new development concept, which has opened up a new track for the development of the traditional Chinese medicine health industry. It is also a key anchor point for improving the quality, efficiency and the innovative development of the traditional Chinese medicine health industry to ultimately achieve the high-quality development. At present, China's traditional Chinese medicine health industry still faces some bottlenecks, such as insufficient innovation and research and development capabilities, the need to improve the coordination and integration system, the need to enhance low-carbon and green development, the lack of high-quality integration into the international cultural system, and the urgent need to pay attention to the scope of sharing and the element foundation. Based on this, multiple paths for the high-quality development of the traditional Chinese medicine health industry driven by new quality productive forces are proposed. It necessary to enhance the effects of empowerment by cultivating new-quality momentum of scientific and technological innovation; establish a coordinated and integrated development system to strengthen the guarantee of traditional Chinese medicine; encourage green, low-carbon and sustainable development and inject new green impetus; build an external discourse value system to promote the dissemination of traditional Chinese medicine; improve the service sharing system and mechanism to meet new medical demands, and provide a favorable environment for accelerating the high-quality development of the traditional Chinese medicine health industry through the empowerment of new quality productive forces.
  • Study on the quality of life and its influencing factors of older persons with disabilities in China under the perspective of health ecology
    WANG Ziyi, CAI Jieyu, YANG Yifan, LIU Baohua, ZHAO Miaomiao, WANG Jiahui
    Soft Science of Health. 2025, 39(7): 24-30. https://doi.org/10.3969/j.issn.1003-2800.2025.07.005
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    Objective To measure the quality of life of older persons with disabilities in China and explore its influencing factors, so as to provide a reference for improving the quality of life of older persons with disabilities in China. Methods Based on the EQ-5D-3L scale, the data of 2018 China Health and Retirement Longitudinal Study (CHARLS) were used to measure the value sets of the quality of life of Chinese residents. The quality of life of 4,688 older persons with disabilities aged 60 and above who were finally included in the study was analyzed and the influencing factors were analyzed by using the Tobit regression model. Results The range of health value sets of older persons with disabilities was -0.167 to 0.686, and the median was 0.462. The results of Tobit regression analysis showed that gender, age, level of education, types of chronic diseases, and disability level in “personal characteristics”, alcohol consumption, sleep duration, and health checkups in “behavior and lifestyle”, marriage and family financial support in “interpersonal networks”, types of houses and housing cleanliness in “living conditions”, and regions and urban/rural areas in “macro policy level” had an impact on the health value sets. Conclusions At present, the quality of life of older persons with disabilities in China needs to be improved. There are factors affecting the quality of life of older persons with disabilities in all five dimensions of the health ecology theory, so it is suggested that comprehensive interventions can be carried out for the older persons with disabilities from multiple dimensions to improve their quality of life.
  • Analysis of the impact of family support and medical social support on the physical health of older adults and gender differences
    CAI Han, CHU Yujing, ZHANG Ying
    Soft Science of Health. 2025, 39(7): 31-34. https://doi.org/10.3969/j.issn.1003-2800.2025.07.006
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    Objective This study aims to analyze the impact of family support and medical social support on the physical health of older adults and gender differences, to provide a basis for formulating policies to improve the health level of older adults. Methods Based on the cross-sectional data of 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), 10, 662 older adults aged 65 and above were selected as the subjects. A multiple regression model was established to analyze the impact of family support and medical social support on the physical health of older adults and gender differences. Results The study found that living with family members (β=2.394, P＜0.001), seeking timely medical treatment (β=2.007, P＜0.001), annual household income (β=1.16×10-5, P＜0.001), annual health checkup (β=2.063, P＜0.001), and types of medical insurance had significant positive impacts on the physical health of older adults. Additionally, older women were more sensitive to family companionship and annual health checkup than men, while older men were more dependent on high-quality medical resources. Conclusions Family support and medical social support play an important role in improving the physical health level of older adults, and there are gender differences, which should be taken into consideration in future policy-making to provide more comprehensive and personalized health support services for older adults.
  • The quality of life of older adults with chronic diseases and its influencing factors in different elderly care models
    LIU Guizhen, MA Li
    Soft Science of Health. 2025, 39(7): 35-39. https://doi.org/10.3969/j.issn.1003-2800.2025.07.007
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    Objective To understand the quality of life of older adults with chronic diseases and its influencing factors in different elderly care models. Methods The 36-Item Short Form (SF-36) Health Survey was used to conduct a questionnaire survey among 263 older adults with chronic diseases in facility-based elderly care and home-based elderly care. The correlation between different dimensions and the quality of life was explored, and multiple linear regression was used to analyze the influencing factors. Results The score of physical functioning (PF) of older adults with chronic diseases in home-based elderly care (58.46±33.29) was higher than that of older adults with chronic diseases in facility-based elderly care (43.29±33.92), P < 0.05. The differences of the scores in other dimensions were no statistically significant. Conclusions The physical functioning of older adults with chronic diseases in facility-based elderly care needs to be improved. For older adults with chronic diseases in facility-based elderly care, the differences of the impact of individual variables on the mental component summary (MCS) were no statistically significant. Age, levels of education and monthly income were the main factors affecting their physical component summary (PCS) scores. For older adults with chronic diseases in home-based elderly care, gender and the number of children were the main factors affecting their MCS scores, while gender and age were the main factors affecting their PCS scores.
  • The predicament of administrative governance of surrogacy in China and paths to overcome it
    DAI Ruxin, WU Zhihong
    Soft Science of Health. 2025, 39(7): 40-45. https://doi.org/10.3969/j.issn.1003-2800.2025.07.008
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    Based on the perspective of administrative law, the core predicaments currently faced in governing the surrogacy lie in two aspects. Firstly, at the institutional level, the reliance on low-level departmental regulations leads to three major flaws: lack of norms, weak intensity of the penalty and limited regulatory subjects, which makes it difficult to precisely crack down on and effectively deter core illegal acts. Secondly, at the practical level, surrogacy agencies are concealed and have the ability to against investigations, making it difficult for law enforcement departments to detect them. Meanwhile, the surrogacy industry chain has significant cross-domain and cross-regional characteristics, and the current decentralized supervision model makes it difficult to form a joint force of law enforcement. Two paths are proposed to break through the predicament. Firstly, the regulatory system should be improved from the top-level design by formulating high-level specialized laws to establish the principle of comprehensive prohibition, systematically expand the regulatory subjects to all links of the entire chain, and set up more stringent punishment measures that match the illegal gains. Secondly, the core of innovative law enforcement practice model is to focus on cracking down on surrogacy agencies to disrupt the industrial chain. At the same time, based on the regulatory model involving different links, responsibility boundaries of each department should be clearly defined and a collaborative mechanism should be established. It is necessary to implement classified supervision and joint law enforcement on information dissemination, medical behaviors, non-medical entities and cross-regional issues, and build a long-term governance pattern.
  • Study on the liability of medical institutions in adverse drug events
    CHENG Yiran, LUO Gang
    Soft Science of Health. 2025, 39(7): 46-50. https://doi.org/10.3969/j.issn.1003-2800.2025.07.009
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    Starting from the legal characterization of adverse drug reactions (ADRs), this article reviews different viewpoints in the academic community on whether ADRs should be regarded as drug defects or inherent risks, and demonstrates that the characterization of “inherent risks” is more reasonable. It analyzes the practical challenges in attributing legal liability for ADRs, and combines the legal principle of tort liability to propose a model of “hybrid attribution of liability”. That is, the principles of fault liability, strict liability, or equitable liability are respectively applied depending on specific circumstances. Supporting measures such as improving legislation, establishing compensation funds for ADRs and compulsory liability insurance are proposed, aiming to safeguard the rights and interests of patients and reasonably allocate legal risks borne by medical institutions to improve the relief mechanism for ADRs.
  • Study on the impact of different cost control measures on the average cost of a hospital visit in a tertiary public hospital from the perspective of public welfare
    SUN Caiyun, WANG Wenjie
    Soft Science of Health. 2025, 39(7): 51-55. https://doi.org/10.3969/j.issn.1003-2800.2025.07.010
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    Objective To analyze the impact of the policies of abolishing drug price markups and implementing DRG on the average cost of an outpatient visit and per inpatient stay, and compare the implementation effects of the two policies, to provide the empirical basis for promoting policies and improving supporting measures. Methods The structural variation degree analysis method was adopted to compare the increase and structural variation of the average cost of an outpatient visit and per inpatient stay of the hospital before and after the implementation of the two policies. Results After abolishing the drug price markups, the average annual increase in the average cost of an outpatient visit and per inpatient stay was 3.32% and 0.73%, respectively, and the structural variation degrees were 24.85% and 23.40%, respectively. After the reform of DRG, the average annual increase in the average cost of an outpatient visit and per inpatient stay was 1.93% and 0.59%, respectively, and the structural variation degrees were 10.12% and 23.59%, respectively. Conclusions The policies of abolishing the drug price markups and adjusting corresponding prices have a substantial impact on the structure of average cost of a hospital visit. The reform of medical insurance payment drives hospitals to strengthen internal management and achieve the dual goals of adjusting the structure and controlling costs.
  • Analysis of the coupling coordination between primary healthcare services and economic development and its influencing factors in eastern, central and western regions of China
    GE Yishan, ZHU Pinghua, ZHANG Yajuan, YANG Haixiu
    Soft Science of Health. 2025, 39(7): 56-63. https://doi.org/10.3969/j.issn.1003-2800.2025.07.011
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    Objective To explore the spatial structure and dynamic evolution of the coupling coordination degree between primary healthcare service capacity and the economic development level in the eastern, central and western regions of China, and to analyze the influencing factors of the coupling coordination degree. Methods The entropy method, comprehensive evaluation index, coupling coordination model and Moran's I were used to evaluate the coordination degree between the capacity of primary medical services and the economic development level from 2015 to 2022. Grey correlation model was used to further analyze its influencing factors. Results The coupling coordination degree between the primary medical service capacity and the economic development level in the eastern, central and western regions of China showed a spatial pattern of decreasing in sequence of “eastern, central and western regions”, and the average annual growth rate showed a downward trend from 2015 to 2022. The coupling coordination degree of the two systems showed a distinct spatial effect, mainly in “high-high” and “low-low” agglomeration types. The number of medical institutions and the number of patients had the highest correlation with the coupling coordination degree of the two systems. Conclusions There are regional differences in the coupling coordination degree between the primary medical service capacity and the economic development level in the eastern, central, and western regions, and there are obvious characteristics of spatial agglomeration. The coordinated development of the two is the result of multiple factors. Each region should implement the concept of coordinated development, improve the mechanism of counterpart assistance, and choose different paths to achieve high-level coupling coordination based on local conditions.
  • Study on influencing factors of the cost of hospital stays and DRG for lung cancer patients based on E-CHAID algorithm
    DING Zhiwei, ZHOU Xiaoping, WANG Qi
    Soft Science of Health. 2025, 39(7): 64-68. https://doi.org/10.3969/j.issn.1003-2800.2025.07.012
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    Objective To analyze the key influencing factors of the cost of hospital stays for lung cancer patients and provide references for improving the DRG payment reform. Methods A total of 6269 inpatients with lung cancer in a tertiary specialized hospital in Beijing from January 2023 to December 2024 were included. Univariate analysis and multiple linear regression were used to screen the influencing factors of costs. The E-CHAID algorithm was applied for DRGs, and the Kruskal-Wallis H test and the coefficient of variation (CV) were used to evaluate the effect of grouping. Characteristics of outlier cases that was exceeding cost thresholds were analyzed. Results Univariate analysis showed that the cost of hospital stays were significantly correlated with age, length of hospital stay, number of surgeries, number of comorbidities, and whether there were critical conditions (P<0.001). Multiple regression identified that the number of surgeriesand the length of hospital stay were the core influencing factors(P＜0.001). The E-CHAID algorithm generated 11 groups, and inter-group cost differences were statistically significant(P＜0.001). The mean CV within the group was 0.34, indicating reasonable grouping. A total of 110 outlier cases (1.75%) were identified, predominantly in groups with surgery count ≤1, length of stay ≥15 days and comorbidities >5(35 cases). No outliers were observed in the high-weight group, reflecting a good match between cost standards and resource consumption. Conclusions The E-CHAID algorithm effectively identifies influencing factors of the cost of hospital stays and enables scientific grouping for lung cancer patients, providing a quantitative basis for the formulation of DRG payment standards and the fine management of hospitals.
  • Study on the structural variation of medical expenses of public hospitals in China from 2012 to 2021
    ZHOU Liqin, LEI Xiaosheng
    Soft Science of Health. 2025, 39(7): 69-73. https://doi.org/10.3969/j.issn.1003-2800.2025.07.013
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    Objective To analyze the structural variation of outpatient care costs and inpatient hospital costs of public hospitals in China, and to provide a reference for further deepening the reform and establishing a reasonable control mechanism of medical expenses. Methods Based on the data of medical expenses of public hospitals from 2012 to 2021, the structural variation analysis method was used to analyze the changes of medical expenses. Results From 2012 to 2021, the maximum values of structural variation degree of outpatient care costs and inpatient hospital costs of public hospitals in China occurred in 2017, which were 5.41% and 7.43%, respectively. Among outpatient care costs and inpatient hospital costs, the contribution rate of structural variation of drug costs was the greatest, but the pulling force was relatively small. The proportion of costs of healthcare material increased significantly, and the structural variation value showed a positive change, with the greatest pulling force. The proportion of items such as surgical fees and nursing fees, which reflected the technical and labor value of medical staff, had increased. Conclusions The controlling effect of drug costs in public hospitals is obvious, and the internal structure of medical expenses has been optimized. It is necessary to further enhance the technical and labor value of medical staff, pay attention to changes in the cost of healthcare materials, and take comprehensive measures to further deepen medical reform.
  • Research on regional evaluation of the allocative efficiency of traditional Chinese medicine health resources in Gansu Province from 2018 to 2023
    SONG Guang, ZHAO Yan, MIN Ting, WANG Wenxin
    Soft Science of Health. 2025, 39(7): 74-78. https://doi.org/10.3969/j.issn.1003-2800.2025.07.014
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    Objective To analyze the allocative efficiency of traditional Chinese medicine (TCM) health resources and its changing trends in Gansu Province from 2018 to 2023. Methods The DEA-Malmquist index model and the entropy weight grey correlation method were used to analyze the allocative efficiency and service capacity of TCM health resources in Gansu Province by combining temporal and spatial perspectives. Results From a static perspective, the comprehensive efficiency was low, and decreasing returns to scale led to a decline in overall efficiency. From a dynamic perspective, technological changes and changes in scale efficiency were the main factors affecting total factor productivity (TFP). From a spatial perspective, the service capacity in Hexi and ethnic autonomous regions was the lowest. Conclusions TCM health resources in Gansu Province exhibit high input and low output. Technology and scale efficiency constraints on the development of TCM resources, and there are regional differences in the allocative efficiency of TCM health resources. Through the coordination between dynamic monitoring and precise investment, ensuring the scale efficiency of technology while increasing investment in technology, structural adjustments and optimizing the overall allocative efficiency of resources throughout the region,the equalization of TCM services can be promoted to facilitate the implementation of the “Healthy Gansu” strategy.
  • Coupling coordination and analysis of spatial characteristics between medical security level and regional economic development in China
    ZHENG Jiangshan, WANG Junyong, LIU Xia, WANG Li
    Soft Science of Health. 2025, 39(7): 79-83. https://doi.org/10.3969/j.issn.1003-2800.2025.07.015
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    Objective To analyze the coupling coordination level and spatial evolution characteristics between medical security level and regional economic development in China from 2013 to 2022, and to provide the reference for promoting the balanced development between the two systems. Methods The evaluation index system of the two systems of medical security level and regional economic development was constructed. The improved entropy method was used to determine the index weight. The coupling coordination model, relative development degree model and spatial autocorrelation Arc Gis 10.8 were used to analyze the coupling coordination and spatial evolution characteristics of the two systems. Results From 2013 to 2022, the coupling coordination degree between medical security level and regional economic development in China was continuously improved. The overall range of the mean was between 0.385 and 0.564, mostly in the middle-level coordination (adaptation period). There was a positive spatial correlation in the coupling coordination degree of the two systems in each province. Conclusions Medical security level is better than the level of regional economic development in China. The coupling coordination degree of the two systems needs to be improved. The coupling coordination degree presents a spatial distribution pattern of “high in the east and low in the west”. It is necessary to strengthen the top-level design of the government to promote the coordinated development of the two systems; deepen the construction of medical insurance system and improve the level of regional economic development; to encourage strengthening regional cooperation and exerting the spatial spillover effect of coupling coordination degree.
  • SWOT analysis of the sustainable development of Huimin insurance in China
    YAN Yunli, YANG Weiyue, ZHANG Junxia
    Soft Science of Health. 2025, 39(7): 84-89. https://doi.org/10.3969/j.issn.1003-2800.2025.07.016
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    Based on the SWOT analysis method, the current development status of Huimin insurance was sorted out. It is expounded that Huimin insurance has advantages such as universality, government's participation and support, and connection with medical insurance; disadvantages such as the death spiral, insufficient subject linkage, poor management and operational efficiency, and limited coverage and level; opportunities include policy support, growing market demand, and technological empowerment; threats such as fierce market competition, profit pressure on insurance companies, insufficient public awareness, and poor connection with basic medical insurance. It is also suggested that the stability of the Huimin insurance policy can be guaranteed at the government level and the supervision for the insurance industry can be strengthened. The products of Huimin insurance can be optimized to enhance the service level from the industry level. Public awareness of insurance and their trusts hould be enhanced by moderate publicity from the social level, so as to promote the sustainable development of the Huimin insurance.
  • Research on the current status of diagnostics and treatment capacity for common illnesses of primary care physicians in Yancheng under the hierarchical diagnosis and treatment system
    CHANG Li, XU Lan, QIAN Xiaojuan, HAO Ling
    Soft Science of Health. 2025, 39(7): 90-94. https://doi.org/10.3969/j.issn.1003-2800.2025.07.017
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    Objective To understand the current status of diagnostics and treatment capacity for common illnesses of primary care physicians in Yancheng under the hierarchical diagnosis and treatment system, analyze the existing problems and explore corresponding countermeasures. Methods Physicians in primary medical and health care institutions in various counties of Yancheng were selected as the subjects. An online survey was conducted by using Wenjuanxing, whose content included two parts: the basic information of primary care physicians and diagnostics and treatment capacity for common illnesses. Results A total of 327 valid questionnaires were collected. 33.94% of primary care physicians had the diploma of technical secondary school or below; 31.80% of primary care physicians had no professional titles; 10.70% of primary care physicians had rural doctor certificates, while 13.15% of primary care physicians had no practicing qualifications. Among the 327 primary care physicians included in the analysis, only 85.32% of them believed that they had the ability to diagnose and identify common illnesses; 68.81% believed that they had the ability to interpret the results of common laboratory tests; 81.04% believed that they had the ability to use commonly prescribed drugs; and only 63.61% believed that they had the diagnostics and treatment capacity for common illnesses. The abilities of primary care physicians in Yancheng to interpret X-ray examination, electrocardiogram results, and use emergency drugs were significantly lower than the interpretation ability for the test results of other laboratories and the ability to use other commonly prescribed drugs, and the differences were statistically significant. Conclusions There is a shortage of high-quality talents in the team of primary care physicians in Yancheng, and the single diagnostics and treatment capacity for common illnesses is insufficient. Urban and rural primary care physicians tend to have similar abilities in diagnosing and treating common illnesses, but there is a phenomenon of skill gap. The comprehensive service capacity for common illnesses of primary care physicians in Yancheng needs to be improved. The positioning of primary medical and health care should be reconstructed and transformed towards the integration of “prevention — treatment — rehabilitation” to enhance the service capacity of primary medical and health care institutions.
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