Objective This paper analyzes the current situation and expectation of health workers' satisfaction with salary in public hospitals in the pilot city launched salary system reform, so as to provide the reference for deepening the reform of salary system in public hospitals. Methods A sample questionnaire survey was conducted among 743 health workers from ten municipal public hospitals in Shenzhen, and the results were described and tested statistically. Results A total of 674 valid questionnaires were collected. The overall scores of satisfaction with salary and merit pay were 2.77±1.11 and 2.88±1.11, respectively. The staff with intermediate professional titles, 6-10 years of work and relatively low monthly income were more dissatisfied with their overall salary(P<0.05). The staff with less than five years of experience, higher monthly income and contract employees presented greater satisfaction about merit-pay (P<0.05). The distribution of merit pay and the proportion of fixed pay were the most concerned elements of pay structure for health workers. The actual proportion of fixed pay (26.0%) was significantly lower than the expected proportion of pay (50.0%). Conclusions Currently, the satisfaction with salary and the proportion of fixed pay of health workers in public hospitals in Shenzhen need to be improved. There are differences in the satisfaction with overall salary among health workers with different professional titles, different years of experiences and different income levels. There are differences in the satisfaction with merit pay among health workers with different marital status, different years of work, different income levels and different employment forms.

Objective To analyze the historical evolution and policy structure of centralized drug procurement, and to propose suggestions for optimizing the related policies. Methods From the perspective of policy tools, a three-dimensional analytical framework was constructed by integrating the dimensions of stakeholders and policy evolution. The content analysis method was employed to conduct a three-dimensional quantitative analysis of policy texts. Results Cross-analysis of policy tools and stakeholder dimensions revealed that the content related to the government level in the policy text accounted for the highest proportion (38.68%); the content related to medical institutions ranked second (26.13%); and the content related to patients was the least (4.53%). The cross-analysis of the policy tools and policy evolution dimensions revealed that in the three stages of policy evolution, the environmental-oriented policies accounted for the highest proportion, while the demand-oriented policies accounted for the lowest proportion. The cross-analysis of stakeholders and the dimension of policy evolution revealed that medical institutions were most involved, with proportions of 29.35%, 39.13% and 31.52% at different stages, respectively. The cross-analysis of the three dimensions found that the use of policy tools for each stakeholder increased in the in-depth development stage and the comprehensive promotion stage, but the centralized drug procurement policies issued in the comprehensive promotion stage still focused on environmental-oriented tools, and the coverage of drug distribution enterprises and patients was still relatively limited. Conclusions The structure of the use of policy tools is unbalanced, and there is a gap in the degree of participation of different subjects. Therefore, it is necessary to establish and improve the dynamic adjustment mechanism of the centralized drug procurement.

With the application and continuous expansion of artificial intelligence in the medical field, many legal questions have arisen, such as the recognition of the main body of tort liability for medical damage caused by medical artificial intelligence. From the perspective that there is no independent consciousness of medical artificial intelligence and it is not feasible to carry out property penalties for medical artificial intelligence, the article analyzes that artificial intelligence can not bear tort liability, and does not have the constitutive elements of the main body of tort liability for medical damage. Therefore, the tort liability for medical damage caused by the application of artificial intelligence should be borne by the holder of medical artificial intelligence or medical institutions.

Taking Guangxi as an example, this paper introduces the general situation and effect of the construction of three national regional medical centers, and summarizes the experiences from top-level design, resource coordination, implementation of responsibilities and guarantee, a system of innovation, strengthening supervision and efficiency. The practice of Guangxi reminds us that the construction of national regional medical centers should take the actual demand as the guide to plan the layout, deepen the reform of the management system, promote homogeneous management, innovate the talent management model, coordinate the development of medical education and research, and enhance the regional influence.

Objective This paper hierarchically studies the allocation level and spatial differences of medical and health resources in China from the perspective of hospitals and primary medical and health institutions, so as to provide references for further optimizing the allocation of medical and health resources. Methods Health Resource Density Index and Dagum Gini coefficient were used to calculate the health resource allocation level index, so as to empirically analyze the allocation level and spatial differences of medical and health resources in China. Results From 2013 to 2021, the resource allocation levels of hospitals and primary medical and health institutions in China have increased. Among them, the mean value of health resource allocation level index of hospitals increased from 0.1915 to 0.2936, and that of primary medical and health institutions increased from 0.2810 to 0.3554. In terms of spatial differences, the equity of health resource allocation level in hospitals was west < east < central region, and that in primary medical and health institutions was west < central region < east. Conclusions The overall level of medical and health resource allocation in China has been improved, but the structural rationality is insufficient and there is a significant regional gap. The development strategies should be adjusted according to local conditions to promote the coordinated development of hospitals and primary medical and health institutions in various regions.

Objective To understand urban residents' satisfaction with primary healthcare services and its influencing factors, and to provide a reference for improving residents' satisfaction with primary healthcare services, promoting initial visits at primary medical institutions and tiered diagnosis and treatment. Methods Based on the Anderson model, this study employed convenience sampling to conduct questionnaire surveys among residents in Yunyan District, Guiyang City. Chi-square tests and binary logistic regression models were used to analyze urban residents' satisfaction with primary healthcare services and its influencing factors. Results The overall satisfaction rate of primary healthcare services among the respondents was 81.76%. Demand-side factors of residents: age, household registration, the level of awareness for primary healthcare institutions, annual household income, income source, the type of medical insurance, subjective evaluation for primary health services, and previous medical behaviors all had an impact on satisfaction (P<0.05). Supply-side factors of institutions: various dimensions of healthcare services, such as the medical environment, availability of drugs and equipment, the accessibility and timeliness of services, healthcare providers' attitudes during communication, and the quality of technical services, all had an impact on residents' satisfaction (P<0.05). The results of the multivariate binary logistic regression analysis revealed that those aged 60 and above, who had a high level of understanding of primary healthcare institutions, a household annual income of more than 30,000 yuan, a relatively good subjective evaluation on the utilization of primary health services, receiving medical services 1 to 3 times per month, excellent medical environment, good communication attitudes of medical staff, and receiving high-quality technical services reported higher satisfaction with primary healthcare services. Conclusions Urban residents' satisfaction with primary healthcare services in the study area is influenced by factors such as the respondents' age, household income, cognition, subjective evaluation on service utilization, and the process of healthcare services.

Objective To analyze and discuss the influencing factors of overspending cases in FM19 disease group in public tertiary hospitals in Chongqing, and to provide ideas for medical institutions and relevant departments to strengthen the control of overspending cases. Methods The relevant data of 6,747 patients in FM19 disease group with DRG settlement in public tertiary hospitals in Chongqing were collected from January 1, 2022 to March 31, 2023. Descriptive statistical analysis, single factor analysis, multiple logistic regression analysis and association rules analysis were used to analyze the factors affecting the overspending of DRG cases. Results Disease factors (types of diseases, previous medical history of percutaneous coronary intervention) and socioeconomic factors (types of medical insurance, hospital length of stay, the number of stents, the number of treated vessels, and whether other procedures were combined) were significant influencing factors of overspending cases with DRG settlement (P<0.05). Further association rules analysis showed that overspending cases with DRG settlement were most likely to occur when patients had multiple socioeconomic factors. Conclusions Medical institutions should focus on patients who meet the conditions of strong association rules, strengthen the management of interventional surgery path planning by standardizing the diagnosis and treatment process, establish an internal review mechanism to adjust and improve clinical pathways in time, and strengthen the communication with the healthcare security department to give timely feedback on settlement problems. It is necessary to effectively control medical costs and promote the high-quality development of medical institutions and the sound operation of the healthcare security system.

Objective To systematically evaluate the prevalence trends and influencing factors of overweight and obesity among older adults in China from 2008 to 2018, providing a basis for optimizing the prevention and control policies and intervention strategies for obesity among older adults. Methods Based on the data from Chinese Longitudinal Healthy Longevity Survey (CLHLS), 27,363 older adults aged ≥60 years in 2008, 2011, 2014 and 2018 were included, and overweight and obesity were classified by the BMI index. The chi-square test, T-test, ANOVA, and rank sum test were performed by using SPSS 23.0. The binary logistic regression model was applied to identify factors influencing overweight or obesity and its changes. Results The overall overweight prevalence of the subjects increased from 11.84% in 2008 to 25.46% in 2018, and the obesity prevalence rose from 2.82% to 8.49%. The overweight prevalence and obesity prevalence significantly decreased with advancing age, which were higher in urban areas than in rural areas. The overweight Prevalence of women was higher than that of men, and the obesity prevalence of men was higher than that of women. Risk factors influencing overweight or obesity of the subjects included higher living standards (OR=1.178), being married (OR=1.147), chronic diseases (OR=1.740), and a high intake of staple foods (OR=1.236), etc. Protective factors included a light diet (OR=0.838), smoking (OR=0.759), and a high frequency of raising livestock or pets (OR=0.913). Older adults who were married, rarely experienced hunger in childhood, had chronic diseases, consumed vegetables less frequently, drank alcohol and did not smoke were more likely to be overweight or obese. Conclusions The prevalence of overweight and obesity among Chinese older adults showed a year-by-year increase, with notable urban-rural disparities. Factors such as health status, diet and lifestyle behaviors significantly influenced their occurrence.

Objective To explore the main influencing factors of fluctuations in medical service prices and to provide references for the government to formulate and dynamically adjust medical service prices. Methods Based on the China Statistical Yearbook from 1998 to 2022, LASSO Regression was applied to select the main influencing factors of medical service prices, and the random forest model was used to rank the relative importance of these factors. Results The LASSO Regression identified eight key variables. The ranking Results of the random forest model showed that the Consumer Price Index(CPI)(0.194), the proportion of personal health expenditure(0.125), the proportion of government health expenditure (0.082), the total dependency ratio(0.079), per capita health expenditure (0.069), the number of participants in basic medical insurance for urban employees (0.062), per capita disposable income of residents(0.056), and the bed occupancy rate(0.052) accounted for 72.63% of the total importance. Conclusions CPI plays a leading role in the fluctuations of medical service prices. The proportion of personal health expenditure, the proportion of government health expenditure, changes in population structure and the utilization efficiency of medical resources have significant impacts on medical service prices.

Objective Based on the Healthy China strategy, this paper systematically reviews the evolution and current configuration of traditional Chinese medicine (TCM) policies to provide an optimized direction and reference path.Methods 52 TCM policies closely related to Healthy China from 2016 to 2024 were collected, whose evolution process was analyzed. Meanwhile, NVivo12 software was used to code and analyze the text content, and a quantitative model was built from three dimensions of policy tools, stakeholders and policy intensity.Results Policy changes were divided into three periods. In the initial stage, a macro strategic plan was established as the foundation. In the middle stage, innovative practices were explored. In the later stage, reforms were driven by social demands, gradually promoting the high-quality development of Healthy China. In the dimension of policy tools, environment-oriented policy tools were the most(41.34%), followed by supply-oriented policy tools (40.08%), and demand-oriented policy instruments had the smallest proportion (18.58%), and there was a shift in focus of the secondary policy instruments. In the dimension of stakeholders, social forces and the pharmaceutical industry have always been in a marginal position. In terms of policy intensity, it was found that policy formulation lacked high-level planning and the overall intensity was relatively weak. In the three-dimensional analysis, there were structural contradictions among policy tools, stakeholders and policy intensity.Conclusions The policy tool system of TCM policies is out of balance; there is imbalance within the policy tools; some stakeholders are marginalized, and the matching of the policy structure is insufficient.

The Yangtze River Delta region is one of the regions with the strongest innovation, the highest openness, and the deepest ageing in China. In recent years, the pressure of elderly care has gradually become prominent. The integration of smart elderly care is an important connotation of deep integration and high-quality cooperation in the Yangtze River Delta region. Starting from the current situation of coordinated development of policies and practices of smart elderly care services in three provinces and one municipality of the Yangtze River Delta, this paper finds that smart elderly care services in this region have achieved certain results and have formed certain experiences in resource integration, organizational construction, personnel training and policy coordination through literature retrieval, field research, data analysis, etc. But at the same time, there are also a series of problems such as incomplete investment and cooperation mechanisms, obvious supply-demand structural contradictions, the need to strengthen standardized development, and the lack of a regional integration platform. To address these pain points, it is necessary to further improve the new administrative structure, establish cross-regional and urban and rural coordination mechanisms, strengthen the training of smart elderly care talents, strengthen the industrial chain to improve product quality, and establish an integrated platform and unified service standards, in order to promote the high-quality coordinated development of smart elderly care in the Yangtze River Delta region.

Building robust and resilient health systems is crucial for advancing universal health coverage and global health security. On the basis of summarizing the evolution of the concept of resilience, this paper systematically overviews theories related to resilience, and focuses on the connotation and application status of resilience in the current health field of individual psychology, hospitals and medical and healthcare systems. It is pointed out that the research on resilience in the field of health still has some shortcomings, such as isolated research content, single research method, and relatively lagging research on interventions for resilience enhancement. In the future, it is necessary to strengthen the research on“health resilience” from the perspective of multidisciplinary integration.

Objective To reveal the differences of research hotspots and development trends in the field of artificial intelligence (AI) in healthcare at home and abroad through bibliometric analysis, providing a reference for future in-depth studies. Methods 2, 580 relevant documents in the field of AI in healthcare at home and abroad from 2015 to 2024 were retrieved and screened by taking Web of Science and CNKI as data sources. The characteristic information of the documents was extracted by using CiteSpace, and the distribution of research hotspots and the evolution trends of the frontiers were visualized and analyzed. Results Foreign research was driven by clinical issues and gradually focused on the application and performance evaluation of technologies such as deep learning and large language models in clinical diagnosis and treatment as well as medical education. Domestic research was policy-oriented, concentrating on the construction of smart healthcare systems, the application of auxiliary diagnostic systems, and the governance of medical ethics. Conclusions Future efforts should reinforce the research and development of AI in healthcare and the construction of ethical governance frameworks, draw on the foreign experiences in optimization algorithms, deepen international cooperation, explore scientific regulatory systems and medical insurance payment systems, accelerate the clinical transformation of technologies, cultivate interdisciplinary talents, to promote the efficient and safe development of China's smart medical systems.

Objective To understand the structural variation of hospitalization costs of patients with coronary artery disease (CAD) under the background of DRG payment reform, analyze the factors and categories affecting the changes in costs, and discuss the internal connection between policies and fee changes, so as to provide a reference for promoting the reform of the medical insurance payment system. Methods The data of 41679 inpatients with CAD in The First Affiliated Hospital of Guangxi Medical University from 2019 to 2023 were analyzed by structural variation degree and new grey relational analysis. The structural variation degree was used to describe the overall situation and the trend of dynamic changes of the composition of hospitalization costs, and new grey relational analysis was used to evaluate the degree of correlation between hospitalization costs and costs of each item. Results From 2019 to 2023, the average hospitalization costs per visit of patients with CAD overall showed a decreasing trend, with an average annual decrease of 5.6%.From 2019 to 2023, the structural variation degree of the average hospitalization costs per visit was 8.59%. The top three contribution rates of structural variation of types of costs were treatment costs (32.9%), drug costs (27.0%) and diagnostic fees (17.1%), and the cumulative contribution rates of the three items were 77%. Among them, the proportion of drug costs decreased year by year, and there was a reverse change between costs of comprehensive medical services and diagnostic fees. Drug costs, costs of comprehensive medical services and other costs (mainly consumables) had the greatest correlation with hospitalization costs. Conclusions The structure of hospitalization costs of patients with CAD has been optimized, with short-term fluctuations due to the epidemic. Drug costs remain the main item in hospitalization costs. Incentives for the value of medical workers are insufficient. The DRG/DIP payment reform and clinical pathways management have shown initial Results, but more efforts are needed.

This paper reasonably delineates the scope of privacy protection in psychological counseling, clarifies the basic norms for exceptions to privacy protection, and establishes a set of complete and practical procedural privacy protection norms to protect the privacy of clients in psychological counseling throughout the whole process. This paper collects and analyzes Chinese and foreign literature, relevant judicial cases, and authoritative and official information, as well as conducts key informant interviews with counselors to understand the current jurisprudential base and rule of law environment. The existing problems are sorted out as follows: At present, the scope of privacy protection in psychological counseling in China is not clear, and methods of protection are inadequate; the rules of protection are too general, and there is a lack of consensus on exceptions to confidentiality; there is a lack of specific norms to protect the privacy of special clients such as high-risk clients, minors and those involved in judicial investigations; and the protection mechanism is imperfect, and there is a lack of protection throughout the whole process. At the same time, the following suggestions are put forward. The boundaries of clients' privacy should be established by law. Basic norms for exceptions to privacy protection should be established, especially for higher-risk clients, minors and criminal suspects in judicial investigations. Procedural privacy protection norms should be established that apply to the whole process.

Objective This paper explores policy effects of medical insurance for urban and rural residents on quality of life of older adults from the aspects of economy, medical care and health indicators, and provides the reference for the follow-up policy adjustment. Methods Based on the five panel data of 2011-2020 China Health and Retirement Longitudinal Study (CHARLS), people over 60 years were selected as the subjects, and a PSM-DID model was built to assess the policy effects of medical insurance for urban and rural residents from three indicators: economy, medical care and health. Results Both regression results and robustness testing indicated that the medical insurance for urban and rural residents increased the expectation of future income, and total income and total consumption increased to varying degrees (0.085, 0.246,P<0.01); the health expenditure of older adults was increased (0.879,P<0.01) to promote the utilization of medical services; self-assessed health of older adults was improved (0.499, P<0.01), and quality of life of older adults was improved to varying degrees. In terms of heterogeneity, medical insurance for urban and rural residents had a positive expected effect on expenditures of low-income seniors (P<0.01), and had a more pronounced effect on the medical indicators of high-income seniors (P<0.01). In terms of health, the policy had a greater impact on the low-income seniors (P<0.01), and women benefited more in terms of medical care and economic income (P<0.01). Conclusions Medical insurance for urban and rural residents can effectively improve quality of life of older adults, including economic, medical and health conditions. At the same time, the policy should be precision targeting to support low-income and other vulnerable groups.

Objective By analyzing the current status, deficiencies and development trends of the unified planning policies of basic medical insurance at the provincial level in typical provinces, this paper proposes policy suggestions for promoting the unified planning of basic medical insurance at the provincial level. Methods Policy texts on the unified planning of basic medical insurance at the provincial level from various provinces were collected. Policy analysis and case study were employed to conduct a content analysis of the specific implementation of each province. In-depth interviews with some managers from medical insurance departments were carried out to gain insights into the current practices, progress and existing shortcomings in the unified planning at the provincial level. Results As of May 2025, 17 regions in China have implemented unified planning at the provincial level. Each area implementing unified planning has adopted unified planning models that suited their local conditions and has formed three typical models: unified revenue and expenditure + vertical management, unified revenue and expenditure + hierarchical management, and risk-adjusted funds + hierarchical management. Moreover, a risk shared responsibility mechanism, performance assessment mechanism, operation management system, and related supporting measures have been established. However, it still faced challenges such as inconsistent policy standards, unified planning models that required further optimization, relatively lagging supporting measures, and increased moral hazard. Conclusions Unified planning policies of basic medical insurance at the provincial level have achieved significant progress, but there are still some structural problems such as policy fragmentation and regional imbalance of funds. It is recommended to further improve the institutional framework, optimize the unified planning models, strengthen information construction, prevent moral hazard, and promote balanced allocation of funds.

This paper takes five DIP demonstration cities of Guangzhou, Dongying, Xiamen, Yichang and Luzhou as examples to sort out the current situation of policy implementation, compare the policy implementation in each overall planning area, and analyze the causes of policy design, implementation effects and existing problems. It is found that there are still some differences in the technical specifications of total budget management, disease groups management, settlement and clearing in each overall planning area. From the perspectives of policy, medical insurance and medical treatment, suggestions are put forward to improve the follow-up supporting policies of overall planning areas, optimize and gradually unify the technical specifications of overall planning areas, improve and give play to the management functions of medical insurance departments at all levels, and strengthen the fine management of medical institutions.

Objective This study aims to identify and analyze the key factors and behavioral mechanisms that determine the provision of integrating medical and preventive care services by family doctors, offering references for the formulation of intervention measures and the enhancement of integration of medical and preventive care policies. Methods Guided by the theory of planned behavior, a questionnaire survey was conducted among 180 family doctors from ten community health centers in Nanjing. Structural equation modeling was employed for empirical analysis. Results Perceived benefits (β=0.315, P<0.001), behavioral attitudes (β=0.191, P<0.001), subjective norms (β=0.166, P<0.01), and perceived behavioral control (β=0.188, P<0.001) had a positive impact on the willingness to integrate medical and preventive care. The willingness to integrate medical and preventive care (β=0.507, P<0.001) and perceived behavioral control (β=0.257, P<0.001) had a significant positive impact on the behavior of integrating medical and preventive care. Conclusions Family doctors' behaviors of integrating medical and preventive care are directly influenced by the positive effects of behavioral intentions and perceived behavioral control. Perceived benefits, behavioral attitudes, subjective norms, and perceived behavioral control all have a positive impact on behavioral intentions and indirectly influence the behaviors of integrating medical and preventive care through behavioral intentions.

Objective To analyze the resource allocation, service efficiency and influencing factors of home-based and community-based integration of medical and elderly care services in seven prefectures (cities) of Xinjiang from 2021 to 2023, and to provide a reference for rationally allocating resources and improving service efficiency. Methods The resource density index was used to measure the level of resource allocation. The data envelopment analysis with BCC and Malmquist models were employed to calculate the dynamic and static efficiency of services respectively, and build a Tobit regression model to explore the factors influencing the efficiency. Results In 2023, the ranges of resource density index for healthcare professionals, senior care professionals, hospital beds, and beds for senior citizens in seven prefectures (cities) of Xinjiang were 0.465, 0.191, 0.149 and 0.890 respectively. There were five prefectures (cities) with unbalanced resource allocation, two prefectures (cities) with an overall efficiency < 1, and three prefectures (cities) with a decrease in the total factor productivity index. Conclusions The resource allocation for home-based and community-based integration of medical and elderly care demonstrates structural imbalances in Xinjiang. There are significant disparities in the efficiency of resource allocation among different prefectures (cities). The factors influencing service efficiency include the proportion of elderly population, population density, GDP, the level of healthcare services, the ratio of medical and elderly care resources, and the ratio of personnel to beds.

This paper reviews the application status and development trend of complex networks in public health in the past 15 years, with emphasis on the theoretical basis of complex networks, social networks, biological networks, human complex networks and the application of complex network analysis technology in the field of public health. Through combing previous studies, it is found that complex networks, as a multidisciplinary research tool, are of great significance in the establishment of disease transmission models, disease control, and the formulation of health policy. However, there are still many challenges in the application of complex networks in public health, such as the lack of interdisciplinary cooperation and the control of complex model parameters. Meanwhile, complex networks have broad application prospects in the field of public health. It is believed that with the continuous improvement of complex network theory, it will provide new perspectives and new methods for solving problems in the field of public health and medical treatment, and promote the progress and development of global public health.

Objective To understand the cancer patients' current demand for digital health services in China. Methods A total of 4,375 cancer patients in Shanghai were selected to conduct a survey on the demand for digital health by using multi-stage stratified cluster random sampling. The questionnaire included socio-demographic characteristics, the demand for digital health (SCNS-SF34 and self-reported need for digital health services), ECOG Performance Status, Healthy Sleep Score Scale, a nutrition-screening tool named age, intake, weight and walking (AIWW), and mental status (GAD-2 and PHQ-2). Logistic regression analysis was used to explore the factors influencing the demand for digital health. Results The demand rate of cancer patients for digital health was 55.93% (54.46%-57.40%). The most urgent need was health information. The most widely known and used digital health was intelligent healthcare. The results of multiple factor analysis showed that cancer patients with high number of comorbidities, poor sleep, poor health status rated by ECOG, risk of malnutrition, anxiety and depression symptoms were more likely to have the demand for digital health. Conclusions The government and other multi-parties should provide appropriate digital health services such as developing health literacy skills and platforms for psychological counseling based on the current needs.

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.

Objective In response to the collaborative challenges faced by multiple actors in the healthcare industry in the digital era, this study analyzes the construction logic of actor networks in healthcare driven by artificial intelligence (AI) based on Actor-Network Theory (ANT) to provide theoretical support and practical paths for the digital transformation of the industry. Methods Based on ANT, an analytical framework that included human actors such as governments, medical and healthcare institutions, and patients, as well as non-human actors such as AI technology, medical data, and policy regulations was built. Through the translation process of “problem presentation-benefit assignment-recruitment mobilization-objection elimination”, the case of digital transformation of healthcare in Guiyang was combined to examine the key links in the construction of the actor networks. Results The study found that the construction of AI-driven actor networks needed to break through the traditional perspective of technical tools and regard AI as a “non-human actor” with motivation. The case showed that Guiyang has realized the optimization of medical resource allocation through the translation strategy. The error rate of vaccine inventory management has decreased, and there were 310,000 visits in the Internet health platform, which verified the interpretation of ANT for complex social and technical systems. Conclusions The effective construction of the actor networks in healthcare should not only transform the advantages of AI technology into specific solutions to address pain points in the industry, but also establish a mechanism for sharing benefits to ensure the continuous participation of multiple stakeholders. It has expanded the application of ANT in the field of digital health, facilitating the construction of a collaborative and efficient digital ecosystem for healthcare.

Objective To study the impact of DRG payment reform on the operation management of a children's specialized hospital and provide a reference for improving the quality of hospital management.Methods This paper takes a tertiary first-class children's specialized hospital in Shandong Province as the sample, and the first page of medical records, financial data and DRG grouping data of 42 months before and after the implementation of DRG were selected. An interrupted time series model was used to analyze the changes in medical service capacity, quality and efficiency before and after the implementation of DRG payment reform.Results After the implementation of DRG payment reform, CMI increased significantly (β₁+β₃=0.004, P<0.05), while time consumption index (β₁+β₃=-0.001, P<0.05), cost consumption index (β₁+β₃=-0.004, P<0.05) and average cost per visit (β₁+β₃=-32.62, P<0.05) decreased significantly. There was no significant changes in the indicators of medical service quality (15-day readmission rate, mortality rate in the low-risk group, the incidence of hospital infection) (P>0.05).Conclusions The DRG payment reform has effectively improved the medical service capacity and efficiency of children's specialized hospitals.

Objective This study provides the basis for optimizing the disease grouping scheme and payment standards of acute myocardial infarction (AMI) by studying the case-mix and the composition of inpatient hospital costs of patients with AMI at a tertiary hospital. Methods Univariate analysis and multiple linear regression were used to analyze the influencing factors of hospitalization costs of 4,288 patients with AMI from a tertiary hospital from January 2019 to December 2023. Variables of classification thresholds were screened out. A case-mix model for Diagnosis Related Groups (DRG) was developed and the cost standards were established by using the decision tree. The effectiveness of the case-mix model was evaluated by coefficient of variation, variance reduction, and Kruskal-Wallis H-Test. Results Length of hospital stay, age, types of hospital admissions, number of surgeries/procedures, number of other diagnoses and number of emergencies were the main factors influencing inpatient costs. The above factors were incorporated into the decision tree model, forming 11 case-mix groups and charging standards, which could explain 83.72% of the actual costs. The patients who exceeded the cost limitations accounted for 6.90%, consuming 8.47% of medical resources. Conclusions DRG of patients with AMI established by decision tree model were reasonable in this study, and the corresponding hospitalization cost standards and disease weights were obtained. Analysis of exceeded costs was carried out for the disease groups to clarify cost components for both within and outside the cost thresholds, which provides a reference for the decision-making of the local healthcare security department and controls the unreasonable growth of medical expenses.

Objective This study aims to provide robust technical support for improving the governance system of cyberbullying and creating a harmonious online environment to facilitate the healthy development of cyberspace. Methods Ten hot events on Sina Weibo from July 2022 to January 2023 were selected. A web crawler of Python was used to obtain the comment texts and related data of Weibo posts related to these events. Based on the characteristics of texts, emotion and users, the Adaboost algorithm was used for experiments to test the effectiveness of cyberbullying detection. Results The duration of cyberbullying varied significantly for different events, but it mainly appeared in the early stage of the events. The accuracy, precision, recall, and F1 Score of the optimal results were 0.769, 0.758, 0.769 and 0.729 respectively. The results obtained without considering the users' characteristics were approximately 0.01 lower than the aforementioned optimal results. Conclusions Good results can be achieved in cyberbullying detection by combining three types of characteristics. Taking into account users' characteristics can improve the effectiveness of cyberbullying detection to some extent. Paying attention to the evolution of abusive language online or incorporating multi-dimensional information can further improve the effectiveness of detection, thereby strengthening the governance of cyberbullying information and creating a favorable online environment.

Objective To explore the spatial and temporal variation trends of health resource allocation in China from 2017 to 2022, and to provide a reference for optimizing the efficiency of health resource allocation. Methods The super-efficiency SBM-DEA, Malmquist index model and Moran's I were used to analyze the spatial and temporal changes of health resource allocation in China from 2017 to 2022. Results The efficiency in the southern region was significantly better than that in the northern region, and the number of provinces in the south where the static and dynamic efficiencies were greater than 1 was greater than that in the north. From 2017 to 2022, the average value of total factor productivity in China was 0.963; the average value of comprehensive efficiency was 0.983; the average value of technical efficiency was 0.98; the average value of pure technical efficiency was 0.989, and the average value of scale efficiency was 0.994. The Global Moran's I showed that there was a positive spatial correlation in 2017, 2018 and 2020 ( Moran's I > 0 ). The local spatial clustering characteristics were significant. H-H type (high-high type) was concentrated in the Yangtze River Delta, Pearl River Delta and Chengdu-Chongqing region. L-L type (low-low type) was mainly in the northeast, central and western provinces, and H-L type (high-low type) was mostly municipalities. Conclusions There are significant differences in the efficiency of health resource allocation between the north and the south as well as between the east and the west in China, and the equity is insufficient. The spatial dependence of the efficiency of health resource allocation is enhanced, and the proximity effect is significant. The dynamic efficiency of health resource allocation has declined. The scale expansion does not match the management capabilities. It is necessary to strengthen support for underdeveloped areas and scientifically control the scale.

The current management mechanism of patient-physician communication is a management mechanism based on medical documents, and there are shortcomings of emphasizing entity over procedure. In terms of management methods, document production is the starting point. The lack of substantive control measures in the process of patient-physician communication is an important reason for the defects in patient-physician communication in medical institutions. The management mechanism of patient-physician communication based on legal procedures divides the whole process of patient-physician communication into three modules: communicator, communication content and patients' decision-making, which has certain advantages over the traditional management mechanism based on medical documents. Medical institutions have the conditions for standardized management of the patient-physician communication process. Therefore, medical institutions should change the management modes of patient-physician communication, upgrade from traditional document management to process quality control, and improve the management system of medical communication from the setting of working departments, reasonable personnel allocation, and the formulation of management systems. Management paths such as the optimization of identity identification, process quality control, communication records and third-party witness are used to strengthen the management of patient-physician communication.

Objective This study understands the current status of inpatient services and medical costs in a stomatological specialty hospital,and analyzes all inpatient DRG groups in a stomatological specialty hospital from two dimensions: healthcare service capabilities and medical cost management capabilities. Superior and inferior groups of the stomatological specialty hospital are identified from the overall operation level, and management recommendations are proposed. Methods Data of the front page of medical records and cost structure of inpatients with medical insurance from January 1, 2023 to December 31, 2023 were collected. Indicators reflecting healthcare service capabilities and cost management capabilities were selected. The Entropy-weighted TOPSIS method and Boston Matrix were applied to calculate scores and distribution patterns of DRG groups. Results The results of entropy-weighted TOPSIS analysis revealed that from the evaluation of medical service capabilities, DG29 (C_i=0.80), DA19 (C_i=0.46), and DG19 (C_i=0.35) demonstrated superior healthcare service capacities. From the evaluation of cost management capabilities, DZ13 (C_i=0.84), JV1A (C_i=0.83), BY19 (C_i=0.82), DR11 (C_i=0.82), and QR13 (C_i=0.82) had better medical cost management capabilities. The results of Boston Matrix indicated that the main problems of the inpatient services and operation of the stomatological specialty hospital were concentrated in the prevalence of “dog” and “question mark” categories. Conclusions Compared with general hospitals, the inpatient departments in the stomatological specialty hospital are more finely divided. However, the DRG grouping fails to adequately reflect these distinctions, resulting in weaker cost control in groups with better medical service capabilities. Furthermore, the limited capacity to treat diseases from other specialties leads to a higher proportion of patients discharged without undergoing surgery due to contraindications, which explains the prevalence of “dog” and “question mark” categories identified in the Boston Matrix analysis.

Objective To understand the current status of the utilization of outpatient and inpatient services for older adults in urban and rural areas of China, and to explore urban-rural differences in the influence of intergenerational support from children on behaviors of seeking medical care. Methods Based on the data from the baseline survey of 2018 and 2020 China Longitudinal Aging Social Survey (CLASS), 6 201 older adults aged 60 and above with children were selected as the subjects. Logistic regression was used to analyze the effect of children's intergenerational support on urban and rural older adults' behaviors of seeking medical care. An interaction model was used to analyze the interactive effects between different intergenerational supports and healthcare-seeking behaviors. Results Children's financial support had a positive impact on outpatient services for urban and rural older adults (OR urban areas=1.025, OR rural areas=1.019, P<0.05), and had a positive impact on hospitalization services for rural older adults (OR rural areas=1.022,P<0.05), but had no impact on urban older adults (OR urban areas=1.012, P>0.05). The care and support from children had a positive impact on outpatient services for urban older adults (OR urban areas=1.054,P<0.05), but had a negative impact on rural older adults (OR rural areas=0.969,P<0.05), and had no significant impact on hospitalization services for urban and rural older adults (OR urban areas=1.017, OR rural areas=0.989,P>0.05). The emotional support from children had no impact on outpatient services for urban older adults (OR urban areas=0.997,P>0.05), but had a positive impact on hospitalization services (OR urban areas=1.035,P<0.05); and it had a positive impact on outpatient services for rural older adults (OR rural areas=1.025,P<0.05), but had no impact on hospitalization services (OR rural areas=1.001,P>0.05). In interactive effects, there was a positive interaction between intergenerational care and financial support in outpatient services for urban older adults (OR urban areas=1.590,P<0.05), while there was a negative interaction between intergenerational care and emotional support in outpatient services for urban and rural older adults (OR urban areas=0.621, OR rural areas=0.684,P<0.05). Other interactions were not significant (P>0.05). Conclusions There are differences in the impact of intergenerational support from children on behaviors of seeking medical care for urban and rural older adults.

Objective To understand teenagers’ awareness level and information acquisition channels regarding addiction issues and their interest preferences for popular science short videos, and to provide a scientific basis for developing more effective prevention and intervention strategies for teenage addiction.Methods A self-designed questionnaire was used to conduct a survey among 938 students in a junior high school in Kunming through the method of convenience sampling combined with stratified cluster random sampling in May 2024. The data was analyzed by using R statistical software.Results 97% of the respondents believed that they had different levels of understanding about addiction issues. The vast majority of respondents (87.53%) regarded addiction as “an excessive reliance on a certain substance or behavior”, or as “an uncontrollable desire” (79.00%). Illicit drugs (94.67%), tobacco (86.78%) and e-cigarettes (79.42%) were regarded as the substances that were most likely to cause addiction. Only 46.80% of respondents acknowledged the addictive potential of prescription drugs. The respondents obtained knowledge about addiction mainly through school courses (72.92%) and social media (63.86%). Regarding the demands and preferences for short videos about addiction prevention, the respondents showed higher attention to topics such as new emerging substance addiction (63.01%), internet addiction (81.56%), emotional regulation (56.72%), and stress coping (55.54%). Content that was novel and engaging (63.22%), highly interactive (62.26%), and closely tied to daily life (58.85%) was preferred. In terms of video types, styles, and narrative approach, they favored anime videos (51.39%), humorous and witty styles (65.25%) and sharing of real-life case (67.80%).Conclusions Teenagers have a certain understanding of addiction-related knowledge, and their scores in addiction-related topics are at a medium level. However, they still lack depth and breadth in this area, and there are differences among different grades.

Objective To explore the influencing paths of value co-creation behaviors of patients with chronic diseases in the community and provide research perspectives and theoretical directions for chronic disease management in the community.Methods The structural equation model was employed to analyze the influencing paths of value co-creation behaviors of patients with chronic diseases in the community under the “Internet +” environment.Results The scores of value co-creation behaviors of patients with chronic disease in the community were positively correlated with patient ability scores (r =0.679, P < 0.001), patient opportunity scores (r =0.596, P < 0.001), patient motivation scores (r =0.571, P < 0.001), service positioning dominance ability scores (r =0.651,P < 0.001) and the scores of Internet use experience (r =0.546, P < 0.001). Patient motivation (β=0.186, P < 0.01), patient opportunity (β=0.252, P < 0.01), and patient ability (β=0.312, P < 0.01) all had significant positive influence on patients' value co-creation behaviors.Conclusions Patient motivation, patient opportunity, patient ability and Internet use experience all have a positive impact on patients' value co-creation behaviors, and have an indirect impact on patients' value co-creation behaviors through the mediating variable of service positioning dominance ability.

People's health is a fundamental goal and the key to achieve high-quality development for China. Based on a comprehensive understanding of the historical dimension and multidimensional complexity of the connotation of health in the modernization process, it accurately analyzes the demand logic of health such as the superposition of natural and social attributes, the unity of irreplaceability and intrinsic value, the interweaving of dynamic and diversity, and the coexistence of adaptability and plasticity under the guidance of high-quality population development goal. In order to achieve high-quality population development, it is necessary to accelerate the construction of the supply system for high-quality health products and services, cultivate self-reliant health consciousness, deepen the reform of the collaborative governance system of multiple subjects, accelerate the formation of an efficient and connected health governance system of multiple subjects, to enhance the capacity and level of health governance.

Objective To explore the impact and mechanisms of artificial intelligence-based mobile healthcare services on self-management behaviors of patients with diabetes, so as to provide a basis for optimizing paths of mobile health services and improving self-management model of patients with diabetes. Methods A research model was developed based on the source credibility theory and the health belief model. The questionnaire survey was conducted among 408 patients with diabetes who had experiences in using artificial intelligence-based mobile healthcare services, and structural equation modeling was employed for empirical analysis. Results The accuracy, anthropomorphism, perceived expertise and timeliness of mobile healthcare services had significant positive effects on patients' perceived harm and severity caused by the disease, and benefits of changes in behaviors, while a significant negative effect on patients' perceived barriers. Patients' perceived harm and severity caused by the disease and benefits of changes in behaviors had a significant positive influence on self-management behaviors, whereas perceived barriers had a significant negative impact on self-management behaviors. Conclusions Artificial intelligence-based mobile healthcare services can effectively improve self-management behaviors of patients with diabetes. Characteristics of services and patients' health concepts play a key role in it, suggesting that services should be optimized and patients' health concepts should be enhanced to promote patients' health.

Objective To assess the impact of care bundles on the incidence of healthcare-associated infections (HAIs). Methods Inpatients of a Grade-A tertiary hospital were selected as research subjects. Conventional methods for infection prevention and control were adopted for inpatients from the first quarter of 2022 to the second quarter of 2023. From the third quarter of 2023 to the third quarter of 2024, care bundles centered on active screening and cleaning and disinfecting were implemented for inpatients. The interrupted time series was used to analyze the intervention effects in the entire hospital and the ICU. Results The incidence of HAIs decreased from 0.80% before the intervention to 0.70% after the intervention (P<0.05). The interrupted time series analysis showed that the entire hospital's β₁=0.137, β₂=-0.445, β₃=-0.150. All the differences were statistically significant (P<0.05). The differences in β₁ and β₂ of the ICU were statistically significant (P<0.05), while the differences in β₃ were not statistically significant. Conclusions The care bundles have a significant short-term effect in reducing the incidence of HAIs.

Self-medication behaviors present new characteristics in the digital context. As a typical group affected greatly by digitalization, college students commonly engage in self-medication behaviors. With the increasing variety of channels for obtaining drug information and purchasing medicines, self-medication has become more convenient, but it has also made the problem of irrational drug use more prominent. From the perspective of behavioral economics, based on the data of 484 questionnaires collected from college students in a certain province, this article uses prospect theory, nudge theory, heuristic cognitive bias and herd effect to analyze the emergence, increase of self-medication behaviors and irrational self-medication behaviors of college students, and explains the deep-seated reasons for the behaviors. It puts forward corresponding suggestions to improve college students' unreasonable medication behaviors, enhance their awareness of safe drug use, and promote their rational self-medication behaviors based on framing effect, dual-process theory and nudge theory.

This article introduces broad application prospects of ChatGPT-4o in medical data management, assisting clinical decision-making, and promoting the popularization of digital healthcare by virtue of its real-time video conversation capability and exceptional retrieval and generation capabilities. The problems associated with its application are analyzed, such as data breaches, risk of improper handling and risk of human damage caused by intelligent decision-making errors. The following suggestions are put forward. In terms of responsibility after the event, medical personnel, medical institutions and developers of medical artificial intelligence should be required to bear civil liability, administrative liability and criminal liability respectively under certain conditions based on the concepts of joint administration of civil, administrative and criminal laws and multiple subjects. In terms of pre-event risk prevention, it is necessary to build a compliance management mechanism of medical data full lifecycle, system of algorithm interpretation right, and algorithm filing system. Algorithm design, operational logic and potential risks are incorporated into the legal and regulatory framework to comprehensively prevent risks.

Based on the current policy practice of “nation-local-community”, this paper sorts out the participants of community-based smart elderly care services. Taking Smith Model as the theoretical basis, this paper discusses the practical dilemma of policies of community-based smart elderly care from four aspects: policy core, executive agencies, target groups and environmental factors. It proposes that in the core aspect of policy, digital empowerment should be a firm foundation to improve the top-level design of policy. In terms of executive agencies, services should be expanded to boost the value co-creation of relevant responsible subjects. In terms of target groups, the digital divide should be bridged to improve literacy and digital age-friendly products. In terms of environmental factors, various forces should be aggregated to create a good policy environment. The quality of elderly care services and the elderly care service system with Chinese characteristics are improved through above measures.

In order to further understand the characteristics of China's policy of the integration of medical and elderly care services and promote the high-quality development of integrated medical and elderly care services, this study constructs a three-dimensional framework of “policy tools — the main body of the policy — stages of the policy” and quantitatively analyzes the contents of 40 policies of integrated medical and elderly care services issued at the national level from 2013 to 2024. The Results indicate that there are some problems such as insufficient use of demand-oriented policy tools, insufficient participation of market entities and poor cohesion between different stages of the policy in China's policy of the integration of medical and elderly care services. Therefore, it is important to emphasize the role of demand-oriented policy tools, increase the participation of market entities, and strive to solve the problem of cohesion between different stages of the policy.