Objective To understand the occurrence of sexual behaviors among female college students in Shanxi Province, and to explore the correlation between the age of first sexual behavior and HIV-related high-risk sexual behaviors, so as to provide a basis for sex education among college students in Shanxi Province in the future. Methods Female college students (undergraduates and postgraduates) in Shanxi Province were selected as the subjects by cluster sampling method, and the subjects were invited to fill in the questionnaire anonymously online. Results A total of 488 female college students participated and completed the questionnaire.The average age of the subjects was (22.98±0.62) years, and the incidence of sexual behaviors was 23.6%.There were statistically significant differences in the occurrence of sexual behaviors of the subjects in different age groups (P<0.001).82.0% of the subjects received sex education.41.7% had their first sexual encounter in college, 40.0% in high school, and 18.3% in middle school.Among them, subjects who had first sexual encounter with the opposite sex in college accounted for 97.9%.The use rate of condom for first sexual encounter was 70.8%, and 64.6% preferred to take other measures as contraception.77.1% had less than two sexual partners in the past year, and the rate of condom used frequently and each time in sexual behaviors in the past year was 77.1%.Compared to that, the subjects who had their first sexual intercourse before college had the characteristics of not using a condom for the first sexual behavior(P<0.001), being more inclined to use condoms as contraception (P<0.001), having ≥2 sexual partners in the last year (P=0.002), and never or occasionally using condoms in the last year (P=0.009). Conclusions Female college students in Shanxi Province have higher incidence of sexual behaviors and more HIV-related high-risk sexual behaviors, and those who have their first sexual behavior earlier are more likely to have HIV-related high-risk sexual behaviors.

Objective This paper studies the allocative efficiency of primary medical and health resources and influencing factors in China to provide the reference for improving the allocative efficiency of primary medical and health resource in China. Methods The number of personnel, the number of beds and the number of institutions in primary medical and health institutions were selected as input indicators. The number of patients diagnosed and treated and the number of hospital admission were selected as output indicators. The per capita disposable income of rural residents, urbanization rate, the number of practicing (assistant) doctors and gross regional product were environmental indicators. The data of primary health care in China from 2012 to 2021 were analyzed by static analysis and regression analysis by three-stage DEA-Tobit model. Results Per capita disposable income of rural residents, urbanization rate, the number of practicing (assistant) doctors and gross regional product had a significant impact on the primary medical and health resources in China. After eliminating the influence of environmental variables and random interference, the average decline of comprehensive efficiency, pure technical efficiency and scale efficiency of primary medical and health resources in China was 8.5%, 1.8% and 8.7%, respectively, indicating that resource inputs and outputs did not match. SFA regression analysis showed that the number of practicing (assistant) doctors was a significant factor affecting the value of comprehensive efficiency. Conclusions There are obvious differences in the allocation of health resources of primary medical and health institutions in different regions, and the shortage of talents and the level of economic development restrict the allocative efficiency of primary medical and health resources. The government should strengthen the training and support for medical professionals in grassroots, remote areas and in short supply through macro-control to narrow the gap of human resources allocation among urban and rural areas, regions and specialties.

As a cutting-edge technology, artificial intelligence (AI) has brought revolutionary changes to the medical field, which can not only provide personalized medical services for patients, significantly improve the efficiency of doctors' diagnosis and treatment, help hospitals realize intelligent management, but also enhance the country's capacity to respond to public health emergencies. However, due to the inherent characteristics of AI technology such as high dependence on data and black box of algorithms, current medical AI faces a series of challenges in terms of data security, medical risks, fair return and public acceptance and trust. This review delves into the application value of medical AI and the risks and challenges it faces, and proposes a range of countermeasures and suggestions in line with national conditions by analyzing the underlying reasons, such as strengthening the security protection throughout the data circulation process, developing transparent and explainable AI products, formulating industry standards to avoid algorithmic discrimination, and strengthening publicity and education to enhance public trust.

This study aims to explore the application value of nursing decision support system model in clinical practice based on medical big data mining. Multi-source medical data set, data preprocessing and integration technology are used to construct decision support model by machine learning algorithms. The results demonstrate that the model shows high accuracy in predicting nursing needs, changes of patients' condition, and responding to random events, which could effectively reduce the workload of nursing staff and improve the precision and response speed of nursing care. By deeply mining patient data, the system provides personalized recommendations for care to promote patient health outcomes.

Objective Taking the promotion of tiered diagnosis and treatment policy as the starting point, this paper analyzes the allocation of primary health resources in China from 2012 to 2021 to provide the reference for the government to formulate targeted spatial intervention policies and optimize the allocation of primary health resources. Methods The Gini coefficient was used to analyze the equity of allocation of primary health resources as a whole. Then the tiered diagnosis and treatment policy was taken as the starting point to study the equity and spatial distribution of regional allocation of primary health resources in 2015, 2018 and 2021. Results During the study, the average annual growth rates of the number of primary medical and health institutions, the number of beds and the number of health technicians were 0.77%, 2.81% and 5.43%, respectively. According to the population distribution, the Gini coefficients of beds and health technicians were both lower than 0.2, and the Gini coefficient of medical and health institutions fluctuated between 0.1848 and 0.2020, indicating good equity; according to geographical area distribution, the Gini coefficients of the three indicators were all greater than 0.5, indicating poor equity. In terms of spatial distribution, the global Moran's I index of medical and health institutions and beds were greater than 0, indicating that there was a positive spatial autocorrelation of health material resources and a spatial aggregation distribution. The Moran's I index of health technicians was negative, with no significant spatial autocorrelation. The results of local spatial autocorrelation showed that the primary health resources in China were differentiated distribution in the eastern, central and western regions after the implementation of tiered diagnosis and treatment. The spatial distribution of various health resources was unbalanced. Conclusions The primary health resources in China show an increasing trend, and the population distribution is relatively equitable, but the inequality of geographical distribution and resource aggregation are still significant. It is suggested that the government should consider the differences in population and geographical distribution, optimize the allocation of health resources, and enhance communication and collaboration among medical institutions in the region.

This paper reviews the status quo of the construction of national and regional medical centers. As of August 2023, China has set up five national and regional medical centers for children; 14 provinces (municipalities) have reached cooperation with National Health Commission to build national and regional medical centers, and 125 construction projects of national and regional medical centers have been identified in five batches. Standards for setting up national regional medical centers of different categories and Management Measures for National and Regional Medical Centers (Trial) have been issued. According to the setting principle and target orientation of national and regional medical centers, it is found that the construction of national and regional medical centers faces difficulties such as unclear objectives, insufficient promotion of public construction experience, incomplete functional construction and limited enthusiasm of construction subjects. It is proposed to accelerate the issuance of the evaluation plan and policies of the center, promote the typical construction experience, stimulate the enthusiasm of the construction subjects, and establish the economic operation mechanism of the center.

Both DIP and DRG are tools of disease classification based on ICD-10 for diagnosis and ICD-10-CM for clinical procedure, and they share the commonality of case-based payment. The difference is that the granularity of diagnosis and operation is different, resulting in different numbers of disease groups and differences between disease groups, and the different impacts on clinical behaviors, medical management and the allocation of health insurance funds. Through the comparison of empirical data in some regions, it is found that DRG payment is more conducive to the compensation and control of unreasonable medical behaviors in health facilities. By comparing the historical development and evolution of DRG groups in the United States, European countries and Japan, this paper evaluates the relative positions of DRG and DIP groups in China, and provides ideas for the reform of medical insurance payment in China.

This paper analyzes the current supply of community-based elderly care services in urban areas from two aspects, policy promotion and practice mode. It is found that there are some problems in the supply of community-based elderly care services in urban areas, such as the shortage of fund support for the construction of elderly care services, the lack of overall planning and coordination ability of service resources, the fragmentation of community-based elderly care service system and policies, and the lack of professional elderly care service talents in the community. Suggestions are put forward from the aspects of ensuring the investment of service funds, improving the ability of overall planning and coordination ability of resource, speeding up the construction of talent team for community-based elderly care services and improving the top-level design of elderly care services.

Objective To understand the hospitalization expenses of the elderly with osteoporotic fracture in public hospitals of Shanxi Province and the difference of hospitalization expenses among different types of medical insurance, and to provide suggestions for perfecting the medical insurance policy and reasonably controlling medical expenses. Methods A total of 582 patients from ten tertiary hospitals and ten secondary hospitals in 12 districts of Shanxi Province were selected and their hospitalization costs were analyzed by rank sum test. The orthopedic full-time nurse filled in the Patient Discharge Settlement Fee Schedule. Results There were statistically significant differences in total cost, operation cost, check-up cost, laboratory cost, nursing cost and medical cost of secondary hospitals and tertiary hospitals (P<0.05). There was no statistically significant difference in the overall payment of patients with different types of medical insurance in the same level of hospitals (P>0.05). In tertiary hospitals, the average hospitalization expenses and out-of-pocket expenses of patients with basic medical insurance for urban and rural residents, and out-of-pocket expenses of patients with basic medical insurance for urban workers were higher than that of secondary hospitals, and the difference was statistically significant (P<0.05). Conclusions The overall efficiency of China's medical insurance policy is good, but it still needs to pay continuous attention to the key control objects.

Based on the historical background of DRG/DIP payment reform, this paper analyzes the application in dominant diseases treated by TCM in various provinces (municipalities) in China. The dominant diseases treated by TCM show different distribution characteristics due to the differences in the regions, levels and key specialties of TCM medical institutions. There are three ways to select the dominant diseases treated by TCM: ①through the provincial administrations of Chinese medicine, ②joint selection by medical institutions, health commissions and medical insurance bureau, ③calculation based on the historical data of the province and argumentation of Chinese medicine experts. The payment system of dominant diseases treated by TCM is designed as a combination system including single diseases, DRG and DIP. Its application has reduced the economic burden of patients to a certain extent, encouraged hospitals to control cost and increase efficiency, and improved the use efficiency of medical insurance funds. However, there are still some problems, such as the ununified code of TCM classification of diseases, further development of the construction of clinical pathways for dominant diseases treated by TCM and evidence-based clinical practice, and the lack of incentive of payment system for both doctors and patients.

Disease and health are the important contents that Marx always pays attention to, and there are many important discussions on health care, which contain Marx's rich thoughts of health care. Starting from the source, main content and contemporary value of Marxist thoughts of health care, this article analyzes Marxist thoughts of health care from the perspective of productive forces and relations of production, in order to provide the theoretical reference for deepening reform of medicine and healthcare system, improving medical and healthcare system with Chinese characteristics, and promoting the construction of Healthy China.

Building high-quality smart elderly care services is an inevitable requirement to transform the traditional elderly care service model, adapt to the development of the times, and actively respond to the aging population. Based on the TOE analysis framework of “technology-organization-environment”, the internal logic of digital technology enabling smart elderly care is mainly reflected in the digital technology as the driving force, the elderly care demand as the driving force, the policy guidelines as the pulling force, and the technical dilemma of digital challenges, the organizational dilemma of constraints of the main body and the environmental dilemma of insufficient support. It is necessary to realize the deep integration of digital technologies, enhance the digital capabilities of organizations, and build a digital inclusive society in the smart elderly care enabled by digital technology, so as to achieve high-quality development of elderly care services.

Each life-cycle stage of drugs can reflect the different value of drugs, and drug economic evaluation is an important means to evaluate the value of drugs. At present, pharmacoeconomic evaluation is mainly used in the negotiation of access to the medical insurance catalogue, and there are few application scenarios in other fields. Based on the perspective of drug life cycle, this study reviews domestic and foreign literature on the application of pharmacoeconomic evaluation. The application of pharmacoeconomic evaluation is studied from four stages: research and development and project approval, listing pricing and access to the medical insurance catalogue, admitted to hospital and clinical use of drugs, drug post-marketing change and re-registration, and delisting. This paper analyzesthe application environment of pharmacoeconomic evaluation in the drug life cycle, and proposes to strengthen the policy support for the application of pharmacoeconomic evaluation, form a paradigm for pharmacoeconomic evaluation at each stage of the drug life cycle, and focus on the multi-perspective coordination mechanism of pharmacoeconomic drug life cycle, in order to provide references for the discipline construction and benign development of pharmacoeconomics in our country.

Objective In the context of the reform of the support mechanism for covering outpatient medical bills under the employee basic medical insurance, this paper analyzes the current policy and actual progress of integrating designated retail pharmacies into risk pooling of outpatient services in Shandong Province, so as to provide the reference for the follow-up policy improvement. Methods From February 15, 2023 to March 31, 2024, policy documents of pharmacies included in risk pooling of outpatient services in 16 prefecture-level cities in Shandong were retrieved and collected for qualitative description and quantitative analysis to summarize the current progress, policy models and existing problems in each city. Results As of February 2024, eight prefecture-level cities in Shandong Province have issued specific documents on the designated retail pharmacies included in risk pooling of outpatient services. A total of 235 pharmacies included in risk pooling of outpatient services accounted for 0.6% of the total number of designated retail pharmacies. The selection of pharmacies was carried out in all 16 prefecture-level cities according to the model of encouraging inclusion. At present, while the electronic prescription transfer has not been fully realized, these areas adhered to the same basic medical insurance benefits policy as that of designated primary medical institutions in the overall planning area. Deductibles ranged from 0 to 200 yuan across prefecture-level cities, and the maximum payment limit for employees was more than 4, 500 yuan in 70% of prefecture-level cities. Conclusions The selection criteria of pharmacies in different cities are generally consistent, but the quantity is still inadequate. The lack of incentive for prescription transfer and the improvement of benefits in the risk pooling of outpatient services may have an impact on the pattern of medical treatment, and heighten competitive pressures in the market for pharmacies. It is recommended to further do the layout planning and management of pharmacies included in risk pooling of outpatient services, promote the transfer of electronic prescriptions, establish an incentive mechanism for the management of reasonable drug price, and enhance the service ability and level of pharmacies included in risk pooling of outpatient services.

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 changes of hospitalization expenses of patients with depression before and after the DIP reform in the psychology department of a general hospital, and to provide empirical data and support for improving the reform of medical insurance payment. Methods According to the implementation time of DIP in the sample hospital, the information of inpatients with depression was collected and they were divided into two groups before and after the reform. The chi-square test was used to analyze the differences of basic information between groups. Structural variation and grey correlation analysis were used to analyze the changes of total and sub-item costs of average hospitalization expenses per admission of patients with depression. Results Before and after the DIP reform, there was no statistically significant in differences of patients' age and gender (P>0.05). The length of hospital stay was shortened (P<0.05), and average hospitalization expenses per admission decreased after the reform (P<0.01). Structural variation analysis showed that the degree of structure variation (DSV) of average hospitalization expenses per admission of patients with depression from 2021 to 2023 was 33.08%, with a large variation. The top three contribution rates of structural variation (CSV) of average single hospitalization expense per admission were treatment cost, medical diagnostics cost and drug cost, which were the main factors that caused the change of hospitalization expenses of patients with depression. Grey correlation analysis showed that the correlation coefficient between treatment cost and total cost was 0.930, which was the highest in average hospitalization expenses per admission. Conclusions DIP reform is helpful to optimize the structure of hospitalization expenses, shorten the average length of stay, reduce the total cost and control cost reasonably for health workers, but there is still room for further improvement.

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.

Objective To systematically evaluate the effectiveness of China's DRG/DIP payment reform on the medical service capacity of medical institutions. Methods Databases including PubMed, Embase, Web of Science, CNKI, CBM, WanFang Data and VIP were retrieved, and all the retrieved literature were screened based on predefined inclusion and exclusion criteria. The quality evaluation of the literatures conforming to the research was carried out. Thematic synthesis was employed to make a comprehensive analysis of the literature included in the research scope, forming a core theme and three evaluation indicators. Results A total of ten studies were included, and the scores of literature quality were 14 or above, with a total of 716, 721 subjects. The results of systematic evaluation showed that compared with the non-DRG /DIP group, the CMI value (P<0.05), the total weight and the number of DRG groups increased in the DRG/DIP group. Conclusions The implementation of DRG/DIP payment system can effectively improve the medical service capacity of medical institutions, but there is still room for improvement. It is imperative to optimize the quality system of the front page of medical records, give play to the evaluating function of CMI index, improve service quality and patient satisfaction, so as to promote the long-term development of medical institutions.

Taking the assistance of medical group of Zhuhai People's Hospital to Zheng'an County People's Hospital as an example, this paper summarizes the practices and achievements of the tertiary hospital group's assistance to county hospitals in key counties to receive assistance in rural revitalization. Zhuhai People's Hospital innovatively launched the construction of the “seven new systems” to provide all-round and multi-dimensional assistance in aspects such as developing new platforms, new management efficiency, new assistance mechanisms, new talent driving forces, new technological trends, new smart healthcare and new hospital culture. It has effectively improved the business volume and medical quality of the paired hospital, strengthened the construction of key disciplines and clinical research, comprehensively strengthened the construction of county-level emergency, chronic disease management, and tumor prevention and treatment, and achieved breakthroughs of multiple indicators from zero to some. The successful experience of medical paired assistance work is summarized. It is necessary to select high-quality and scientific assistance teams, innovate assistance modes and methods, optimize the management mechanism and evaluation system of whole-process assistance. It is necessary to solve the practical problems of paired hospitals by optimizing resource allocation, strengthening the introduction of talents, focusing on sustainable development and strengthening the communication and cooperation among 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.

“Living will” has been explored in both national and local legislation in our country. It is in line with the principle of autonomy of the will in China's Civil Code and the concept of protecting the dignity of life, and it is approved by legislation of Shenzhen Special Economic Zone on Medical Regulations (revised in 2022). This paper analyzes the legislative motivation and current situation of living will in our country. It expounds the eligible subject, effective content and elements of the legal procedure of living will, and puts forward the legislative conception of living will.

The reform of DRG payment is an important starting point for the reform of medical and health system, and also a management tool for medical institutions to standardize doctors' diagnosis and treatment and measure the quality of medical services. From the perspective of stakeholders, this paper analyzes the current situation and existing problems of DRG reform from the three aspects of policy system, medical institutions and medical staff, and proposes to formulate corresponding countermeasures for improvement from the aspects of policy system, medical institutions and personnel, so as to provide the reference for public hospitals to better implement DRG payment policies and high-quality development and transformation.

Objective To understand the publication status of articles published in Soft Science of Health from 2013 to 2023, and to provide the basis for the high-quality development of the journal. Methods The literature source of “Soft Science of Health” was searched through CNKI, and the papers published between January 1st, 2013 and December 31st, 2023 were retrieved and statistically analyzed. Results From 2013 to 2023, 2 526 papers were published in Soft Science of Health, among which 2 253 were cited, with a total citation frequency of 15 825, and average citation per article was 7.02. Most articles, 1 234 articles (54.78%) were cited 1-5 times; 905 articles (40.17%) were cited 6-20 times; 114 articles were cited more than 20 times (5.06%); and the maximum citations of per article was 112 times. Conclusions From 2013 to 2023, the ratio of fund projects, citation numbers, citation rates and average citation per article of Soft Science of Health have significantly increased, which has a positive impact on improving the level of the journal and expanding its influence.

Objective To evaluate operational efficiency of clinical departments in a tertiary grade A public hospital by applying data envelopment analysis, and to provide the reference for hospital operation and management. Methods CCR, BCC and Malmquist index models were used to conduct static and dynamic analysis on the operational efficiency of 28 clinical departments in sample hospitals from 2020 to 2023. Results Among the 28 clinical departments, the number of DEA effective departments were 10, 12, 14 and 13 respectively from 2020 to 2023, and the average annual value of comprehensive technical efficiency was 0.827, 0.878, 0.894 and 0.888, respectively from 2020 to 2023, which was mainly affected by pure technical efficiency. There were 23 departments with total factor productivity greater than 1, and five departments with total factor productivity less than 1, which was mainly affected by the index of technical change. Conclusions Pure technical efficiency is the main factor affecting comprehensive technical efficiency, and total factor productivity is closely related to the index of technical change. Hospitals and clinical departments should promote operational efficiency through reasonable control of inputs and outputs, improving management and technical level, and strengthening the utilization of digital technology.

Objective To systematically evaluate the impact of the DRG payment reform on the performance of medical services in China, and to provide the reference for the reform of medical insurance payment method in China. Methods Empirical research literatures on the impact of DRG payment reform on the performance of medical services was collected by searching Web of Science, PubMed, Embase, CNKI, WanFang Data, VIP and CBM databases. Data were screened and extracted based on the inclusion and exclusion criteria, and thematic synthesis method was used to conduct a comprehensive analysis of the included literatures, forming three core themes and six evaluation indicators. Results A total of 13 literatures were included, including seven ITS studies, five BA studies, and one RCT study. The statistical results showed that after the implementation of DRG, the capacity, efficiency, quality and safety of medical services have been improved. The hospital's CMI index, the number of DRG groups, and the total weight of DRG showed an increasing trend, indicating an increase in the capacity of medical services. The time consumption index and cost consumption index showed a decreasing trend, indicating improved efficiency of medical services. The mortality rate in the low-risk group decreased, indicating improved quality and safety of medical services. Conclusions DRG is beneficial to improve the performance of medical services, thereby enhancing the fine management level of hospitals. However, there is a problem of insufficient connection with the national monitoring analysis of the performance appraisal.

When dealing with the typical case of test tube baby's claim for alimony after the father's death at work, the judicial personnel innovatively identified the in vitro embryos as “quasi-fetuses”, confirmed the parent-child relationship between the children conceived through posthumous assisted reproduction with the deceased spouse, and gave full relief to the damage, reflecting the maximum protection of the judiciary for “potential people”. In the context of the absence of law, this judgment provides guidance for the legislation of posthumous assisted reproduction and in vitro embryo after the death of parents. In order to eliminate the potential doubt that the judiciary is result-oriented in the process of law application and breaks the existing rules, it is necessary to conduct in-depth argumentation on the two major legal issues of extended protection of fetal interests and identifying parent-child relationship involved in this judgment based on reasonable and legitimate jurisprudence.

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.

Guided by the ICOPE Implementation Framework issued by the World Health Organization, this paper analyzes various problems in the integrated care for older people in China, such as the lack of coordination mechanism among various departments, the neglect of primary health care, and the unmet individual needs of the elderly. The implementation framework of integrated care for older people in China is established from the macro, meso and micro levels based on China's practical experience. By establishing unified leadership, strengthening departmental integration, implementing community responsibilities, assessing individual needs and other measures, departmental responsibilities are cleared. The ICOPE framework is flexibly applied to enhance community engagement and personalized care, improve the quality and efficiency of elderly care services, thereby providing comprehensive, continuous and coordinated integrated care services for the elderly and promoting healthy aging.

Based on the law enforcement experience of combating surrogacy in Yangpu district, this paper analyzes the key and difficult points in the administrative supervision of surrogacy through field research, data analysis and expert interviews, and puts forward suggestions from the aspects of establishing multi-department and multi-region linkage mechanism, applying technical law enforcement means, increasing publicity and punishment and improving legislation.

Objective This paper analyzes the impact of the current DRG payment on orthopedics and traumatology in TCM by taking distal radius fracture as an example. Methods A total of 101 patients with distal radius fracture (AO classification: type A, type B) discharged from a tertiary first-class TCM hospital in Hubei Province from 2021 to 2022 were selected as the research object. The patients were divided into the orthopedics and traumatology in TCM group and the western medicine surgery group according to the surgical methods. The average cost per case, DRG weight, DRG payment standard, and profit and loss of the two groups were analyzed. Results The total hospitalization expenses (12,742.58 yuan), DRG weight (0.46), and DRG payment standard (5,259.18 yuan) of the orthopedics and traumatology in TCM group were lower than the total hospitalization expenses (33,613.97 yuan), DRG weight (3.20), and DRG payment standard (35,805.00 yuan) of western medicine surgery group, with statistically significant differences (P<0.05). The profit and loss of the orthopedics and traumatology in TCM group was -2,540.14 yuan before medical insurance compensation, and the profit and loss of the orthopedics and traumatology in TCM group was -1,151.14 yuan after medical insurance compensation, both of which were in a state of loss. The profit and loss of the western medicine surgery group before and after medical insurance compensation both were 4,432.18 yuan, indicating a profitable state. The difference between profit and loss of two groups before and after medical insurance compensation was statistically significant (P<0.05). Conclusions The current DRG grouping fails to assign a reasonable weight value to the orthopedics and traumatology in TCM, resulting in the “same disease with same therapeutic effect but different costs” between the orthopedics and traumatology in TCM group and the western medicine surgery group, which causes a significant disadvantage of the application of the orthopedics and traumatology in TCM in DRG payment. Therefore, it is urgent to explore an independent payment method which is suitable for traditional Chinese medicine hospitals.

Objective This paper analyzes the structure of income and payment and surplus changes of all levels of public hospitals in Beijing from 2015 to 2022, and analyzes the effect of comprehensive medical reform in Beijing from the perspective of financial data to put forward the reference for the high-quality development of hospitals in the future. Methods Based on the data of annual health statistics of Beijing, descriptive analysis was carried out by trend comparison analysis and degree of structural variation analysis. Results From 2015 to 2022, the overall surplus of hospitals increased by 8.33 times. The surplus of tertiary hospitals increased by 10.77 times; secondary hospitals suffered losses for 5 years in 8 years, and primary hospitals had a slight surplus to maintain development. From 2015 to 2022, the proportion of drug income decreased while the proportion of medical service income increased. The structural variation analysis found that the contribution rate of the two to the structural variation of medical income reached more than 84%. From 2015 to 2022, the income of TCM decoction pieces increased first and then decreased and stagnated. Conclusions The overall development of public hospitals is rapid, but the balance of development and the overall operational efficiency need to be further improved. The structural adjustment of hospital's income and payment has achieved remarkable results at this stage, but there is still room for further optimization of the structure of income and payment. The income of TCM decoction pieces reflects that there is large room for improvement in the utilization of TCM services in hospitals.

The development of China's medical and health field has gradually entered the intelligent stage. The embedding of artificial intelligence in medical education has brought opportunities and innovation, but also produced corresponding ethical risks. The generating logic of ethical risks of artificial intelligence embedded in medical education is mainly due to the arrogation of technology application to educational ethics, the imbalance between technological rationality and emotional demands, and the respect for efficiency and utilitarianism. The main ethical risks are the dissolution of the status of teachers and students as educational subjects, neglect of the emotional needs of educational subjects, and deviation from the essence of personalized education. To address the ethical risks of artificial intelligence embedded in medical education, we should return to the main focus of medical education and break away from “technology fetishism” to accurately grasp the emotional demands, break through “thinking conventions”, create an intelligent education model of “learning driven by technology”, and break the “fixed algorithm”.

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 This paper studies the retention intention of current students and in-service employees in compulsory rural service directed medical student free training program, and analyzes its influencing factors, so as to provide theoretical references for the training of medical students in compulsory rural service directed medical student free training program. Methods A total of 1 024 current medical students in compulsory rural service directed medical student free training program and 683 in-service contracted employees in Shanxi Province were selected as the research objects to conduct an online questionnaire survey. Statistical description, rank sum test, multiple response analysis and unconditional logistic regression were used for data analysis. Results Among the 1 024 current medical students in the program, 299 (29.2%) would choose to remain in office after the expiration of their contract. Grade, confidence in general practice and willingness to practice general practice were the factors influencing the intention to stay. Among the 683 in-service contracted employees, 163 (23.9%) would choose to remain in office after the expiration of their contract. Age, job satisfaction and salary satisfaction were the factors influencing the intention to stay. In the analysis of the ranking of retention factors, the improvement of salary and benefits, the support of the employer for further training and education, the promotion of professional titles and the support for multi-site practices ranked the top three successively. Conclusions The retention intentions of current medical students in compulsory rural service directed medical student free training program and in-service contracted employees are low. Grade or age is a negative influencing factor of retention intention, while confidence in general practice and voluntariness and job and salary satisfaction are positive factors influencing retention intention.

Objective To explore the coupling coordination degree between resource allocation of elderly care and regional economic development in China, and further promote the positive interaction between the development of elderly care and regional economy. Methods Based on the cross-sectional data of 30 provinces (municipalities and autonomous regions) in 2022, the coupling coordination model was used to explore the coordinated development between resource allocation of elderly care and regional economy. Results There were five provinces with comprehensive development index of resource allocation of elderly care (U1) >0.5, and 17 provinces were lower than the national average. The comparison between the comprehensive development index of resource allocation of elderly care (U1) and the comprehensive development level index of regional economy (U2) showed that ten provinces were backward in resource allocation of elderly care. The coupling coordination degree was only good in Guangdong Province, and most provinces were barely coordinated, barely uncoordinated or uncoordinated. The coupling coordination degree of spatial characteristics of ladder pattern distribution was not obvious, and it was mainly distributed in a point distribution pattern. Conclusions The low level of resource allocation of elderly care in China has not formed a good coordinated and interactive relationship with regional economy. The coupling coordination degree is generally low, which shows that eastern > central > western regions, and the northwest and northeast regions show inefficient agglomeration development.

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.

Objective To study the impact of DIP reform on hospitalization expenses of neonates with pneumonia, so as to provide a basis for reasonable cost control and deepening medical insurance reform. Methods The data of neonatal pneumonia in a tertiary grade-A maternal and child care hospital from 2021 to 2023 were collected and divided into two groups, before and after DIP reform. Data were analyzed by chi-square test, Mann-Whitney U test, new grey correlation and structural variation analysis method. Results After DIP reform, the total hospitalization cost of neonates with pneumonia was reduced by 14.47%; diagnostic cost decreased by 36.08%; drug cost decreased by 38.96%, and consumables cost decreased by 22.94%. The differences were statistically significant (P<0.001). Before and after the reform, the correlation between diagnostic cost and hospitalization cost was the highest, which was 0.8778 and 0.9274, respectively, but the component ratio of diagnostic cost decreased by 5.68%. Before and after DIP reform, VSV of medical service fee, nursing fee and treatment fee were 1.04%, 1.18% and 10.67%, respectively; VSV of diagnostic fee, medicine fee and consumables fee were -3.88%, -8.93% and -0.13%, respectively. Conclusions The DIP reform reduces the hospitalization cost of neonates with pneumonia, and the diagnostic fee is the main factor affecting the structural change of hospitalization cost. The DIP reform optimizes the structure of hospitalization cost to some extent.

Through the analysis of the application status of digital intelligence technology in the field of medical services, it is found that digital intelligence technology plays an important role in medical big data analysis, medical image recognition, smart medical management and other aspects, and promotes the rise of new models such as precision medicine, “Internet + healthcare”, and doctor-patient collaborative medical treatment. The advantages of medical service model driven by digital intelligence in improving medical efficiency, optimizing resource allocation, innovating service content, etc., and the challenges in data security, laws and regulations, and personnel training are analyzed and discussed. It is necessary to strengthen top-level design, promote diversified cooperation, strengthen personnel training, accelerate breakthroughs in key technologies, and deepen reform of medicine and healthcare system to promote the development of new models.

Objective This paper analyzes the composition and characteristics of changes of inpatient income of public hospitals under the background of the reform of medical services pricing, and provides a reference for policy formulation and adjustment. Methods Based on the data of inpatient income of eight tertiary public hospitals in Nanning from 2018 to 2022, characteristics of structural changes of various items in inpatient income were analyzed by structural variation analysis. Results The overall degree of structural variation of inpatient income in eight sample hospitals ranged from 9.76% to 35.59%. Medication, treatment and laboratory tests were the main sources of income for all sample hospitals, with treatment being the primary driving force for the structural changes of inpatient income in all sample hospitals. The values of structural variation were predominant positive in nursing, sanitation material, treatment and surgery; the values of structural variation were predominant negative in bed occupancy, laboratory tests, other services and medication. Conclusions The proportion of technical labor services income for health continues to increase, while the proportion of drug income shows a negative trend. The reform of medical services pricing has achieved certain results, but the structure of inpatient income still needs to be further optimized.

Objective Based on the national trial index, this paper explores the evaluation index system for high-quality development of tertiary public TCM hospitals that highlights characteristics of Shanghai. Methods A pool of alternative indicators for evaluation was constructed through literature search and policy review. A preliminary framework of the index system was formed through expert interviews, and the final index system was determined by Delphi expert consultation method. Results The questionnaire recovery rate of the two rounds of expert consultation was 100%. The expert authority coefficient was above 0.86, and the expert coordination coefficient was above 0.82. The constructed index system had six first-level indexes, 16 second-level indexes and 52 third-level indexes, including guidance in party building, ability improvement, structure optimization, innovation and efficiency, cultural cohesion and industry leadership. Conclusions The evaluation index system for the high-quality development of tertiary public TCM hospitals has certain innovation, highlights the characteristics and connotation of traditional Chinese medicine, and provides an evaluation tool for the management department to understand the high-quality development of TCM hospitals.