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 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.

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.

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 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.

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.

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.

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 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.

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.

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.

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 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 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 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.

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.

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.

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.

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 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.

Objective To explore the effect of Diagnosis-Intervention Packet (DIP) on the hospitalization expenses of patients in public hospitals, evaluate the effectiveness of cost control of DIP, and provide references for optimizing medical expense structure and promoting refined management in public hospitals. Methods A total of 2,078,923 information of front page of medical records of discharged patients from a third-class hospital in Henan Province from 2021 to 2023 were collected. By screening the top ten diseases of discharges, 69,934 valid data were obtained. Non-parametric test, grey relational analysis and structural variation were employed to analyze changes of hospitalization expenses. Results After the reform of DIP payment method, the total cost of inpatients and average cost per hospitalization have decreased significantly, and the inspection and laboratory examination fees were the most related to the total cost per hospitalization. The structural variation degree of medical cost of the top ten diseases was 14.32% from 2021 to 2023. The contribution rates of structural variation in descending order were material fees (29.36%), inspection and laboratory examination fees (25.64%), western medicine fees (20.64%), medical service fees (17.49%), traditional Chinese medicine fees (6.81%), and other fees (0.06%). Conclusions The DIP payment method effectively controls hospitalization expenses of patients and plays a guiding role in optimizing the cost structure of public hospitals. Material fees, with a relatively high structural contribution rate, are the main factor affecting the variation of average expenses per hospitalization.

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 analyze the possible influence of DRG payment on the hospitalization cost structure and medical treatment of patients with cerebral infarction, and to understand the impact of DRG payment on clinical practice and countermeasures of medical institutions. Methods This paper analyzed the cost structure of 837 patients with cerebral infarction before and after the DRG payment reform in Xuanwu Hospital of Capital Medical University, and 162 questionnaires were distributed to clinicians in the hospital for survey. The composition of expenses and the change of medical treatment were analyzed statistically. Results After DRG payment, the proportion of drugs in the cost structure of patients with cerebral infarction decreased significantly. The proportion of check-up cost, laboratory cost, and treatment cost increased significantly, and the average length of stay decreased. There would be risks of abnormal behaviors and the bias for patient selection in medical institutions after DRG payment. Conclusions The research shows that DRG payment system plays a positive role in optimizing the cost structure of medical institutions, improving treatment efficiency and promoting the standardization of medical treatment. However, there are some abnormal behaviors such as buck-passing in admitting patients and upcoding medicare. Medical insurance agencies should actively explore new regulatory measures to adapt to DRG payment system.

DRG payment is an opportunity for the high-quality development of China's medical service system, which is reflected in the fact that DRG is an effective tool to promote the medical management and performance management. The reform of DRG payment promotes the quality of hospital medical records, promotes the development of rational drug use and clinical pharmacy, promotes the fine management of medical consumables, promotes the better integration of medical laboratory science and clinical treatment, improves the medical service efficiency and reshapes medical service system. Meanwhile, issues such as the scientific setting and implementation ability of DRG, the requirements of the outpatient reimbursement for the management of medical insurance payment, the obstacles of the quality of primary health workers to the establishment of the primary consultation and referral system, and the payment methods of outpatient services in primary health care institutions and hospitals under the mutual-aid mechanism for covering outpatient bills are challenges to the reform of payment methods and China's medical service system. The future trend of China's health care delivery system is scale reducing of tertiary hospitals and establishment of the gatekeeper system in the community. One of the important factors affecting the reform is the reform of the medical service pricing mechanism.

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.

With the further deepening of the reform of healthcare system and the implementation of the medical security plan for the “14th Five-Year Plan” period, the number of people covered by medical insurance and medical insurance information have increased substantially, and the traditional supervision methods can no longer meet the requirements under the new situation. It is urgent to establish a standardized, scientific and normalized supervision system for china's healthcare security fund. This paper uses SWOT analysis to describe the basic pattern and practical experiences of intelligent supervision of healthcare security fund in China. In the face of problems such as insufficient cross-departmental coordination, unbalanced regional development and poor data sharing in the supervision of healthcare security fund, corresponding suggestions are put forward from the perspectives of the construction of work system, application of new technical means and professional personnel training.

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.

Objective This paper analyzes the current situation and equity of resource allocation of integrated medical and elderly care services in Chengdu in 2020 to provide the reference for optimizing the resource allocation of integrated medical and elderly care services. Methods Descriptive analysis was used to clarify the current situation of resource allocation of integrated medical and elderly care services in Chengdu. Lorenz curve, Gini coefficient and Theil index were used to analyze the equity of resource allocation of integrated medical and elderly care services, such as the number of institutions and the number of health technicians. Results By the end of 2020, there were 121 institutions with integrated medical and elderly care services, 10 168 health professionals, 2 919 physicians, 4 255 nurses, 3 194 nursing workers and 30 232 beds in Chengdu. Based on population and area distribution, Gini coefficients of the resource index of integrated medical and elderly care services were 0.235-0.398 and 0.496-0.653, respectively. The total Theil index of resources of integrated medical and elderly care services based on population distribution ranged from 0.0374 to 0.1716, and the differences within groups were greater than the differences between groups. The total Theil index based on geographical area distribution ranged from 0.2498 to 0.5243, and the differences between groups were greater than the differences within groups. Conclusions The total amount of resources of integrated medical and elderly care services is insufficient and the distribution is unbalanced in Chengdu. The medical service capacity of institutions with integrated medical and elderly care services is not strong. It is suggested to strengthen the top-level design of the resource layout, scientifically and rationally arrange the institutions, build a medical consortium, and vigorously train the talents of integrated medical and elderly care services.

Objective To analyze the distribution characteristics and influencing factors of cases with extra-long length of stay in a hospital in 2023, and to explore strategies of shortening average hospitalization days. Methods Discharged patients from sample hospitals whose hospitalization days were 30 days or more were defined as extra-long length of stay. Microsoft Excel 2010 was used for data sorting and IBM SPSS 24.0 was used for data analysis. Results There were 345 patients of extra-long length of stay, accounting for 1.36% of all discharged patients. The number of patients staying in hospital for 30-39 days was the largest, accounting for 60.58%. Male patients were much higher than female patients, and the ratio of male to female was 7.02∶1; the age was mainly distributed in 19-29 years old, accounting for 49.6%. The top five constituent ratio of departments where patients were extra-long length of stay were: rehabilitation medicine department, orthopedics department, general surgery department, infectious disease department and geriatrics department. The top six categories of diseases were: circulatory system diseases, digestive system diseases, injuries or poisonings and certain other consequences of external causes, urogenital system diseases, factors affecting health status and contact with health care institutions, musculoskeletal system and connective tissue diseases. Conclusions Patients with extra-long length of stay have a great impact on the overall average length of stay in a hospital. Gender, age, medical payment method, whether surgery, whether other diagnoses, whether serious illness, whether transferring to another department are the main influencing factors of extra-long length of stay.

China's current dispute resolution mechanism for pharmaceutical patent linkage has established a judicial and administrative ruling model to confirm whether it falls into the scope of patent protection. By combing through the specific provisions of relevant laws and policy documents of China's pharmaceutical patent linkage system, this paper analyzes the parallel dilemma of administrative ruling and civil litigation, as well as the potential dilemma between them and patent invalidation procedures and patent infringement litigation. The reason is that the application for listing of generic drugs has not been classified as infringement, and it follows the traditional dual track solution model for patent infringement and the administrative solution model for patent confirmation. The solutions are put forward from the perspectives of establishing a dispute resolution mechanism with “artificial act of infringement” as the core, selecting appropriate administrative and judicial procedures, and exploring the introduction of patent invalidation defense.

Objective This paper evaluates the public health level of Henan Province comprehensively to provide policy suggestions for improving the public health level. Methods The evaluation system index of public health was determined by literature review method, and the entropy weight-TOPSIS model was used to evaluate and classify the public health level of Henan Province from 2010 to 2021. The evaluation result of entropy weight-TOPSIS method was used as the value of RSR to evaluate and classify again, which compared with the previous result. The obstacle degree model was used to identify main obstacle factors affecting the level of public health. Results The public health level in Henan Province showed an upward trend from 2010 to 2021. The scores of resource allocation and evaluation on population health level were relatively low, while the scores of environmental quality and service level increased year by year. The obstacle degree model indicated that environmental quality and service level were the main obstacle indicators, and the growth rate of obstacle effect of population health level was the fastest, which was 50.75%. Conclusions The public health in Henan Province has developed well, but there are still problems such as unbalanced resource allocation and insufficient supply of health personnel. It is necessary to allocate resources rationally, enhance the health level of the population and ensure the supply capacity of public health services.

This paper reviews the current legislation of encouraging overseas rare disease drugs to be listed in China, and summarizes the problems existing in the legal system of rare disease drugs in China, such as imperfect legal system, insufficient incentive of legal system and imperfect drug guarantee mechanism, and their causes. The mature experiences of legislation in the United States, Japan and the European Union are discussed, and the following suggestions are put forward to encourage rare disease drugs to be listed in China: to improve the legislative system and strengthen legislative coordination; to improve the legal incentive system and the supporting system; to explore a multi-tiered medical security system and encourage multiple parties to participate in co-payment.

Objective To analyze the influencing factors of excess hospitalization expenses of patients in urology, and to provide the reference for medical institutions to control overspending and formulate high-quality development policies for hospitals. Methods Taking the cases of overspending in urology of a third-grade hospital in Nanjing as an example, the influencing factors of overspending were analyzed by single factor analysis and structural equation model. Results The effect of robot assistance on excess hospitalization expenses of patients in urology was 0.525. The impact of complications on cost overrun was -0.314. The impact of the number of operations on cost overrun was 0.168. The impact of hospital days on cost overrun was 0.122. The impact of fund types on cost overrun was 0.071. The effect of age on cost overrun was -0.047. Conclusions The use of robot assistance has the greatest impact on the overspending in urology department. The hospital length of stay not only affects the cost overrun, but also positively affects the relationship between other factors and cost overrun. Excess hospitalization expenses of patients in urology without complications are generally higher than that of patients with complications.

With the rapid development of digital technology, the importance of digital literacy in the field of healthcare has become increasingly prominent. This study explains the concept of digital literacy in the field of healthcare, systematically sorts out its main applications from business scenarios, education scenarios and innovation scenarios, and summarizes the research value. The current situation and trend of research and application of digital literacy in the field of healthcare are analyzed from two dimensions at home and abroad. It is found that those studies focus on competency framework of digital literacy, training platforms of digital literacy, health equity and health promotion. The research puts forward suggestions to further strengthen the application and research of digital literacy from three aspects: to carry out extensive research from specific populations to multiple subjects, to promote the transformation from digital skills to digital literacy, and to accelerate the research process of digital literacy promoting digital health.