Population aging and the prevalence of chronic diseases have led to a continuous increase in the demand for health security among people with pre-existing conditions in China. With the development of health management, the integration of health insurance and health management has gradually become a key path to enhancing the accessibility of protection for people with pre-existing conditions. From the perspective of health management integration, this study reviews the institutional evolution and international experience of health insurance for people with pre-existing conditions and analyzes its operational mechanisms from three aspects: product supply characteristics, risk control strategies, and the embedding of health management. Main obstacles of the development of health insurance for people with pre-existing conditions in China are revealed from aspects such as institutional support, risk regulation, health intervention capacity and integration benefits. On this basis, suggestions for optimized path are proposed, including improving institutional support and policy incentives, establishing an industry risk-sharing mechanism, perfecting the classified management of health management services, and innovating settlement methods to promote the deep integration of health insurance and health management, and enhance the health security level of people with pre-existing conditions.

Objective This paper analyzes the impact of Diagnosis Related Group (DRG) reform on the changes of hospitalization expenses in 3A public hospitals at the county and district levels and evaluates the cost control effect of DRG to provide a reference for optimizing the structure of hospitalization expenses. Methods A total of 154,563 DRG payment cases in Nanjing Jiangning Hospital from 2021 to 2023 were collected. Based on the actual situation of disease types, the information of the top ten diseases accounting for the largest proportion of discharged patients was selected, totaling 40,476 cases. Grey relational analysis, structural variation degree analysis and Interrupted Time Series (ITS) analysis were used to analyze the changes in the structure of hospitalization expenses. Results After DRG payment, except for the increase in comprehensive medical service fees, average hospitalization expenses per hospital admission and other expenses all decreased. Inspection and laboratory examination fees were most closely related to the average hospitalization expenses per hospital admission. The structural variation degree of inpatient expenses for patients in the top ten diseases was 6.91%. The top three changes of the contribution rate of structural variation were drug expenses (47.75%), comprehensive medical service fees (28.89%), and treatment fees (11.95%), with a cumulative contribution rate of 88.59%. ITS analysis indicated that drug and material expenses decreased after the DRG reform, and the decline of material expenses slowed down. Conclusions After DRG payment reform, the overall cost control ability of county-level hospitals has been improved. Hospitals should further optimize the structure of costs based on their own medical service characteristics.

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

Large language models (LLMs) in healthcare are vertical applications of LLMs in the healthcare domain based on technologies such as Transformer architecture and big data analytics. While empowering the digital and intelligent transformation and development of medical scenarios, they also give rise to a series of ethical risks that require urgent governance and response. The paradigm of value symbiosis not only provides a theoretical perspective for deeply examining the generative mechanisms of ethical risks in LLMs in healthcare, but also offers methodological support for the governance mechanism of ethical risks in LLMs in healthcare. By reviewing the main application scenarios of LLMs in healthcare, this article summarizes and analyzes the subject ethical risks resulting from the weakening of the dominant positions of patients and doctors and the trust crisis, the institutional ethical risks arising from the mismatch between model iteration and institutional rigidity, the responsibility ethical risks due to unclear rights and accountability in human-machine collaboration, the technical ethical risks resulting from the conflict between algorithmic black boxes and the transparency of diagnosis and treatment, and generative mechanisms. A coupling analysis is conducted on the paradigm of value symbiosis and the governance stance for ethical risks of LLMs in healthcare. Based on the paradigm of value symbiosis, the article explores the governance approach for the ethical risks of LLMs in healthcare from four dimensions: building a governance community founded on collaborative co-governance, establishing an ethical institutional system guided by value consensus, shaping a responsibility mechanism oriented towards risk sharing, and developing a technical model aimed at human-machine symbiosis.

Objective To analyze the influencing factors and enhancement strategies of the attractiveness of primary health care jobs, thereby assisting primary health institutions in attracting and retaining talents. Methods A stratified sampling method was adopted to conduct a questionnaire survey on the respondents. Independent samples t-test and one factor analysis of variance were employed to study the perception for job attractiveness among primary health care workers with different characteristics. Based on the Existence-Relatedness-Growth (ERG) theory, a structural equation model was constructed to analyze the relatedness between research factors and the attractiveness of primary health care jobs from three dimensions, and relevant suggestions were put forward. Results The scores of job attractiveness for primary health care workers showed statistically significant differences among the variables such as region, gender, age, education level, whether they were local residents, position, years of work, and job satisfaction (P<0.05). The structural equation modeling of the attractiveness of primary health care jobs showed that the standardized path coefficients of existence dimension, relatedness dimension, and growth dimension were 0.77, 0.10, and 0.21, respectively, indicating that the existence dimension had the strongest impact on job attractiveness, while the relatedness dimension had the weakest effect. In the existence dimension, the effect of salary level (0.91) ranked first. In the growth dimension, the effects of value realization (0.90) and the promotion of professional title (0.87) ranked first and second. In the relatedness dimension, the effect of doctor-patient relationships (0.88) ranked first, while the path coefficient of policy support (-0.43) was negative. Conclusions Salary level, value realization, doctor-patient relationships, professional title advancement, and policy support are significant influencing factors for the attractiveness of primary health care jobs.

Objective To analyze the key factors influencing the operational efficiency of hospitals, and to provide a reference for improving the operational efficiency of hospitals in Western China. Methods A three-stage DEA-Tobit modeling was used to evaluate the operational efficiency of hospitals in 12 western provinces of China from 2013 to 2022 and explore the influencing factors. Results After removing environmental factors, the average comprehensive technical efficiency of hospitals in Western China increased from 0.954 to 0.959; the average pure technical efficiency rose from 0.960 to 0.963, and the average scale efficiency increased from 0.994 to 0.996. The per capita gross regional product (GRP) was negatively correlated with the adjusted comprehensive technical efficiency value (P<0.05), while the elderly dependency ratio was positively correlated with the adjusted comprehensive technical efficiency value (P<0.05). Conclusions The per capita GRP has a negative impact on efficiency, suggesting a mismatch between resource input and output efficiency. The elderly dependency ratio shows a positive impact, and the continuous demand for medical services exerts a driving force for the optimization of hospital processes.

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

Objective To analyze the overall characteristics and implementation status of the policy texts on hospice care in China, and to provide references for the subsequent optimization and improvement of policies. Methods The central level policies related to hospice care from 2016 to 2024 were taken as the subjects, and a two-dimensional policy analysis framework of “policy tools (X dimension)-stakeholders (Y dimension)” was constructed to quantitatively analyze the policies. Results A total of 65 policy documents were included, and 177 items have been encoded. In terms of the X dimension, the proportions of the utilization of supply-oriented, environment-oriented and demand-oriented policy tools were 38.42%, 36.16% and 25.42%, respectively. In terms of the Y dimension, the proportions of the executing party, the leading party, the funding party, and the demand party were 53.67%, 31.64%, 10.73%, and 3.96%, respectively. Conclusions China's hospice care policies have initially established a multi-level service system through supply-oriented and environment-oriented tools, with social benefits gradually emerging. However, there are still problems such as an imbalance in the structure of policy tools, weak driving force of the demand side, uneven coverage of stakeholders, and insufficient two-dimensional coupling. It is suggested to optimize the policy tool framework to strengthen the traction on the demand side; boost the cohesion among relevant parties by balancing the distribution of interests and responsibilities; and enhance the coupling of the two-dimensional framework to implement precise policy intervention.

Objective Based on the Diagnosis Related Groups (DRG) indicators, a comprehensive evaluation of the performance levels of medical services of each clinical department in the sample hospital is conducted to provide a decision-making basis for the optimization of hospital operations. Methods Entropy weight TOPSIS and rank sum ratio (RSR) method were employed to classify and rank the performance levels of medical services of each clinical department in the sample hospital from five dimensions: medical service capability, cost control capability, medical service efficiency, medical service quality, and medical service safety. Results The evaluation results for the departments of Respiratory Medicine, Tuberculosis, Hepatology, and Interventional Medicine were excellent. The evaluation results for the departments of Gynecology, Rheumatology and Immunology, and Endocrinology were poor. The evaluation results for the remaining departments were moderate. Conclusions There are significant differences in the medical performance levels among the 19 clinical departments of the sample hospital. The hospital should identify its development orientation and take measures based on circumstances of clinical departments to promote the overall improvement of medical performance levels of the hospital.

Objective To explore the degree of coupling coordination between resource allocation in mental health and regional economic development in China, and to promote the coordinated progress of resource allocation and economic development. Methods Panel data of 31 provinces (autonomous regions and municipalities) in 2020 were organized. A comprehensive evaluation model, a coupling coordination model, and a spatial auto-correlation model were used to analyze the resource allocation in mental health and regional economic development index. Results The comprehensive development index for resource allocation in mental health (U₁) was generally lower than that for regional economy (U₂). Through comparison, it was found that many provinces were of the type with lagging resource allocation. The results of the coupling coordination degree showed that only Guangdong Province achieved high-quality coordination, while most provinces were in a state of barely coordinated, marginally disordered, or seriously disordered. Spatial dependence of the coupling coordination degree was significant. Conclusions Resource allocation in mental health and regional economy in China have not yet formed an effective coordinated interaction. It is suggested that measures be taken based on local conditions to achieve optimal development.

Objective To thoroughly analyze the the operational efficiency and influencing factors of close-knit county-level medical consortia in Shandong Province, and to provide policy suggestions for improving the operational efficiency and achieving high-quality development of close-knit county-level medical consortia. Methods Based on the monitoring data of close-knit county-level medical consortia in Shandong Province from 2018 to 2022, the DEA-BCC and Malmquist index models were used to analyze the relevant indicators of the medical consortia. The Tobit regression model was employed to analyze the main factors influencing the operational efficiency of county-level medical consortia. Results The comprehensive technical efficiency of close-knit county-level medical consortia in Shandong Province in 2022 exhibited significant regional disparities, indicating considerable room for improvement. The total factor productivity increased initially and then declined from 2018 to 2022, mainly affected by technical change indicators. The Tobit regression results showed that the number of level 3 and level 4 surgeries performed by the leading hospital, the medical insurance fund income of the members in medical consortia, and the proportion of medical services income of primary hospitals and the leading hospital in the total medical income were significantly positively correlated with the comprehensive technical efficiency of the close-knit county-level medical consortia. The average cost of discharged patients in medical consortia and the land area of the county were significantly negatively correlated with the comprehensive technical efficiency. Conclusions The development of the close-knit county-level medical consortia in Shandong Province is uneven. Pure technical efficiency is the main factor restricting the efficient operation of the close-knit county-level medical consortia. Technical changes are the key to promoting the operational efficiency, and internal factors are the long-term driving force for the sustainable development of the close-knit county-level medical consortia in Shandong Province. It is suggested that measures be taken based on local conditions to promote the synergistic development of close-knit county-level medical consortia in various regions. The management-enhanced efficiency and scale synergy drive the development of close-knit county-level medical consortia with double effects. Technological progress promotes the efficiency of close-knit county-level medical consortia. Internal vitality should be stimulated to promote the high-quality development of close-knit county-level medical consortia.

Objective To investigate the utilization status of Internet-based health management services among patients with chronic diseases in Taizhou and analyze its influencing factors, and to provide a scientific basis for optimizing the intelligent management of chronic diseases. Methods A questionnaire was designed based on the theoretical framework of the Andersen Model. Through convenience sampling, 400 patients with chronic diseases who visited medical institutions at all levels in Taizhou from January to June 2023 were selected. Socio-demographic characteristics, health status, and service utilization data were collected. The influencing factors were analyzed using the Chi-square test and binary logistic regression. Results The utilization rate of Internet-based health management services among patients with chronic diseases was 65.56%. The results of the logistic regression analysis revealed that influencing factors of Internet-based chronic disease management were age and education level among the predisposing factors; the number of concurrent chronic diseases, self-reported health, the number of medical visits due to chronic diseases in the past six months, and life satisfaction among the demand factors; and the current average monthly income, medical insurance and pension insurance among the enabling factors. Conclusions The utilization rate of Internet-based health management services among patients with chronic diseases in Taizhou is influenced jointly by predisposing factors, enabling factors, and demand factors. In the future, more user-friendly service models should be designed for vulnerable groups such as older adults and less educated people, and the medical insurance reimbursement policies should be improved to enhance service accessibility.

Objective This paper studies the current status of human resources supply in healthcare in Fujian Province and predicts the trend of changes in health workers, so as to provide a reference for promoting the balance between supply and demand of human resources in healthcare in Fujian Province. Methods The combination of forecasts method was adopted. The gray GM(1,1) model, quadratic regression model, Holt-Winters linear model, and ARIMA model were used for individual predictions. The weights of each model were determined by the Reciprocal of Error Sum of Squares to construct a combined model, and its effectiveness was verified through error comparison. Results The combined model achieved the optimal prediction accuracy and the best stability. The RMSE values of the three types of health personnel that were health technicians, practicing(assistant)physicians and registered nurses were 0.25,0.45 and 0.09,respectively. The MAE values were 0.19,0.34 and 0.07,respectively. From 2024 to 2028, the three types of health personnel would continue to grow. It was projected that the number of healthcare professionals would increase from 339,800 to 394,500; the number of practicing (assistant) physicians would rise from 132,500 to 156,200; and the number of registered nurses would increase from 168,700 to 199,100. The average annual growth rates were 4.28%, 5.80% and 4.33%, respectively, all of which were lower than the historical growth rates from 2009 to 2023. Conclusions The combination of forecasts model is applicable for medium-to-long-term predictions of regional human resources in healthcare. The demand for human resources in healthcare in Fujian Province is still on the rise. Efforts should be made to strengthen the talent team by optimizing the structure, improving the quality and enhancing policies.

Objective To analyze the gap between the development status of the traditional Chinese medicine (TCM) medical service system and the goal of building a strong province in Shanxi Province, and to provide a reference for promoting the construction of a province strong in TCM. Methods Based on the data of TCM medical service system in the “Traditional Chinese Medicine Medical Service Monitoring Network Direct Reporting System” of National Administration of Traditional Chinese Medicine for Shanxi from 2021 to 2023, as well as the data from the “Shanxi Statistical Yearbook” during the same period, the scale and structural characteristics of the TCM medical service system were analyzed. The Dagum Gini coefficient was used to evaluate the balance of its distribution in different regions, and it was compared with the goals of a strong province. Results The scale of the TCM medical service system in Shanxi Province continued to expand from 2021 to 2023. The number of TCM hospitals increased from 245 in 2021 to 259 in 2023, with the proportion of private hospitals rising and secondary public hospitals dominating (80%). The bed utilization rate of tertiary hospitals reached 92.05% in 2023. The number of secondary or above public TCM hospitals with rehabilitation department and geriatric department has increased, and the coverage rate of grassroots TCM clinics has reached 93.98%. The Gini coefficient of TCM general practitioners in Jinzhong region (0.428) was higher than that in Jinbei region (0.158). The number of TCM practicing (assistant) physicians per thousand population (0.35) had not met the requirements of a strong province. Conclusions The TCM medical service system of Shanxi Province still has deficiencies in terms of system structure, the connotation of grassroots services, the total number of talents, and regional balance. In the future, it is necessary to optimize the system structure, deepen the construction of connotation, innovate talent mechanisms, and strengthen resource regulation.

Objective To explore the impact of social capital on the utilization of basic public health services by older adults, and to provide a reference for promoting the utilization of basic public health services among older adults. Methods A multi-stage random cluster sampling was used to conduct a questionnaire survey among urban elderly people aged 65 and above in Chengdu. Single factor analysis and logistic regression model were used to explore the influence of social capital and other factors on the utilization of basic public health services. Results 37.4% of respondents were aware that their information had been recorded; 33.2% knew that they had contracted family doctors, and 40.7% of them had received health check-ups at the grassroots level in the past year. The higher the score of family social capital was, the lower the possibilities of not establishing health records (OR=0.990, 95%CI:0.982~0.997) and not receiving health check-ups were (OR＝0.987, 95%CI:0.980~0.993). The higher the individual's social capital score was, the lower the possibility of not contracting a family doctor was (OR=0.988, 95%CI:0.982~0.995). Conclusions Individual and family social capital are important social factors influencing the utilization of basic public health services by older adults.

Objective To understand the current operational status of the “electrocardiograph network” project at county-level areas, and to explore the effectiveness of the “electrocardiograph network” in preventing and treating cardiovascular diseases in rural areas. Methods Semi-structured interviews were conducted with the officials related to “electrocardiograph network” project in the Health Commission of Haian and medical institutions at all levels, as well as cardiologists. The thematic analysis method was used to analyze the significance, current status, effectiveness, problems and solutions of the project. The quality of life of patients with yellow and red warning levels was evaluated in the telephone follow-up screening by using the EQ-5D-5L questionnaire. Non-parametric tests were used for single factor analysis, and Tobit regression was used to conduct multiple factor analysis to explore the influencing factors of quality of life. Results Since the implementation of “electrocardiograph network” project in Haian for two years, a total of 20,827 people have been screened. 1,661 were yellow warning and 139 were red warning which indicated critical condition. The program had a wide coverage, clear operating procedures and fast response speed for treatment, which played an important role in coping with aging population, improving the efficiency of diagnosis and treatment by electrocardiograph in rural areas and promoting hierarchical diagnosis and treatment. The 95%CI for average quality of life of the follow-up patients was 0.892 (0.866~0.918), and 95%CI for VAS score was 81.40 (80.01~82.78). Advanced age and being female were risk factors for low quality of life. Conclusions The “electrocardiograph network” in Haian contributes to the early detection and treatment of heart diseases, improves the quality of life of patients, and achieves good social benefits. However, its full potential has not yet been realized.

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

The community-embedded elderly care model, as a pioneering exploration in the field of elderly care services, is a crucial initiative of the proactive national strategy in response to population aging. This paper constructs a community-embedded elderly care services chain based on service chain theory. Through a systematic perspective, it analyzes the dynamic process of community-embedded elderly care services from three stages: service provision, service transmission, and service utilization. It clarifies the factors and conditions that constrain the development of community-embedded elderly care services and proposes corresponding optimization strategies. This approach can integrate community-based elderly care resources, enhance service efficiency and quality, and advance the realization of high-quality elderly care goals.

With the rapid development of the market of traditional Chinese health preservation services, the disorderly application of traditional Chinese medicine (TCM) techniques in non-medical institutions has become increasingly prominent. The core issue lies in the ambiguous definition of TCM diagnostic and therapeutic activities. This paper analyzes typical cases to clarify the current positioning of TCM techniques and systematically reveal the problems existing in the current qualitative methods of traditional Chinese health preservation services. By reviewing theories defining medical treatment and considering the characteristic of “integrated prevention and control” in TCM, it is argued that the “risk theory of professional behavior” is applicable in the governance of the traditional Chinese health preservation industry. Centered on the professionalism and risks of the conduct, this theory not only appropriately positions TCM techniques, but also alleviates the pain points of reviewing subjective intent. Accordingly, this paper innovatively proposes a definition model of “static risk classification + dynamic comprehensive characterization”, providing a reference for resolving the boundary issues between traditional Chinese health preservation and medical services, and promoting the healthy and orderly development of the market of traditional Chinese health preservation.

Objective To explore the impact of the integration of medical insurance system on the health and health inequality of rural older adults in China, and to provide a reference for the improvement of the medical insurance system. Methods Based on the data of 2015 and 2018 China Health and Retirement Longitudinal Study, propensity score matching and the difference-in-differences method were used to examine the extent to which the integration of medical insurance system affected the health and health inequality of rural older adults in China. Results The results of baseline regression showed that the integration of medical insurance system improved the health level of rural older adults by 10.3% and reduced the health inequality by 1.3%. The analysis of mediating effects showed that the integration of medical insurance system improved the health level through improving the utilization of the health care services for older adults. Heterogeneity analysis showed that the integration of the medical insurance system improved the health status of the high-income group and the group without chronic diseases by 10.7% and 10.3%, respectively, and reduced the health inequality of the group without chronic diseases by 12.0%. Conclusions The integration of medical insurance systems can improve the health conditions of rural older adults, but effective measures are needed to be taken to consolidate the achievements. The integration of the medical insurance system reduces health inequality among rural older adults by promoting the utilization of medical services, but its mediating role is extremely limited. The focus is on the low-income older adults in rural areas and the vulnerable groups with chronic diseases, and precise medical assistance measures are implemented.

Objective To understand the impact of older adults in the community using the Internet on health-related quality of life (HRQoL) in Chengdu, explore the mediating role of social isolation and provide a reference for promoting HRQoL of older adults. Methods Purposive sampling was used to survey 548 older adults aged 60 and above in two communities in Chengdu. The Social Isolation Scale (SIS) was used to measure the degree of social isolation, and the Chinese version of the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) was used to measure HRQoL. Multivariate Tobit regression was used to analyze the influencing factors of HRQoL, while structural equation modeling was used to analyze the mediating role of social isolation between Internet usage and HRQoL. Results The Internet usage rate among surveyed older adults was 75.36%; the score of social isolation was 20.0 (15.0, 24.0) points; the connection score was 10.0 (7.0, 12.0) points; the sense of belonging score was 10.0 (7.0, 12.0) points; and effect values of the HRQoL was 0.949 (0.891, 1.000). Tobit regression analysis showed that the scores of age, employment status, suffering from chronic diseases, Internet usage and social isolation were the influencing factors of the HRQoL of older adults. Older adults who used the Internet (β=0.037, P=0.007) and had higher scores of social isolation (namely a lower degree of social isolation) (β = 0.007, P<0.001) demonstrated higher effect values of HRQoL. In the Mediation Model, the standardized effect value of social isolation among older adults was 0.100 (95%CI: 0.066~0.135, P<0.001), accounting for 42.55% of the total effect. The parallel mediation model showed that the effect value of the degree of connection was 0.022 (95%CI:0.009~0.036, P<0.001), accounting for 28.21% of the total effect. Conclusions The Internet use among older adults is positively correlated with the HRQoL of older adults through direct paths as well as indirect paths that reduce social isolation.

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

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

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

Objective To explore configurational paths associated with high incidence of cross-provincial health-seeking behavior, and to provide a reference for the rational control of cross-provincial seeking healthcare. Methods Relevant publicly released data from 31 provinces (autonomous regions and municipalities) in China were collected. Fuzzy-set Qualitative Comparative Analysis (fsQCA) was applied to conduct configurational analysis. Results A total of seven configurations were identified, which can be classified into four typical models: low-cost service-driven type, high-quality and low-cost service-driven type, transportation-driven type, and resource-constrained type. Conclusions Cross-provincial health-seeking behavior in our country has shown a generally rapid growth trend. The high incidence of cross-provincial health-seeking behavior is the result of the complex combination of multiple factors.

Objective This paper analyzes the current situation and development trends of burden of disease of malignant tumors in China in 2021, and compares with the global data, in order to provide a reference for the prevention and treatment of malignant tumors in China. Methods Based on the data from the Global Burden of Disease in 2021 (GBD 2021), the Joinpoint log-linear model was applied to calculate the average annual percentage change in the incidence, mortality, and disability-adjusted life years (DALYs) of malignant tumors in different genders and age groups in China from 1990 to 2021. A Bayesian age-period-cohort model was built to predict the burden of disease from 2022 to 2035. Results From 1990 to 2021, the standardized incidence rates of malignant tumors in China showed a significant increase and surpassed the global level. Meanwhile, the standardized mortality rates and standardized DALYs in China remained consistently higher than the global benchmark. At the gender level, burden of disease for men had always been significantly higher than that of women in China, and the gender disparity was greater than that in the global context. At the age level, the relevant indicators in China have been continuously increasing with age. The older adults bore the most significant burden of disease. The incidence of malignant tumors showed a trend of becoming more common among young people. From 2022 to 2035, China's standardized incidence rates were projected to keep rising, while the standardized mortality rates and the standardized DALYs declined. The global trend remained downward. Conclusions China has achieved phased results in the prevention and treatment of malignant tumors, but the overall prevention and control situation still faces major challenges. The standardized incidence rate, standardized mortality rate and standardized DALYs of malignant tumors in China are all higher than the global average. Moreover, the standardized incidence rate is expected to continue to increase, and the burden of disease on the older adults and men is heavy.

Objective To sort out and quantitatively evaluate the digital health policies at provincial level during the “14th Five-Year Plan” period, and to provide countermeasures and suggestions for policy formulation and improvement. Methods The ROST CM 6.0 software was used to conduct text mining on 11 digital health policies, and a Policy Modeling Consistency (PMC) index model was constructed, which included nine first-level variables and 39 second-level variables. Quantitative analysis was carried out on the policy texts. Results The average PMC index of 11 policies was 6.41, among which three were excellent policies and eight were acceptable policies. Among the first-level variables, X₁ policy nature (0.89), X₈ policy function (0.87) and X₉ policy evaluation (0.86) had relatively high scores, while X₂ policy timeliness (0.33), X₃ issuing institution (0.34), X₅ policy target (0.73) and X₇ policy content (0.76) had relatively low scores. Conclusions There is room for improvement in digital health policies at the provincial level in China. It is suggested to strengthen organic connection among short-term breakthroughs, medium-term layout, and long-term leadership of policies; establish a governance system led by the government, with diversified collaboration, joint construction and shared benefits; and focus on improving the balance and integrity of the policy system to stimulate the vitality of regional innovation and development.

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

Objective To analyze the current status and equity of healthcare resource allocation in Tianjin, and to provide a reference for optimizing the layout during the “15th Five-Year Plan” period. Methods Relevant data from 2019 to 2023 were collected. Statistical methods were used to describe the total volume and growth of healthcare resources in Tianjin. The Lorenz curve, Gini coefficient, Theil index, and health resource agglomeration degree and Global Moran's I of spatial autocorrelation were employed to conduct a comprehensive evaluation from the economic, demographic, and spatial dimensions. Results The total volume of healthcare resources in Tianjin continued to increase from 2019 to 2023, but there were significant differences among different districts and regions. The Lorenz curve showed a relatively small degree of curvature in terms of population distribution, but a significantly greater curvature in terms of geographical and economic distribution. The allocation of various resources exhibited better equity based on economic distribution (with a Gini coefficient ranging from 0.211 to 0.267), relative rationality based on population distribution (0.258~0.331), and the poorest equity based on geographical allocation (0.209~0.410). The analysis of the Theil index indicated that regional disparities were the main cause of inequity (the contribution rate between groups ranging from 42.271% to 88.865%). The analysis of Global Moran's I revealed that there was a significant positive spatial clustering effect in the spatial distribution of various core healthcare resources (Moran's I = 0.181~0.238), further confirming the “center-periphery” pattern of resource allocation. The analysis of agglomeration degree further revealed that although resources in the central urban area were geographically highly concentrated, there was a phenomenon of insufficient “per capita occupancy rate”. The five peripheral zones exhibited the opposite structural characteristics. Conclusions The total volume of healthcare resources in Tianjin has increased, but the scientific rigor and equity of allocation still face challenges and need to be further optimized.

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

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

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

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

Objective To evaluate the effectiveness of fine management of medical insurance in hospitals under the reform of Diagnosis Related Groups (DRG) payment system, and to provide feasible suggestions for the further development of fine management. Methods 4, 666 cases from a Grade-A tertiary hospital in Wuhan from June 2022 to December 2024 were used as the subjects. A two-group interrupted time series model was adopted to analyze the differences in the changes of average total medical expenses per case, average drug expenses per case, average consumables cost per case, and average hospital length of stay between the experimental group and the control group before and after the implementation of fine management. Results The fine management of medical insurance in hospitals demonstrated significant improvements in the average total medical expenses per case and average drug expenses per case for disease group A (β₆=-2435.660, P<0.1; β₆=-780.333, P<0.05), which was consistent with the results of two-group interrupted time series model of the experimental group of disease group C (β₆=-326.148, P<0.1; β₆=-803.055, P<0.01). However, its effect on average consumables cost per case and average hospital length of stay was not significant (P>0.1). The degree of dispersion of various cost indicators significantly decreased after the intervention, and changes slowed down. Conclusions Under the DRG system, fine management of medical insurance in hospitals has demonstrated a positive effect on reducing patients' expenses and contributes to achieving the “identical treatment for the same disease with the same price”.

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

Objective To explore the relationship between the quality of life (QOL) of patients with cervical cancer and social support, and to provide a reference for improving the QOL of patients. Methods A cross-sectional design was adopted, and the QLICP-CE (V2.0) scale and the SSRS-10 scale were used for the survey. Analysis of variance was used to compare the differences between the total score of QOL of patients with cervical cancer and various dimensions under different factor levels. Multiple linear regression and canonical correlation analysis were employed to explore the correlations between different factors and the QOL of patients with cervical cancer, as well as the specific impacts. Results The total score of the QOL for 179 patients was (63.27±11.60) points. The total score of social support was (41.44±7.86) points, with the scores for subjective support, Objective support and support utilization being (24.45±4.58), (9.57±2.63), and (7.42±2.13), respectively. Multiple linear regression showed that age, education level, medical insurance type, and social support were related to QOL, among which social support level and age positively predicted the QOL. Canonical correlation analysis revealed that there was a correlation between social support (three dimensions) and QOL (five dimensions). The correlation coefficients of the first pair and the second pair of canonical variables were 0.680 and 0.308 respectively. The first pair of canonical variables contributed the most to support utilization and Objective support (respectively explaining 63.3% and 29.2% of the variance in social support and QOL). Conclusions Social support is a key protective factor for the QOL of patients with cervical cancer. Objective support and support utilization rate play a crucial role in enhancing the QOL of patients.

Objective To evaluate the impact of Diagnosis-Intervention Packet (DIP) on resource allocation and medical quality. Methods The interrupted time series analysis (ITS) was employed to assess changes of disease types-related indicators in the performance assessments before and after the implementation of DIP in a tertiary hospital. Results In terms of resource allocation, in the initial phase of the implementation of DIP, the average expenditure per admission and average length of stay for each disease decreased. The average expenditure per admission for acute myocardial infarction and chronic obstructive pulmonary disease decreased by 6053.91 yuan and 4496.22 yuan respectively. The average length of stay for certain disease categories showed a significant upward trend over time (P<0.05). In terms of medical quality, in the initial phase of the implementation of DIP, in-hospital mortality rates of each disease did not increase significantly. The in-hospital mortality rates of some diseases showed a significant upward trend over time (P<0.05). Conclusions DIP initially optimizes resource allocation without compromising medical quality. However, the long-term effect of DIP is not good and it may have certain negative impacts on the control of medical expenses and medical quality, which requires further research.

Objective To assess the characteristics and implementation effectiveness of the China-Serbia health cooperation model, and to explore the demonstrative significance of this model for the building of the Silk Road of Health and regional health governance. Methods By employing content analysis, case study and expert interviews, a thorough analysis of health cooperation between China and Serbia was conducted. Results From 2012 to 2024, 11 health cooperation agreements were signed between China and Serbia, with the country/government being the main cooperation entity (54.5%), focusing on areas such as disease prevention and control (36.4%) and scientific and technological innovation (27.3%). Typical projects such as the Huada “Huo-Yan” laboratory and the China-Serbia “Belt and Road” Joint Laboratory on natural products and drug discovery had achieved remarkable results. From 2015 to 2024, the medical trade between China and Serbia witnessed a stepwise growth, indicating an upgrade in cooperation from one-way output to synergy and mutual benefits. The expert interviews focused on mechanism establishment, technological exchange, policy planning, industrial collaboration, and the construction of public health systems. Conclusions China-Serbia health cooperation has achieved remarkable results, featuring a government-led approach, crisis-driven strategy, and bilateral focus. A new type of health diplomacy model has been established based on the principles of equality and mutual benefit, and regional influence has been formed, providing theoretical support and practical foundation for the construction of the “Silk Road of Health” and the improvement of the global health governance system.