[目的]探讨2012-2021 年我国卫生服务效率变化趋势,为下一步合理配置卫生资源提供科学依据.[方法]采用2013-2022 年《中国卫生统计年鉴》和《中国统计年鉴》数据,选取我国31 个省份的医疗卫生机构为研究对象.借助BCC模型、Malmquist指数模型以及固定效应模型对31 个省份的卫生机构服务效率进行分析.[结果]我国卫生机构服务效率处于中等水平,2012-2021 年,我国全要素生产率指数均值为1.037.25个省份的卫生服务效率的全要素生产率指数均值大于 1,占比 80.6%.[结论]我国卫生服务效率整体不佳,大部分省份DEA无效且规模报酬递减,相应投入没有得到预计的产出.区域内发展不平衡,各省份之间卫生服务效率差别较大.我国卫生服务效率的增长属于技术进步导向型增长.医师日均担负诊疗人次数、日均担负住院床日和人均GDP对医疗服务综合效率有正向影响.
With the rapid development of digital intelligence technology,it has become an important engine for empowering mutual aid elderly care.Through literature review and data review,it is found that there are still some difficulties in the process of empowering mutual aid elderly care,such as the lack of digital intelligence consensus,weak collaborative links in multiple networks,difficulties in organic integration of resources,lack of exploration of innovative mode and insufficient"senior-friendly"products of digital intelligence,which limit the role of digital intelligence technology in empowering mutual aid elderly care.It is proposed to provide scientific support for addressing challenges from the aspects of cognitive improvement and mindset change,capacity training and structural adjustment,data sharing and resource integration,model exploration and local adaptation,and demand response and deep interconnection.
Objective This study aims to analyze medical services and public health services in grassroots healthcare institutions in Hohhot and explore the synergistic development of these two types of services,to provide the reference for improving the development of grassroots healthcare institutions.Methods Relevant data of grassroots healthcare institutions in Hohhot from 2016 to 2019 were collected.The entropy weight method was used to determine the weights of each indicator.The analysis method of coupling coordination degree was employed to analyze the changing trend of the coupling coordination degree between public health services and medical services in grassroots healthcare institutions.Results From 2016 to 2019,the coupling degree of medical services and public health services of grassroots healthcare institutions in Hohhot showed a downward trend year by year,with the coupling index T decreasing from 0.2482 to 0.1709.In 2019,57.75%of institutions had less than intermediate synergies,and 67.61%were more focused on providing public health services.The coupling degree of institutions in areas with relatively good economic development level was 0.2514,which was better than those in areas with poor economic development level.Regions with better economic development tended to develop medical services.The coupling degree of the"state-owned and privately operated institutions"was 0.1379,significantly lower than wholly state-owned institutions'coupling degree 0.1923.Conclusions In recent years,the coordinated development level of medical services and public health services in primary medical and health institutions in Hohhot is low,and the public health services are relatively good.In addition,regional economic conditions are closely related to the level of coordinated development of primary health care institutions.There is room for improvement in the model of"state-owned and privately operated"primary health care institutions.It is suggested that the government take various measures to improve the service quality and coordinated development of grassroots healthcare institutions.
Based on the theory of public values,this article explains the theoretical logic of building a community of common health for mankind featured as the public characteristics,and reflects the natural endowment virtues of maintaining human health,the moral virtues of strengthening mutual benefit and cooperation among members,and the rational virtues of pursuing science and enhancing wisdom.Based on this,the path to build a community of common health for mankind is proposed from three aspects:forming concepts,establishing systems,and improving technology.
Compared with the transmission of traditional medical data,the application of blockchain technology in the medical field can break the information isolation to achieve information sharing,and can also reduce data loss and tampered data,which is more in line with the current requirements for data storage and transmission in the medical field.At present,blockchain technology in healthcare is used in many fields,such as electronic medical record storage and sharing,drug traceability and anti-counterfeiting,and settlement and supervision of medical insurance payment.However,as an emerging technology,the application of blockchain technology is in conflict with the application of traditional legal norms,mainly including the definition of personal information,regulatory methods,rights relief and value cognition problems.In this regard,we can learn from the EU regulations to establish the data security principal system,innovate regulatory concepts,realize the co-governance of technology and regulation through soft regulation,and enhance value cognition to solve the contradiction between the existing blockchain technology applied to the medical field and legal regulation.
In the context of high-quality development of public hospitals,the governance of low-value healthcare is conducive to reducing unnecessary waste in the medical process,and has great significance for alleviating the pressure of medical resource allocation.By studying the concept,performance,harm and treatment measures of low-value healthcare,this paper compares the governance of domestic excessive medical treatment and unreasonable medical treatment with low-value healthcare,and summarizes similarities and differences to provide references for the high-quality development of hospitals in China through the precision governance system.
Objective To understand the liabilities status,analyze the solvency and causes of liabilities of public hospitals in Hebei Province and propose countermeasures.Methods Descriptive statistics and semi-structured interviews were applied to study total liabilities,structure of liabilities and solvency of public hospitals.Causes of liabilities were analyzed through interviews with key informants.Results From 2019 to 2021,the annual average growth rate of liabilities of public hospitals in Hebei Province was 11.61%,and the liabilities were mainly current liabilities.The asset-liability ratio decreased from 49.24%to 48.47%,but it was still higher than the national average level.Conclusions The main reasons for the liabilities of public hospitals were insufficient financial investment,insufficient price adjustment after the abolition of drug and consumables markup,heavy pressure on hospital rigid expenditure,and inefficient operation and management.
Objective To analyze the characteristics of high hospitalization cost cases under DIP payment and put forward suggestions for management.Methods Data source was from DIP payment settlement results of a tertiary general hospital.Z-test and Chi-square test were used to analyze the differences between high hospitalization cost cases and normal hospitalization cost cases from three dimensions:difficulty of diagnosis and treatment,case enrollment in disease groups and medical cost structure index.Results From February to June 2023,there were 1,367 high hospitalization cost cases in sample hospitals,accounting for 4.72%of all DIP cases.Among the top five diseases,only the fifth was surgical disease.The high hospitalization cost cases caused by coding errors accounted for 20.6%.Among 12 indicators in three dimensions of difficulty of diagnosis and treatment,case enrollment in disease groups,and structure index of medical cost,there were statistical significance in difference between high hospitalization cost cases and normal hospitalization cost cases except the proportion of medical service income.Conclusions Cases with difficult diagnosis and treatment,high coding error rate,and unreasonable cost structure are more likely to have high hospitalization cost.It is necessary to pay attention to the quality of the first page of medical records,strengthen the supervision of diagnosis and treatment behaviors,develop differential specialists,formulate special assessment methods,establish and improve communication mechanisms,and improve supporting policies.
Objective The aim of this study is to explore the effect of commercial health insurance on the health performance of middle-aged and elderly people in China,in order to provide a scientific reference for improving the multi-level medical security system and further playing the role of commercial health insurance.Methods This paper used data of the 2018 China Health and Retirement Longitudinal Study(CHARLS)and employed the elderly dependency ratio as an instrumental variable.The effect of purchasing commercial health insurance on the health performance of middle-aged and elderly people was measured by using instrumental variable models and two-stage least squares regression models.Results Among the 17,651 samples included in the analysis,the average self-rated health score was 3.056,indicating an overall"good"level of health.The instrumental variable of the elderly dependency ratio was effective in addressing the endogenous issue between commercial health insurance and self-rated health status.After incorporating the instrumental variable,the effect of commercial health insurance on self-rated health status increased from 0.210 units to 7.805 units.Individual factors such as gender,age,educational background,marital status,social insurance,and income also had an impact on self-rated health status.Conclusions The purchase of commercial health insurance can improve the health performance of middle-aged and elderly people,and can also further alleviate the working population's economic burden caused by disease,serving as a supplement to health policy.However,there is still a need to increase the coverage rate of commercial health insurance for middle-aged and elderly people,and to improve the healthcare insurance system.
Objective To evaluate the efficiency of resource allocation of medical and health institutions in China in the past 10 years and analyze its changing trend,and provide the reference for improving the operating efficiency of medical and health institutions in China.Methods BCC-DEA model and superefficient DEA model in data envelopment analysis were used for static analysis,and Malmquist index model was used for dynamic analysis.Results The study found that the overall level of resource of medical and health institutions in China was low and there were large provincial and regional differences.The changes of resource allocation efficiency in China's medical and health institutions in the past ten years were mainly divided into three stages:the steady rise period from 2012 to 2015,the reform and adaptation period from2016 to2018,and the COVID-19 epidemic period from 2019 to 2021.Conclusions The overall resources of medical and health institutions in China have not been effectively allocated.The efficiency level has a large regional difference,which is seriously affected by policy environment and emergencies,and the fluctuation is relatively obvious.
With the continuous development and maturity of information technologies such as big data,cloud computing and the Internet,the value and effect of big data applied to public health emergencies continue to be highlighted.By combing the background of the application of big data in public health emergencies and combining the concept and characteristics of big data,this paper analyzes the current application of big data technology in public health emergencies,and concludes that there are problems such as widening digital divide,serious privacy leakage and abuse of data rights in the application of big data in public health emergencies.It is proposed to promote the healthy development of big data technology in public health emergencies through improving social regulations,strengthening institutional constraints,strengthening digital construction,eliminating digital divide,preventing privacy disclosure,and safeguarding data rights.
In this paper,the application procedures of Breakthrough Therapy designation in the United States are studied,and the characteristics and advantages of the procedures are summarized.On this basis,it is proposed that"breakthrough therapy designated drugs"can be improved by establishing a diversified communication system,a mandatory expert consultation system,and clarifying the responsibilities of active guidance of drug evaluation institutions.On the basis of ensuring the safety and effectiveness of anti-tumor drugs,the speed of drug evaluation should be accelerated,and the approval rate of technical review of applications for drug marketing authorization should be improved.
Objective By analyzing coupling coordination development of the primary healthcare system and its spatial characteristics in Chengdu under the background of medical and preventive integration,this paper provides a reference for better promoting the development of primary medical and preventive integration in Chengdu.Methods Firstly,entropy method was used to determine the weights of evaluation indicators,and then coupling coordination model was used for coupling analysis.Finally,STATA 15 was used for spatial autocorrelation analysis.Results The coupling coordination degree of primary medical services and public health services in Chengdu increased first and then decreased from 2017 to 2021,with an average value of 0.69,indicating a low coupling coordination degree and great room for improvement.Local spatial autocorrelation showed that high-high,low-low and low-high clustering patterns appeared in some regions.Conclusions The coupling coordination development of primary medical services and public health services needs to be improved.And regional development is unbalanced.In some counties(cities,districts),the coupling coordination development of medical services and public health services has spatial clustering,and attention should be paid to the coordinated development of the two.
Objective Taking a city in Shandong Province as a case study,this paper analyzes the current situation and influencing factors of medical service efficiency in primary medical and health institutions,and puts forward policy suggestions for improving the efficiency of medical services.Methods Financial data and survey data of primary medical and health institutions collected in 2022,were used to calculate the medical service efficiency of primary medical and health institutions by data envelopment analysis.Multiple linear regression analysis was performed to analyze the influencing factors of the medical service efficiency.And policy strategies were put forward.Results The average scale efficiency,pure technical efficiency and comprehensive efficiency of medical services in the primary medical and health institutions of the city were(0.912±0.113),(0.699±0.225)and(0.632±0.207),respectively.Among them,types of institution and the proportion of key population in the jurisdiction were the influencing factors of the scale efficiency of institutional medical services;the balance level of institution and the actual monthly salary per capita of unbudgeted posts were the influencing factors of pure technology and comprehensive efficiency of institutional medical services(P<0.05).Conclusions The overall scale efficiency of medical service of the primary medical and health institutions in the case city is relatively high,so more attention should be paid to the grassroots construction in areas with relatively scarce medical resource allocation and relatively large demand,to ensure the balance of income and expenditure of the primary medical and health institutions.More budgeted posts and financial support directly related to it should be given to the primary institutions.
Objective To evaluate the implementation of long-term care insurance system in Nanning City,find out the problems,and put forward feasible policy suggestions,so as to provide the reference for other less developed ethnic areas and areas that have not implemented the long-term care insurance system.Methods The 360-degree feedback method was used to construct the evaluation index system of the implementation effect of long-term care insurance from three dimensions of individual,family and society.The Fuzzy Analytical Hierarchy Process was used to comprehensively evaluate the long-term care insurance system of Nanning by combining the opinions of experts and audience.Results The evaluation value of the target level of the implementation effect of long-term care insurance system of Nanning was 2.9103,which was between"general"and"satisfactory".At the criterion level,family dimension(B2 =3.1145)>social dimension(B3 =2.8122)>individual dimension(B1 = 2.7484).Conclusions The overall implementation effect of long-term care insurance system of Nanning is good.The respondents are generally satisfied with it.However,there is still room for improvement at the level of detailed indicators.The evaluation system should be optimized to ensure accurate services;the specialization of institutions and professional nursing staff should be improved;the intelligent online supervision mechanism of long-term care insurance should be established;and the Internet Plus should be used to empower the publicity of long-term care insurance.
Objective To analyze the medical expenses of public hospitals and provide a scientific basis for promoting expense control in public hospitals in China.Methods Gray correlation analysis was used to analyze the degree of correlation of outpatient and hospitalization expenses,and degree of structure variation was used to analyze the structural change of outpatient and inpatient expenses.Results In the composition of outpatient expenses,the expenses of western medicine accounted for the largest share,and the expenses of surgery and health materials accounted for a smaller share.The largest correlation of outpatient costs was the cost of health materials,and the smallest correlation was the cost of surgery.In outpatient expenses,the values of structural variation of examination expenses,treatment expenses and surgery expenses were positive and varied in a positive direction.The contribution rates of structural variation of western medicine expenses and Chinese medicine expenses were the most,both of which exceeded 48.10%.In the composition of hospitalization expenses,western medicine expenses accounted for the largest proportion,accounting for no less than 22.45%.The largest correlation of hospitalization costs was other costs,and the smallest correlation was western medicine costs.In hospitalization expenses,the values of structural variation of examination expenses,surgery expenses and health materials were positive and varied in a positive direction.The values of structural variation of western medicine expenses and Chinese medicine expenses were negative,and varied in a negative direction.The contribution rates of structural variation of western medicine expenses were the most.Conclusions The expenses of western medicine and Chinese medicine vary in a negative direction,and have a low correlation degree with medical expenses.The expenses of treatment and health materials vary in a positive direction and have a high correlation degree with medical expenses.The expenses of surgery account for a small proportion of medical expenses and have a low correlation degree.
Objective To verify the effectiveness of commercial medical insurance on suppressing poverty caused by health expenditure,and provide a basis for leveraging the role of commercial medical insurance in the multi-level medical security system.Methods Based on data of Chinese General Social Survey(CGSS),propensity score matching(PSM)was used to empirically test the impact of commercial medical insurance on poverty due to health expenditure,to further explore its mechanism.Results Households purchasing commercial medical insurance can significantly inhibit the incidence of poverty due to health expenditure.For example,incidence of poverty due to health expenditure among households purchasing commercial medical insurance was 4.1%lower than that in the family without commercial medical insurance.Conclusions Commercial medical insurance can inhibit the occurrence of poverty caused by health expenditure by increasing the stock of family health human capital,education human capital,financial capital and social capital.Moreover,commercial medical insurance plays a more significant role in alleviating the poverty due to health expenditure in areas with high insurance depth and agricultural registered household population.
Objective To forecast the total health expenditure and its composition in Henan Province from 2021 to 2027,and to provide the reference for relevant departments to formulate and improve health strategies in Henan Province.Methods Based on ARIMA model and GM(1,1)model,a combined model was established to predict the total health expenditure and its composition in Henan Province during 2021-2027 by using the data of total health expenditure and its composition in Henan Province during 2012-2020.Results The combined model had good fitting effect and was the best model.The model showed that from 2021 to 2027,the total health expenditure in Henan Province increased from 436.07 billion yuan to 730.58 billion yuan;the proportion of government health expenditure increased from 29.13%to 31.23%,while the proportion of social and personal health expenditure decreased from 41.35%and 29.52%to 40.2%and 28.56%,respectively.Conclusions The total health cost of Henan Province is increasing year by year.It is predicted that the total health cost of Henan Province will continue to grow steadily from 2021 to 2027.Henan Province still needs to attach great importance to the development of medical and health,and control the growth rate of health expenditure.
Objective To analyze the influence factors of pharmaceutical management level of urban medical groups in western regions,and to put forward the improved strategies to promote the high-quality development of pharmaceutical management level of medical groups.Methods The monitoring data were collected through the hierarchical diagnosis and treatment system platform of the Health Development Research Center of National Health Commission.SPSS 26.0 was used for data analysis,and the median(Interquartile Range),M(P25,P75)was used to describe the non-normal data.Wilcoxon rank sum test was used for comparison between groups.Results A total of 55 groups were included in the analysis.The M(P25,P75)of use ratio of drugs for centralized procurement in hospital groups was77.9(57.2,93.5).There was statistical significance in whether to establish a unified code for drug consumables and whether to develop an integrated clinical pathway for chronic disease management(P<0.05).The M(P25,P75)of ratio of hospital review prescriptions to total prescriptions in hospital groups was 11.3(6.0,17.5).There was statistical significance in whether to develop an integrated clinical pathway for chronic disease management(P<0.05).The M(P25,P75)of the utilization rate of essential drugs in inpatients in hospital groups was 94.07(81.6,97.3).There was statistical significance in whether the catalog of medicines was connected,whether drug purchase data was shared,whether a unified platform for drug consumables management was established,and whether continuous services of diagnosis,treatment,rehabilitation and long-term care were provided for patients(P<0.05).Conclusions The effect of pharmaceutical platform linkage between the leading hospital and its member units in the group is weak.The proportion of review prescriptions in total prescriptions is low,but the continuous construction of pharmaceutical services has shown initial results.The utilization rates of drugs for national centralized procurement and inpatients'essential drugs are high.
[目的]梳理影响"互联网+中医诊疗"发展的内部和外部关键因素,并对如何促进"互联网+中医诊疗"的发展提出参考意见.[方法]通过知情人访谈法、专家咨询法和优序图法确定"互联网+中医诊疗"的内部和外部因素评价指标,并以此为基础确定研究对象在IE矩阵中的区间位置.[结果]IFE矩阵中内部优势和劣势的加权分值分别为1.684 和0.839,IFE总加权分值为2.523;EFE矩阵中外部机会和威胁的加权分值分别为1.341 和1.374,EFE总加权分值为2.715.[结论]"互联网+中医诊疗"的内部和外部发展环境均处于IE矩阵的第V区间,适合采用以市场渗透为主的坚持和保持型发展战略.健全监管标准、推动技术创新、完善医保支付和加强人才培育有助于促进"互联网+中医诊疗"的高质量发展.
