Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high-level hospitals with primary health services. This study aimed to evaluate the performance of the urban medical group using the triangular value chain framework. Methods:The evaluation was conducted using the Donabedian model, focusing on three key dimensions: safety and quality, accessibility, and affordability. Longitudinal data were collected from 2016 to 2022 through government annual reports, the medical insurance bureau, and hospital information systems. Preprogram and postprogram outcome measurements were compared to assess differences and trends, providing a clear picture of the program's effectiveness. Results:Accessibility improved significantly, with the number of hospital beds per 1000 residents increasing from 2.62 in 2017 to 3.76 in 2022. The availability of general practitioners (GPs) also rose markedly, from 0 per 10,000 residents in 2017 to 6.27 in 2022. Regarding safety and quality, the proportion of complex medical procedures conducted within the New District expanded substantially, from 7.35% in 2017 to 38.11% in 2021. Additionally, there was an enhancement in the standardized management rate of chronic diseases. Affordability assessments showed that the proportion of medical income derived from the medical insurance fund increased by nearly 22.81 percentage points between 2012 and 2021. By 2021, 75.02% of medical patients were covered by medical insurance, representing an increase of approximately 44 percentage points from 31.19% in 2012. Conclusions:The implementation of the urban medical group in Dapeng New District has led to substantial improvements in healthcare accessibility, safety and quality, and affordability. Future initiatives will focus on advancing the "Dapeng Mode" to generate exemplary healthcare outcomes and minimize disparities in basic health services and health status between urban and rural populations. The reform agenda includes piloting payment reforms and innovative payment models within the Dapeng group, complemented by a health assessment and performance incentive system aimed at encouraging healthcare institutions to prioritize health management.

Objectives:Aging anxiety is not only a health issue but also a stress response to the structural risk of insufficient medical resources. This study aims to reveal the impact of aging anxiety on individual healthcare utilization and the complex psychosocial mechanisms behind it. Methods:Based on large-scale data from the 2021 Chinese General Social Survey (CGSS), the study employs a Double Machine Learning (DML) method to build a causal inference model. The random forest algorithm is used to estimate the marginal effect of aging anxiety on healthcare utilization. The robustness checks and placebo tests are conducted to further verify the model's stability and validity. Finally, heterogeneity analysis explored the differential impact of independent variables across groups by age, education, household health status and kid number. Results:Aging anxiety has a significant positive effect on healthcare utilization (β = 0.110, t = 4.895). It mediates through multiple pathways including healthcare accessibility anxiety (β = 0.344, t = 16.904), affordability anxiety (β = 0.384, t = 19.845), physical deterioration (β = 0.160, t = 7.286), psychological pessimism (β = 0.175, t = 7.819), sleep disorder (β = 0.104, t = 6.124), and self-efficacy loss (β = 0.160, t = 5.595). Heterogeneity analysis shows significant differences in this effect across groups with different socio-demographic characteristics and health statuses, reflecting variations in medical demand and anxiety responses among populations. Conclusion:To alleviate anxiety related to medical resource shortage and promote healthy aging, a multidimensional response system is needed. This includes improving medical insurance, advancing primary healthcare management, enhancing health literacy, and building family-community support networks. Policy design should emphasize the synergy between psychosocial factors and institutional frameworks, providing theoretical and empirical support for equitable, inclusive healthcare utilization and sustainable health development.

Background This study aims to compare hospitalization costs between traumatic brain injury (TBI) and non-traumatic brain injury (non-TBI) patients with disorders of consciousness (DoC) to explore cost determinants.Methods A retrospective analysis was conducted on 210 DoC inpatients admitted to Shenzhen Longcheng Hospital, a tertiary rehabilitation hospital located in China's Pearl River Delta region, between 2015 and 2020. Patients were categorized into TBI (n = 44) and non-TBI (n = 166) groups based on etiology. Demographic, clinical, and hospitalization cost data were collected for each patient. The study compared the cost composition for DoC patients by etiology and used multivariate analysis to identify factors influencing hospitalization costs.Results The median length of stay (LOS) and cost for TBI patients were 363.5 days and $57,366.05, respectively, while for non-TBI patients, the medians were 280.5 days and $57,117.64. Across both groups, the highest cost components were rehabilitation, medication, and treatment expenses. Factors associated with higher hospitalization costs included non-TBI etiology, local residents, medical insurance, LOS, self-employed, surgical treatment, and traditional Chinese medicine (TCM) intervention.Conclusion Hospitalization cost structures were similar across etiologies, emphasizing value-driven care priorities. Key factors associated with higher hospitalization costs included non-TBI etiology, local residency, medical insurance, LOS, self-employment status, surgery, and TCM. These findings highlight key drivers of healthcare costs in DoC care, emphasizing the need for targeted policy interventions. However, given the limitations of this study, further research with larger, more diverse samples is essential to comprehensively assess the impact of costs on patient outcomes and care quality.

ObjectiveIn China, patients requiring intensive rehabilitation often face a gap between acute treatment and sub-acute rehabilitation. This study evaluates the composition and determinants of post-acute hospitalization costs in stroke patients with disorders of consciousness (DoC).MethodsData from 133 stroke patients with DoC who underwent inpatient rehabilitation at a tertiary hospital from 2015 to 2020 were collected, including demographic characteristics, clinical features, and hospitalization costs. Descriptive statistical analysis and univariate analysis were performed, followed by path analysis and Bootstrap mediation tests to explore factors influencing hospitalization costs.ResultsThe median hospitalization costs were $56,860.80. Rehabilitation costs accounted for the largest proportion of total hospitalization costs (36.55%). Direct factors influencing total costs included payment method, admission to the intensive care unit (ICU), pulmonary infection, and length of stay (LOS) (p < 0.05). The effect sizes ranked in descending order were LOS, ICU experience, payment method, and pulmonary infection. Bootstrap mediation tests revealed significant mediation effects (p < 0.05) of payment method, occupation, patient origin, hypertension, ICU experience, and death on total costs, indicating that these factors indirectly influenced costs by affecting LOS.ConclusionGreater attention should be given to meeting the rehabilitation needs of patients by expanding resources for intensive rehabilitation and ensuring continuous rehabilitation services. Comprehensive and effective measures should be implemented to address cost-influencing factors early, without compromising the quality of care.

Some regions in China have already implemented capitation payment or capitation budget management for medical insurance funds. However, there remains a shortage of adequate tools and methodologies to accurately quantify differences in population health risks. Therefore, this paper constructs a health performance assessment model that comprises four steps. The first step is to categorize all participants into health risk groups based on whether they have contracted with a family doctor, their age, sex, and the type of consultation. The second step is to categorize health risk groups based on differences in healthcare resource utilization. The third step is to analyze health performance by examining healthcare resource utilization year over year. The fourth step is to apply the assessment results to assist local finance bureaus and medical insurance bureaus in developing incentive schemes. According to cost weights, the health risk groups are split into six classes: insured residents without health care visits, healthy insured person, slightly ill insured patients, ill insured patients, more seriously disease patients, and severely ill insured patients. We evaluate one compact medical community's health performance by examining changes in the proportion of resource usage group size and expense. From 2019 to 2021, both the proportion of patients with severe and ultra‐severe diseases and the proportion of costs in the sample increased, according to changes in resource utilization levels. This result indicates that the population's overall health has not improved and that the compact medical community is still primarily focused on treating diseases, with poor implementation of health maintenance measures and minimal improvement in health performance.

近期,职工基本医保个人账户和门诊共济制度改革引起了公众的普遍关注. 个人账户是中国医保发展初级阶段的试验项目,这是由中国国情决定的.1998年,国务院《关于建立城镇职工基本医疗保险制度的决定》规定设立了职工基本医疗保险个人账户,将个人缴费(工资的2％)和用人单位缴费(工资的6％)的30％计入个人账户,用于支付在定点医疗机构发生的门诊医药费用和住院医药费用的自付部分,没有社会互济功能,支付能力不足.

现代医学始于人类具有造纸和文字记载能力之后.公元前5世纪,名医扁鹊总结了望、闻、问、切四诊法.古希腊西方医学之祖希波克拉底在其《希氏文集》第70卷的医学观察记录和病理说中提出做"有利和尊重(保密)患者"的事情,成为医疗伦理的奠基石.其后经历了文字、数字、数据、信息、智能、能力的人类智慧发展过程,特别是在20世纪70年代以后人类进入计算机时代,完成了从数字到数据的生产过程,计算机工程师与相关领域专家合作,大大推动了信息化、人工智能化的发展,人类预测、决策和社会生产能力得以快速提高.

目的:分析宁夏各市医疗资源配置情况,为促进该地区医疗资源公平配置提出建议.方法:以2021 年《宁夏统计年鉴》相关数据为基础,运用基尼系数和区位熵运算方法做数据处理,观察宁夏各市医疗卫生人力资源和物力资源的配置公平性.结果:宁夏基尼系数的人口维度各项数值在0.03-0.15 之间,属于高度公平区间,基尼系数的地理维度各项数值处于0.19-0.45 之间,其中卫生技术人员、执业医师、执业(助理)医师和注册护士基尼系数数值>0.4,资源配置差距较大;医疗资源区位熵结果中,石嘴山市各项指标区位熵>1,资源配置最为公平,其余四市在人口和地理维度的区位熵均<1;基层医疗资源的区位熵结果中,银川市人口维度区位熵<1,吴忠市、中卫市地理维度区位熵<1.结论:宁夏医疗资源空间分布不均衡,具体表现为南北两地差异明显,同时面临医疗资源人力总量配置不足,应针对地理和人力两方面的配置不公平给予相应的医疗政策、资金等倾斜,促进宁夏医疗资源的高质量均衡发展.

基本养老金是保障退休家庭基本生活的准公共产品.20世纪70年代以后,伴随人口老龄化和人口结构的变化,各国基本养老金的财务可持续性遇到问题.本文通过对1972年以来养老金改革国际文献知识图谱研究发现,柔性政策成为各国养老金改革的主流策略.本文归纳了全球养老金改革的柔性政策的时期线索、主要内容、主要特征和主要做法,由此构成养老金柔性政策运行矩阵.中国与时俱进地完成了养老金三支柱的制度安排,但与公平、效率和可持续的养老金高质量发展尚有距离.本文回顾现行基本养老保险和企业年金文献并找到制度刚性渊源,有针对性地提出增加政策柔性的建议,包括:为中小民营企业和灵活就业人员参保减负、降低企业年金门槛的雇主供款计划、雇主供款计入职工个人养老金账户一并管理等.

广西柳州市在国内率先形成了依据中医病种结算数据制定的中医病种医保支付标准.这对鼓励中医医疗机构积极采用中医疗法,促进中医药发展具有重要意义.本文基于柳州市全市医疗机构住院结算数据,对柳州市中医优势病种按病种分值付费的医保支付方式改革进行评估.结果显示,经过严格遴选的中医病种的服务可及性逐步提高;对于脊柱退行性改变病种,中医治疗组的成本管理总体优于西医治疗组;对于下呼吸道感染性疾病,中医治疗组的成本管理还有待进一步加强;中医治疗能够较好地控制药费和检查费用的增长,其患者体验较好、医疗安全和质量有保障.本文还总结了柳州市中医病种支付方式改革经验,并提出了进一步完善中医病种分值医保支付改革的政策建议.

在《社会保险法》实施12年之际,《社会保险经办条例》(以下简称《经办条例》)出台,将于今年12月1日实施.社会保险属于准公共产品,其经办包括政务服务和社会治理,要将管理寓于服务,对人讲服务、对事讲管理.社会保险公共服务覆盖全体国民的一生,是服务型政府建设的最大项目.在经济转型、人口老龄化和推进共同富裕的新时期,完善我国社会保险制度既要强化政府责任,也要建立利益相关者之间的协商机制,才能推动制度创新,有效应对挑战."三分政策、七分执行",《经办条例》的颁布和实施将推动社会保险公共服务进入讲公平、求效率和确保可持续发展的法治时代.

Prolonged disorders of consciousness (pDoC) severely affects the patients' survival and quality of life, and causes an extremely heavy disease burden. At present, considerable resources and studies have focused on the acute care of patients with pDoC, and substantial progress has been made in detecting, predicting and promoting recovery of consciousness, but there is little research on post-acute rehabilitation outcomes and care. In views of this, we reviewed the definition, epidemiological surveys, clinical symptoms and diagnosis criteria of pDoC, summarized the associated factors, interventions and nursing regarding rehabilitation outcomes of pDoC. Then, we put forward the following recommendations relevant to future research and practice in China: (1) improving the epidemiological data related to pDoC to provide data for relevant decision-making; (2) studying and applying new technologies to interventions for pDoC rehabilitation, and integrating clinical practice, rehabilitation prediction and prognostic management; (3) further identifying key elements and trajectory for pDoC recovery to reduce the uncertainty of prognostic outcomes due to excessive disease duration; (4) establish a continuity of care system based on the pDoC rehabilitation trajectory from acute transition, sub-acute to chronic period to improve the quality of and access to care and achieve continuous improvement in the quality of care; (5) systematically reforming the current care system to further improve the continuity of care system that contributes to rehabilitation, and strengthening the participation of the patient's family, community, disability agencies and other stakeholders besides the multidisciplinary team and the cooperation between them. It is hoped that we can provide insights into the development of research and clinical practice of pDoC in China.

规定退休年龄是政府机关人事管理制度之一,很多国家的公务员在退休离开政府之后选择去做自己喜欢的事情.对于企业职工而言,绝大部分国家只规定领取法定养老金的年龄,体现对劳动者权利的保护.早年很多西方国家对领取养老金者却继续工作者,规定了扣减养老金的政策.20世纪70年代以来,大部分发达国家进入了中度人口老龄化社会,建立早减晚增的养老金领取机制成为积极应对人口老龄化的重要措施之一.

银色经济是百岁人生的大概念,即按照国民不断增长的拥有健康财富的需求,通过制度创新克服生产、分配、流通和消费中的约束条件,实现供需平衡、代际和谐与共同服务的社会活动的总称.银发经济是小概念,主要指事业行业产业适老化发展,以解决"63婴儿潮"和"一孩家庭"一代人的养老服务刚需.

2022年,在中国进入中度人口老龄化社会之际,国务院办公厅印发《关于推动个人养老金发展的意见》(下称《意见》),意义重大. 建立健全国家三支柱养老金体系(基本养老保险、企业/职业年金、个人养老金),将个人缴费、企业供款、政府补贴三个来源的养老金记入社会统筹基金(现收现付、社会互济、非市场化)和个人账户(长期积累、市场化)两个账户,从而提高国民养老金总和替代率,是积极人口老龄化战略的重要组成部分.

从2013年国务院发布了《关于加快发展养老服务业的若干意见》到2021年中共中央、国务院颁布《关于加强新时代老龄工作的意见》,我国养老服务体系建设的发展战略日渐清晰,凸显出"健康老龄化"和"三类产品"的亮点.为此,需要建立个人、社会和政府的三维责任制.围绕"家"文化品牌、"刚需"产业链和"5-4-3有效需求"定价模型三个要素,实现行业产业和企业适老化发展.

我国构建整合型医疗服务体系需尽快完善急性后期康复护理服务体系和医保支付配套措施.本文介绍美国、英国、日本等国的急性后期康复护理服务经验,并与国内先行探索地区经验进行对比,提出健全以功能评价为依据的统一康复诊疗规范,搭建三级康复护理医疗服务网络,完善基于急性后期发展阶段的多元化复合型支付方式等建议.

目的:评估按疗效价值付费的政策效果.方法:选取6个病种的患者作为研究对象,从医疗质量、成本和患者体验三个维度对柳州市中医优势病种按疗效价值付费的政策效果进行探讨.结果:柳州市中医优势病种按疗效价值付费政策具有低成本、高疗效和体验好的特点,但也存在住院时间过长、可选病种十分有限等问题.结论:柳州市应重点推进信息化建设,以可操作性为前提选择病种实行按疗效价值付费,并构建多维的医疗质量评价体系.

2020年,中共中央、国务院出台的《关于深化医疗保障制度改革的意见》引领我国医疗保障进入2.0发展时期,并提出建立"管用、高效"的医保支付机制.本文基于全球医保改革的视角,运用卫生经济、结构分析、案例分析等方法对医保支付机制进行研究,描述了病组分值点数付费和结余留用机制抑制过度医疗、紧密型医共体人头加权总额付费和健康绩效评估促进转型的作用机理.管用机制重在管理和控制,高效机制重在调动当事人积极性与绩效考核,由此形成医保支付二元结构及其整体方案,以及从以治疗为中心转向以健康为中心的实施路径.同时,本文进一步描述了总额预算管理、病组分值点数付费、人头加权预算、健康绩效评估几个关键词的核心内容.

中国已进入深度老龄化社会,启动了个人账户制养老金计划,以提高国民养老金总和替代率.本文实证分析结果表明,养老金替代率每提高1％,国民平均预期寿命将增长0.028岁,养老金与国民健康具有内在联系.商业年金保险潜在消费者问卷调研的统计结果显示,中年消费者购买商业年金保险的意愿更强,关联健康保险和长期护理保险的理性消费偏好特征明显,追求物有所值.因此,在第三支柱个人养老金市场发展的条件下,商业年金保险在产品研发和营销方式上要融合健康保险、长期护理保险、就诊服务高端客服等,按照生命周期为客户及其家庭制定嵌入健康元素的理财计划和提供理财服务.商业保险公司要在组织架构、产品研发平台、营销模式、客服信息系统、人才培养等方面创新发展,抓住第三支柱养老金市场发展的机遇.