Background:Comorbidities may complicate the treatment of pulmonary tuberculosis and exacerbate both the clinical and economic burden. We aimed to examine comorbidity patterns, spatial clustering, and economic burden in hospitalised pulmonary tuberculosis (PTB) patients in Guangdong Province, supporting targeted prevention strategies. Methods:Based on the Hospital Discharge Records Database of Guangdong Province from 2016 to 2024, we collected data on hospitalised PTB patients to analyse the characteristics and temporal trends of comorbidity spectra. We used Global Moran's I and local indicators of spatial association analyses to examine the spatial clustering patterns of major comorbidity pairs. Generalised linear models evaluated the impact of comorbidity count and spatial clustering patterns on economic burden among hospitalised PTB patients. Results:A total of 646,114 hospitalised PTB patients were included from 2016 to 2024, of whom 66.42% had at least one comorbidity. Hypertension (HTN), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD) were the top three comorbidities among hospitalised PTB patients. Spatial analysis indicated that high-high clusters of PTB-HTN were mainly concentrated in the central Pearl River Delta; high-high clusters of PTB-DM in eastern Guangdong and low-low clusters in western Guangdong. High-high clusters of PTB-COPD were primarily located in eastern and northern Guangdong, while low-low clusters remained relatively stable in several cities of the Pearl River Delta region. Among hospitalised PTB patients, the number of comorbidities was significantly positively associated with both direct and indirect economic burden (P < 0.001), with economic burden progressively increasing as the number of comorbidities increased, and the impact of spatial clustering patterns on economic burden exhibited heterogeneity across different comorbidity types. Conclusions:The burden of comorbidities among hospitalised PTB patients in Guangdong Province is substantial, with significant spatial clustering characteristics closely linked to direct and indirect economic burden. It is recommended to incorporate regional comorbidity epidemiological characteristics into PTB comorbidity management and resource allocation optimisation. In addition, both direct medical costs and productivity losses should be considered in prevention and control strategies to reduce the socioeconomic burden associated with PTB.

Dementia prevention is an urgent global health priority in aging populations. Mild cognitive impairment (MCI) presents a key window for intervention, where cognitive training can effectively slow progression to dementia. There remains a need for implementation strategies that activate primary healthcare providers (the first point of contact) to deliver such interventions. This study aims to evaluate a multi‑component implementation strategy (enhanced training, financial incentives, and leadership engagement) to promote the delivery of cognitive training for elderly with MCI by family doctor teams in primary care. This study employs a hybrid type 3 effectiveness-implementation cluster-randomized trial. Guided by the Multiphase Optimization Strategy (MOST) framework, a 2 × 2 × 2 factorial design is used to examine the main effects and interactions of three intervention components (enhanced training, financial incentives, and leadership engagement), thereby generating empirical evidence for optimizing the implementation strategy. It will be conducted across 16 community health centers (CHCs) in Beijing, targeting family doctor teams as the primary intervention units. The active intervention will last 6 months, followed by a 6‑month observational follow‑up to assess sustainability. The primary outcome is the initiation of cognitive training delivery by primary healthcare providers (change from non‑delivery to delivery). Secondary outcomes include providers’ self‑efficacy, patients’ cognitive function, beneficiary coverage, and implementation‑related measures. This study will inform the integration of cognitive training into routine primary care, support the design of community-based dementia prevention strategies, and contribute to promoting healthy aging. The findings will provide actionable evidence for policymakers engaged in active dementia prevention and control globally. The study was registered with the Chinese Clinical Trial Registry ChiCTR2600116108. Registered 05 Jan 2026.

BACKGROUND:Tuberculosis, caused by Mycobacterium tuberculosis, remains a leading global health issue, especially in developing countries. In China, tuberculosis prevention efforts have increased, but the disease still imposes significant economic burdens. Guangdong Province, with its dense population and high mobility, faces substantial challenges in tuberculosis control. This study analyzes hospitalization costs and influencing factors to improve resource allocation and policy-making. METHODS:This retrospective study analyzed the data from the first page of medical records in Guangdong Province, including Tuberculosis patients hospitalized in Guangdong Province from 2017 to 2023. Data covered demographics, hospitalization details, and regional classification. Statistical methods included normality tests, chi-square test, Mann-Whitney U and Kruskal-Wallis H tests, and visualization tools such as Sankey charts. Structural variation and new gray relational analyses assessed the relationship between changes in hospitalization costs and each individual cost. Multivariate regression analyzed significant variables affecting costs, and the Prophet model predicted future trends by fitting cost data from 2017 to 2023. RESULT:The study included 410,484 hospitalization records of tuberculosis patients, with a median cost per hospitalization of 8,548.30 RMB. The Pearl River Delta region had higher healthcare costs and longer hospital stays, possibly due to more comorbidity patients. Structural variation analysis and new gray correlation analysis showed that diagnostic and western medicine fees had the main contribution to changes in hospitalization costs. Multivariate regression analysis showed that hospital class drug resistance and surgery were the main factors affecting hospitalization costs. The Prophet model predicted that hospitalization costs would decrease over the next three years due to improved Tuberculosis control measures and policy adjustments. CONCLUSIONS:This study reveals the economic burden and regional differences of hospitalized Tuberculosis patients in Guangdong Province. Diagnostic costs and western drug costs are the main factors contributing to changes in hospitalization costs, with hospital class, drug resistance and surgery being the main influences, while hospitalization costs will decline over the next three years. Therefore, investing in primary care to improve local healthcare access, empowering providers to manage tuberculosis effectively, optimizing treatment policies, expanding health insurance coverage, and enhancing drug-resistant patient treatment are critical to reducing financial burdens and improving tuberculosis control.

INTRODUCTION:Integrated primary care is advocated worldwide to address the increasing health needs of patients. Inter-professional collaboration (IPC) among family doctor teams (FDTs) aim to provide integrated primary care in China. This study explored how healthcare professionals in FDTs perceive and practice IPC. METHODS:We conducted face-to-face semi-structured interviews with 43 participants from six FDTs, including general practitioners (GPs), nurses, and public health physicians. The interviews were recorded and transcribed, and the transcripts were thematically analyzed. RESULTS:The analysis revealed three themes: notions, key activities, and elements of IPC in FDTs. Although the concept of IPC varied among interviewees, there were a few commonalities. There was IPC in the delivery of basic medical services (daytime outpatient services and knowledge exchange) and public health services (signing contracts with patients, chronic disease management, health examinations for the elderly, and electronic information entry). The seven elements of IPC include shared goals and vision, communication, leadership, familiarization and trust, time and space for interaction, formalization tools, and incentive mechanisms. CONCLUSIONS:IPC in FDTs in Chinese primary health settings is in the stage of development. We recommend inter-professional competence education for all professionals, adequate interactive space and human resources, supporting cultural environment in primary health institutions (PHIs), and a collaboration-oriented incentive system for FDTs in China.

Catastrophic health expenditures (CHE) severely impact families, especially in the context of respiratory diseases and tuberculosis. This study evaluates the determinants of CHE and construct nomogram prediction, with a focus on the diverse impacts of regional disparities and income levels in Guangdong Province, China, drawing from the National Health Services Surveys (NHSS) conducted in 2013 and 2023. To evaluate the determinants of catastrophic health expenditures (CHE) among individuals with respiratory diseases and tuberculosis in Guangdong Province, China, using data from the 2013 and 2023 National Health Services Surveys, and to develop and validate nomograms for predicting CHE while assessing the roles of regional disparities, income levels, and other socioeconomic factors. This multi-year, cross-sectional study utilized data from two NHSS in Guangdong Province. The study population consists of individuals aged 15 years and above with respiratory diseases or tuberculosis in Guangdong Province. CHE was defined as medical and health expenditures exceeding 40% of non-food household expenditures. We employed stepwise logistic regression analyses to identify the determinants of CHE and developed nomograms for prediction, with the Receiver operating characteristic (ROC) curves and the area under the curve (AUC), calibration plots, and decision curve analysis (DCA) utilized to evaluate the predictive accuracy and practical applicability of the models. Mediation analysis was conducted to assess the roles of income and age between regional disparities and the occurrence of CHE. The incidence of CHE was relatively stable in 2013 (13.5%) and 2023 (13.6%). Significant risk factors included increasing age [OR: 2.615 (1.681, 4.069)], having other chronic diseases [OR: 1.921 (1.177, 3.133)], living in northern Guangdong region [OR: 2.043 (1.204, 6.466)], and insomnia almost every day [OR: 2.843 (1.345, 6.013)], while protective factors included higher income [OR: 0.204 (0.046, 0.918)], being widowed and divorce [OR: 0.120 (0.035, 0.415)] and so on. The mediation analysis highlighted income as a crucial mediator between region and CHE occurrence. Nomograms showed good predictive ability with areas under the curve (AUCs) ranging from 0.844 to 0.884 for training datasets across different survey years and the decision curve analysis (DCA) showing excellent clinical benefits. The study highlights the significant effect of regional disparities and socioeconomic status on CHE in Guangdong Province. Income played a pivotal role in mediating these effects, emphasizing the need for targeted economic policies to reduce the burden of health expenditures. The developed nomograms offer practical tools for predicting CHE, aiding healthcare providers in resource allocation and decision-making.

The growing body of research on the effects of physician-patient sex concordance on healthcare delivery across various medical settings has yielded highly heterogeneous results, with limited evidence from low- and middle-income countries (LMICs). This study aims to examine the impact of physician-patient sex concordance on both the quality of care (treatment outcomes and 30-day readmission rates) and medical expenditure (total expenditure and specific fee categories) among hospitalized patients with acute myocardial infarctions (AMI) in China. Using hospital administrative data (2018-2022) from a tertiary general hospital in Eastern China, we focus on the patients with a primary discharge diagnosis of AMI to achieve the random matching between physicians and patients (n = 1299). Our findings indicate that 70 % of AMI patients were treated by surgeons of the same sex. The patients in the physician-patient sex concordance group incurred significantly higher hospitalized expenditure, primarily in medication and surgery expenditure, with no significant increase in diagnostic expenditure. Physician-patient sex concordance was associated with an average increase of 2.3 days of hospitalization and a 4.37 percentage point increase in the copayment rate. However, no significant improvement in quality of care was observed. These findings provide a foundation for future research on the underlying mechanisms driving disparities in healthcare delivery due to physician-patient sex concordance, which is critical for the deep understanding of gender equity in health care.

Quantitative methods for estimating the workload of primary healthcare (PHC) workers are essential for improving the performance of PHC institutions. However, measuring the workload of PHC workers is challenging due to the diverse and complex range of services covered by PHC. This study aims to use an equivalent value (EV)-based approach to assess the workload of PHC workers and inform policymakers about the current workload burden in Beijing, China. The EV-based workload assessment system was designed by three main steps: identifying the list of essential PHC service items provided by PHC workers, quantifying the EV of each service item, and calculating the corresponding workload for PHC workers and community health centers (CHCs). The study included 18 CHCs, which were divided into three groups based on population density and topography: Group I (eight urban CHCs), Group II (six CHCs in semi-mountainous areas), and Group III (four CHCs in mountainous areas). Data were collected from local health information system, which automatically collected real-time service volume data for 500 PHC service items at 18 CHCs in the sample district in Beijing from 2017 to 2021. This study identified 503 essential PHC service items and defined their EVs. The theoretical full-capacity workload per PHC worker was 6024 EVs, serving as the base workload. The actual annual workload per PHC worker was 7240.0 EVs during 2017–2021. The base workload per budgeted position for the three types of CHCs was 6468.6 EVs for Group I, 5268.5 EVs for Group II, and 5038.7 EVs for Group III. Compared with the actual workload of 7702.3 EVs, 6568.3 EVs, and 5979.0 EVs in each group, respectively, all PHC workers in the sample district were overburdened during the study period. The EV-based method provides a feasible solution for comprehensively assessing the workload of publicly funded PHC institutions in other regions. This study offers valuable insights to help local policymakers understand the workload burden of PHC workers, objectively evaluate their performance, and guide future health workforce planning.

Background: Job burnout is particularly prevalent within the healthcare sector, with public health practitioners (PHPs) being especially vulnerable. The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been profound, yet the prevalent level of job burnout among PHPs following the crisis has been largely overlooked. This study aims to assess the prevalence and determinants of job burnout among PHPs in the post-COVID-19 era, thereby providing a theoretical foundation for the development of targeted interventions. Methods: This cross-sectional survey was conducted from July to October 2023, targeting members of the Center for Disease Control and Prevention and the Public Health Service Center in Baoan District, Shenzhen. A non-random convenience sampling was employed to recruit 222 participants. Demographic and work-related information was compiled. Job burnout was assessed with Chinese revised version of the Maslach Burnout Inventory-General Survey. Binary logistic regression analysis was employed to identify factors influencing job burnout among participants. The mediation effect was tested using the bias-corrected percentile Bootstrap method with 5,000 resamples. Results: The prevalence of job burnout among the PHPs was found to be 50.90%, with rates of mild, moderate, and severe burnout at 27.03, 15.32, and 8.56%, respectively. Multivariable analysis indicated that self-rated mental health (OR = 0.436, 95% CI: 0.230, 0.827), workload intensity (OR = 5.183, 95% CI: 1.751, 15.340), and the family support for work (OR = 3.313, 95% CI: 1.335, 8.222) were significantly associated with burnout (p < 0.05). The PHPs exhibiting poorer self-rated mental health, higher workload, and lower family support for work were at greater risk of job burnout. The mediation analysis revealed that elevated workload indirectly increased the likelihood of burnout (indirect effect = 2.931, 95% CI: 1.111, 4.750), exhaustion dimension (indirect effect = 2.801, 95% CI: 1.115, 4.486) and cynicism dimension (indirect effect = 2.977, 95% CI: 1.127, 4.826) by exacerbating mental health deterioration. Conclusion: Job burnout has emerged as a common concern among the PHPs in the aftermath of the COVID-19 pandemic. To effectively address burnout, it is crucial to develop effective intervention measures aimed at mitigating risk factors, ultimately enhancing the well-being of the PHPs.

BACKGROUND: With China’s rapidly aging population, addressing the health management of mild cognitive impairment (MCI) in community settings has become crucial for dementia prevention. This study focuses on developing an integrated primary care intervention (IPC) within primary care system to support home-dwelling older adults with MCI and explore the underlying barriers based on the Consolidated Framework for Implementation Research (CFIR) to the implementation and further scale up of the IPC intervention. METHODS: This study employs a hybrid effectiveness-implementation research type II design. The randomized controlled trail will be conducted to evaluate the IPC intervention for older adults with MCI through primary care networks. The intervention group receiving 16-week family doctor contract services (including online cognitive training, enhanced health management, and usual care) and the control group receiving usual care only. Effectiveness will be measured through changes in participants’ cognitive function (primary outcome), self-efficacy and quality of life (secondary outcome), complemented by cost-effectiveness analysis. Implementation factors will be examined through the CFIR before and during the intervention process. DISCUSSION: This study is expected to demonstrate the effectiveness and implementation of the IPC intervention in managing older MCI adults within primary care setting. The implementation analysis will identify key factors for scaling up the intervention within China’s primary care system, including necessary policy adjustments and training requirements for primary care providers. The findings will provide both practical guidance for China’s dementia prevention strategies and contribute to global knowledge about implementing community-based cognitive health interventions in primary care settings. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2500099744. Registered 27 March 2025.

Limited knowledge has been found on the policies of dementia prevention and control from low- and middle-income (LMIC) countries. This study aims to provide comprehensive evidence of policy progress regarding dementia prevention and control in mainland China by scoping review on the basis of seven priority areas proposed in The Global Action Plan on the Public Health Response to Dementia 2017–2025. We searched the websites of China State Council, National Health Commission, Ministry of Civil Affairs, National Development and Reform Commission, National Healthcare Security Administration and National Administration of Traditional Chinese Medicine for all policies regarding dementia. The keywords included Chi Dai (dementia), A Er Ci Hai Mo (Alzheimer’s), Ren Zhi Zhang Ai (cognitive impairment) and Shi Zhi (dementia), and the search covered materials published by 15 April 2023. Policy diffusion analysis, policy reference network analysis and thematic framework analysis were used to analyse the policy contents. The number of national policies for dementia prevention and control in mainland China increased significantly during 2015–2022. The National Health Commission was responsible for the most policies, while the State Council was responsible for the most important ones. A total of 50 departments were involved in the development of policies for dementia prevention and control, but the stable collaborative relationship among them needs further strengthened. In terms of WHO dementia global action plan, the topic of “dementia as a public health priority” was strongly emphasized, while the areas of “dementia research and innovation” and “information systems for dementia” were less focussed on. Some policy gaps, including priority arrangement, multisectoral cooperation and policy implementation, must still be addressed in the future to support the interests of people with dementia and their caregivers more effectively.

Vertical integration is one possible way to improve the performance of a healthcare system; however, its effects are inconsistent, and there is a lack of evidence from undeveloped nations. This study aims to systematically review the evidence regarding effects of vertical integration on healthcare systems in China. We searched PubMed, Embase, Cochrane Library, Web of Science, ProQuest Health & Medicine Collection, China Knowledge Resource Integrated Database and Wanfang databases from April 2009 (initiation of new healthcare reform) to May 2021 for randomized controlled trials (RCTs), controlled before and after (CBA) trials, cohort studies and interrupted time series (ITS) trials. Vertical integration in the included studies must involve both primary health institutions and secondary or tertiary hospitals. After screening 3109 records, we ultimately analysed 47 studies, including 27 CBA trials, 18 RCTs and 2 ITS trials. The narrative synthesis shows that all but three studies indicated that vertical integration improved efficiency (utilization and cost of health services), quality of public health services and medical services, health provider-centred outcomes (knowledge and skill) and patient-centred outcomes (patients' clinical outcomes, behaviour and satisfaction). Despite the heterogeneity of vertical integration interventions across different studies, the meta-analysis reveals that it lowered diastolic blood pressure (mean difference (MD) -8.41, 95% confidence interval (CI) -15.18 to -1.65) and systolic blood pressure (MD-5.83, 95% CI -9.25 to -2.40) among hypertension patients, and it lowered HbA1c levels (MD -1.95, 95% CI -2.69 to -1.21), fasting blood glucose levels (MD -1.02, 95% CI -1.53 to -0.50) and 2-hour postprandial blood glucose levels (MD -1.78, 95% CI -2.67 to -0.89). The treatment compliance behaviour was improved for hypertension participants (risk ratio (RR) 1.08, 95% CI 1.04-1.13) and for diabetes patients (RR 1.32, 95% CI 1.08-1.61). Vertical integration in China can improve efficiency, quality of care, health provider-centred outcomes and patient-centred outcomes, but high-quality original studies are highly needed.

目的:分析发展型人力资源管理实践对公立医院医务人员创新绩效的影响,以及心理授权和组织认同在其中的中介作用.方法:基于发展型人力资源管理实践量表、创新绩效量表、心理授权量表和组织认同量表对北京市公立医院1 898 名医务人员开展问卷调查.利用Amos 23.0 软件构建结构方程模型进行中介效应检验.结果:北京市公立医院医务人员的发展型人力资源管理实践、心理授权、组织认同和创新绩效两两之间呈显著正相关;发展型人力资源管理实践会影响创新绩效,总效应为0.605,其中直接效应值为0.205,占总效应的33.88%.同时存在一 条间接影响路径,即心理授权的独立中介作用,其中介效应值为0.377;而组织认同的中介效应不显著.结论:发展型人力资源管理实践会直接或间接地通过心 理授权影响公立医院医务人员的创新绩效,提示公立医院管理者在提高创新绩效时要尤为重视发展型人力资源管理的作用,并且需特别注意提高医务人员的心理授权.

Background Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020–2021. Methods It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis. Results The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%−51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively. Conclusions Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.

Objective: To analyze the characteristics and shortcomings of China’s manpower policy of integrated medical and nursing care services in home communities, and put forward policy suggestions for improvement of manpower. Methods: Based on a sample of 31 manpower policies integrating medical and nursing care services in home communities issued by national-level departments in China between January 2013 and September 2021, the study analyzes policy texts within the analytical framework built on the six modules of human resource management. Results: The policies are of good synergy and poor operability. Policies and measures focus on talent development, talent introduction, security and mobility are moderate, and talent incentive policies are insufficient. The relevant provisions of integrated medical and nursing care manpower in home-based communities are integrated under the policy framework of integrated medical and nursing care manpower, and lack specialized and targeted policies. Conclusions: It is necessary to further refine and improve supporting policies, formulate special policies related to the integration of medical and nursing care in home-based communities, and continuously improve talent incentive policies.

目的:对2013年以来国家层面发布的居家社区医养结合服务筹资相关政策进行分析.方法:以"医养结合""居家社区"等为关键词检索国家卫生健康委、民政部等相关政府部门官方网站2013年1月—2021年9月发布的政策文件;对纳入政策文本进行编码和主题框架分析.结果:共纳入28项相关政策,国家卫生健康委参与发文最多(19项),其次为民政部(14项).纳入政策涉及的筹资主题包括财政经费支持(14项)、保险制度(基本医疗保险、长期护理保险和商业保险)(19项)、社会资本(10项)、投融资和财税价格政策(5项)以及其他(福利彩票和社会捐赠)(3项)五类主题.现有居家社区医养结合服务筹资政策的资金筹集和风险分摊功能亟待提高.结论:国家应从顶层设计层面进一步明确国家、社会和个人在居家社区医养结合服务筹资的责任,加强资金风险分摊原则,以实现充足、可持续的筹资目标;加强对不同举办主体机构筹资政策安排的均衡性,确保社会资本和公立基层医疗机构的有效参与;同时注意加强政策内容的可操作性和具体化,促进政策落地与实施.

中国面临日益严峻的老龄化趋势,居家社区医养结合服务成为我国实现健康老龄化的主要策略之一.本文从健康老龄化理念出发,简要介绍了国内外应对健康老龄化的发展趋势,重点分析了我国医养结合服务政策进展、居家社区医养结合服务实践及发展面临的挑战,为我国进一步促进居家社区医养结合服务发展、实现健康老龄化目标提供决策支持.

目的:对北京市丰台区居家医疗服务的政策环境和开展过程进行研究,为相关政策制定提供参考.方法:采用文献法、访谈法、非参与式观察法收集定性定量数据.结果:北京市丰台区具有较好的"国家—市—区"级政策环境,资金补贴及"居委会—社区卫生服务中心双进入"机制,有效推动了居家医疗服务的开展.课题组共观察了 28例患者的居家医疗服务,服务提供者以护师为主(70.0％),服务对象以高龄失能、半失能老年人为主(71.5％),服务内容为置换尿管(64.3％)、胃管(28.3％)等安全性较高且适合居家进行的医疗服务.结论:在良好的政策环境下,北京市丰台区居家医疗服务工作取得了一定成效,未来可通过完善医保政策、价格、支付保障机制和建立信息平台,进一步促进居家医疗服务的高质量可持续发展.

Until the 1980s, institutional elder care was virtually unknown in China. In a few decades, China had to construct a universal social safety net and assure basic elderly care. China’s government has been facing several challenges: the eroding traditional family care, the funding to assure care services for the older population, as well as the shortage of care delivery services and nursing staff. This paper examines China’s Five-Year Policy Plans from 1994 to 2020. Our narrative review analysis focuses on six main topics revealed in these policies: care infrastructure, community involvement, home-based care, filial piety, active aging and elder industry. Based on this analysis, we identified several successive and often simultaneously strategic steps that China introduced to contend with the aging challenge. In Western countries, elder care policies have been shifting to the home care approach. China introduced home care as the elder care cornerstone and encouraged the revival of the filial piety tradition. Although China has a unique approach, the care policies for the aged population in China and Western countries are converging by emphasizing home-based care, informal care and healthy aging.

Introduction:Implementing integrated care for the aged population has been regarded as a mechanism to achieve healthy ageing. However, evidence from undeveloped nations has been scant. This study aims to explore the integrated care experience in Anhui and Fujian Province of China based on the Rainbow Model of Integrated Care (RMIC).Methods:The qualitative study was conducted in Anhui (in the middle area) and Fujian Province (in the eastern area) between May and September in 2018. The interviewees included twenty-eight policy makers working at departments of health and civil affairs at different levels and seventeen heads of medical and elderly care institutions.Results:The preliminary progress of integrated care in the sample cities of two provinces are mainly shown at solid policy basis by multiple key government agencies and political commitment achieved (system integration); preliminary coordination mechanism established between medical and elderly care institutions (organizational integration); consolidation of multi-disciplinary collaboration (professional integration); and reinforced role of family doctor teams for community-home dwelling elderly (service integration). Main challenges are also identified at insufficient inter-agency coordination, weak service capacity, lack of sustainable funding schemes, low level of information integration, and shortage of professional supply.Conclusion:Our findings provide a feasible path for other countries to strengthen integrated care for the aged population, particularly for those confronting rapid population ageing but with fragmented health care and elderly care systems.

Objective This paper systematically analyzes the policies related to the home-community based integrated medical and elderly care issued by Beijing since 2013.Methods Relevant policy documents released from Ja-nuary 2013 to September 2021 on the website of the Beijing Municipal Government were retrieved; Bibliometric and subject content analysis of the included policies were conducted.Results A total of 51 policies were included, with 51,36,34,17,and 15 texts covering service delivery, financing, leadership governance, device technology, and information systems, respectively.Among the 26 independent documents issued by departments, the Beijing Municipal People’s Government issued the most documents, accounting for 18（69.23%）;among the 25 jointly issued documents, two departments and three departments or above jointly issued 5（20.00%）and 20（80.00%）.The home-community integrated medical and elderly care in Beijing’s communities was mainly based on long-term care insurance, especially the development of commercial long-term care insurance; Beijing mainly provided medical care services for the disabled and semi-disabled and other key elderly groups; it focused on establishing a departmental coordination mechanism and had a clear division of labor.Conclusion Beijing should further improve the multiple financing mecha-nism of the home-community integrated medical and elderly care, and pay attention to the introduction of supporting incentive measures, focus on prevention first, increase the attention to community-based elderly care for ordinary el-derly people, and improve the multi-department coordination mechanism, in order to ensure the gradual establishment of the home-community integrated medical and elderly care service system from the policy level.