BACKGROUND:Research on whether Internet use is related to older adults' health service use is limited. Hence, this study aimed to empirically examine the associations between Internet use and the different types of healthcare utilization among Chinese older adults and whether there were urban or rural differences. METHODS:This study used large-scale nationwide data for Chinese older adults from the 2018 China Longitudinal Aging Social Survey (CLASS). The main explanatory variables were general Internet use and different types of Internet usage, including usage for communication, entertainment, and as instruments. The outcome measures included outpatient and inpatient care utilization, specifically examining the choice of health providers after an illness, the rate of outpatient care utilization after an illness, hospital admission, and the number of hospital admissions in the past two years. Logistic regression, zero-inflated negative binomial regression, and multinomial logistic regression were conducted to assess the associations between Internet use and healthcare utilization. Given the potential urban-rural disparities in Internet use, we applied an interaction term between Internet use and urban-rural status in each model to examine its moderating effects. The potential bias was addressed using the propensity score matching (PSM) method. RESULTS:Compared with older adults who did not use the Internet, Internet users had a lower probability of hospital admission in the past two years (OR: 0.63, 95% CI: 0.55-0.72), fewer hospital admissions (IRR: 0.80, 95% CI: 0.69-0.93), and a higher probability of choosing outpatient care in hospitals after an illness (RRR: 1.22, 95% CI: 1.01-1.47). Using the Internet for communication showed the strongest association with healthcare utilization among different types of Internet use. The urban/rural interaction term was negatively associated with outpatient care utilization but positively associated with inpatient care utilization. CONCLUSIONS:This study highlights the important role of the Internet in shaping healthcare utilization, particularly in addressing urban-rural disparities. Implementing Internet-based interventions among older adults is recommended to reduce disparities and improve healthcare access.

Family physician contract service (FPCS) was introduced by the Chinese government in 2016, which entailed the registration of individual patients with a designated family physician in primary healthcare facilities. To assess the yet-to-be realized impacts of incentives for family physicians on the performance of the FPCS policy in China, a qualitative semistructured interview was conducted in 2019 with 36 participants, including directors of local health commissions, leaders of primary healthcare facilities, family physicians, and nurses in eight community health centers in four cities deemed to have advanced and effectively implemented FPCS policies. The data analysis was guided by the framework method, which indicated the necessity of implementing a patient-based capitation system for FPCS and augmenting its financial allocation. The analysis further reveals a divergence in how incentives are perceived based on professional seniority: nonsenior physicians view financial incentives as a matter of livelihood and fairness, while senior physicians approach them strategically, weighing them against other professional activities. The independent distribution method was found to have the potential to enhance the motivation of family physicians in their work. A financing model that relies on health insurance payments may give rise to adverse selection concerns, as it could encourage the selection of healthier patients when making contracts. This issue can be effectively addressed through an innovative modification of the distribution method, whereby higher contract fees are assigned to individuals with more serious medical conditions. The implementation of nonfinancial incentives, including increased authority delegation, closer work relationships, and sufficient self-identification, has the potential to enhance the performance of the FPCS program. Consequently, it remains important to augment family physicians' income and enhance their sense of self-fulfillment in the implementation of the FPCS policy in China.

Objective From the perspective of two main tasks of constructing China’s medical quality management system and a new system of high-quality development of public hospitals, this paper studied the mechanism of national medical quality control center in the two systems, aiming to serve the efficient allocation of medical quality management resources. Methods The mechanism design theory was used to analyze the functional mechanism of national quality control center in the construction of those two systems, as well as the collaboration mechanism between national quality control center and other quality control organizations. Results The establishment of national quality control center is an institutional arrangement of medical quality management with Chinese characteristics, which meets the participatory constraints and incentive compatibility constraints from the perspective of mechanism design theory, and is an effective institutional arrangement. Conclusion In the construction of medical quality management system, national quality control center has played an important role as participating entities. In the construction of a new system of high-quality development of public hospitals, national quality control centers should develop in coordination with other centers, such as national medical centers and national clinical research centers, which will have a positive impact on the efficient allocation and balanced distribution of medical quality resources.

目的:探究健康中国行动政策网络结构特征随时间和层级变迁的演化规律,总结政策网络建设的成果和不足.方法:依托健康中国行动政策文本,基于"行动—部门"隶属关系构建健康中国行动政策网络,运用统计分析、整体网络分析、个体网络分析和核心—边缘分析挖掘不同时间阶段和行政层级的政策网络结构特征.结果:随着健康中国行动从酝酿布局阶段步入全面实施阶段,我国健康中国政策网络框架已基本确立,网络规模和协同格局逐渐明晰.国家政策网络已进入优化升级阶段,省级政策网络尚处于扩充完善阶段,且存在地域发展不均衡、行动兼顾不平衡的问题.结论与建议:基于行动和部门二维导向构建政策网络,从政策管理逐渐实现网络管理,加强地区经验交流和协同机制考核,提升省级整体建设水平和均衡程度,发挥核心部门和核心行动的带动作用,推动健康中国建设全局齐步推进,提升政策网络的整体效能.

Objective To study the connotation and development path of medical quality management in the new development stage in order to provide reference for the innovation and development of medical quality management. Methods To analyze the policy evolution and level expansion of medical quality management in recent years, and study characteristics of medical quality management in specific times from the perspective of management, so as to analyze and ensure the future development direction. Results In recent years, China’s quality management system has undergone significant changes. The main network of multi-level medical quality management and the "double sinking" quality management extension path have been formed. The new system framework shows the characteristics of system, integration and innovation. Conclusion Medical quality management should be integrated into the whole process of management, and be promoted step by step at different stages in various fields; a variety of quality process control means should be applied together, and be deeply integrated with informatization; medical quality management should be compatible with and in balance with economic benefits; paths and models to improve the level and ability of medical quality management should be explored; quality control systems should be further extended to primary healthcare organizations.

Objective To study the pathway and effect of homogeneity management of medical quality in urban compact medical consortiums. Methods From the perspective of comprehensive resource theory, this paper took Xining First Medical Group as an example and conducted in-depth study on its typical cases. It studied the implementation path of homogeneity management of medical quality in compact medical consortiums, and analyzed its effecting mechanism and significance in the improvement of capacity and efficiency of primary healthcare. Results Taking the urban compact medical consortium as a carrier, with the county medical quality homogeneity as the focus, Xining First Medical Group promoted the subsidence of quality healthcare and resources, and improved the capacity and efficiency of primary healthcare at the county level, realizing the hierarchical and orderly visits. Conclusion The innovation of organization mode and mechanism of urban compact medical association can help the homogeneity management of county medical quality. The homogenization of medical quality in the medical consortium plays an important role in improving the grassroots ability and overall service efficiency.

目的:对比分析健康中国战略实施前后我国慢性病政策、管理与服务领域的时间脉络、演进过程、研究前沿,以期对我国未来慢性病治理、卫生政策和服务领域的研究提供借鉴.方法:基于知识网络分析视角,构建慢性病研究关系—结构分析框架,以2010-2022 年间CNKI核心数据为研究样本,通过Citespace软件进行共词分析、中心性分析、聚类分析并绘制科学知识图谱.创新引入2016 年作为健康中国战略实施的分段节点,以政策变迁和研究变迁的视角对我国慢性病研究进行对比分析,从政策与研究关系的时序变化中探讨前后6 年间我国慢性病研究网络与演进机制.结论:慢性病具有"治疗"与"治理"的"双治"特征,并呈现出由"治疗"向"治理"转型的研究趋势,但我国现阶段慢性病政策、管理与服务研究在整个慢性病研究领域的地位仍需强化,知识网络关联度不强,未来研究应当进一步借助公共政策重塑慢性病研究格局,聚焦慢性病治理在公共管理领域的公共价值、范式演进、理论建构与实证检验.

BackgroundVaccination has been considered one of the most effective public health interventions. In the context of the global epidemic of coronavirus disease 2019 (COVID-19), it remains unclear what role general vaccination attitudes and perceptions have on the acceptance of COVID-19 vaccine.ObjectiveThis study aims to explore the impact of general attitudes and perceptions toward vaccination on the acceptance of a newly developed vaccine, taking COVID-19 vaccines as an example.MethodA cross-sectional survey was conducted among 2,013 Chinese adult participants. Generalized order logistic regression and path analysis models were used to analyze impacts of general attitudes and perceptions toward vaccination on the acceptance of the COVID-19 vaccine.ResultsThe prevalence of hesitancy to vaccination in general is 49.9% among the Chinese adult population. General perceptions of vaccination were associated with corresponding perceptions of the COVID-19 vaccine. A “no hesitancy” attitude toward vaccination is a significant determinant (aOR = 1.77, 95% CI = 1.36–2.31) of future COVID-19 vaccination compared to vaccine refusers, and perceptions of COVID-19 vaccine remain a significant determinant for the acceptance of the COVID-19 vaccine. Path analysis indicates that perceptions of the importance and safety of vaccination have a positive overall effect on the acceptance of the COVID-19 vaccine, and that general perceptions of vaccination as a whole on each measure indirectly influence the acceptance of the COVID-19 vaccine.ConclusionGeneral attitudes and perceptions toward vaccination were associated with those of the COVID-19 vaccine and future vaccination intention. To prepare for possible emergence of diseases in the future, routine health campaigns should be launched by relevant government departments and vaccination authorities to enhance the overall awareness and knowledge of vaccination among the public and to ensure optimal vaccination experience. In addition, targeted knowledge dissemination and mass mobilizations should be urged for newly developed vaccines when some specific infectious diseases emerge, such as COVID-19 at present.

专科联盟作为医疗联合体建设的4种组织模式之一,在公立医院高质量发展方面发挥着重要作用.文章分析了专科联盟与其他医疗联合体的特征差异,提出了专科联盟基于资源共享和优势互补的协同合作管理模式.通过分析福棠儿童医学发展研究中心的建设举措、成效和运行机制,进一步阐述了专科联盟管理的新模式及其在推动公立医院高质量发展中的作用机制和实现路径.

文章从分析英国公立医院治理的3个阶段入手,将英国公立医院治理主体分为政府部门、准政府公共机构和社会组织,并分别介绍各治理主体的职责.鉴于英国和我国在医疗服务体系组织模式上的相似性,提出我国公立医院治理部门在"有限政府"前提下,实现协同、确保目标一致性、提高治理能力和治理专业化水平.

分级诊疗背景下,城市医疗集团在带动公立医院高质量发展方面具有重要意义.城市医疗集团的组织模式、运行机制和绩效考评机制能够产生公立医院高质发展的内驱力,可以实现带动公立医院高质量发展的良好效果.通过对西宁第一医疗集团带动公立医院发展案例的深入剖析,验证城市医疗集团带动公立医院高质量发展路径选择和改革效应传导机制.

基于现有社会空间理论、数据科学发展与时空行为大数据实践的最新进展,本文从治理目标与功能方案的视角出发,提出时空行为大数据驱动的流动人群精准健康治理分析框架.通过对两个最新实践的比较分析,发现时空行为大数据通过简化数据分析层次和提升数据信息效率来捕捉人群行为中存在的时间累计效应、行为动态效应以及群体互动效应,有助于实现对于人群健康的实时追踪与预测,从而把控健康风险的复杂性、动态性和预测不确定性.同时,时空行为大数据的利用为健康治理与疾病预防控制体系向精细化、动态化转型提供了可能.

2021年6月,国务院办公厅印发的《关于推动公立医院高质量发展的意见》是新时期公立医院转型发展的纲领性文件,也对医疗联合体建设和发展提出了新目标新要求.文章从构建公立医院高质量发展新体系入手,剖析医疗联合体建设在高质量发展中的战略定位,构建"政策属性、适用范围、适用类别、治理范畴、动力来源"多维分析框架,对政策文本进行分析并发现在19类政策内容中有17项内容适用于医疗联合体、有15项需要注重改革、16项需要注重发展、18项需要注重管理、12项需要注重服务,在明确政策要求的基础上,提出了医疗联合体推动公立医院高质量发展实现路径的5个方面政策建议.

驱动型绩效理论是借鉴企业绩效发展规律、根据公立医院的特点和功能定位而提出的,是一种新型的绩效管理理念,它具有“自上而下”“驱动改革”“3层结构”的特点.在引入公立医院的过程中,注重目标导向、结构调整和增量驱动、层层对应和试点竞争的机制,综合运用科学、适宜的绩效工具构建社会效益和经济效益并重的绩效指标体系,以驱动公立医院改革发展目标的顺利实现.

公立医院绩效管理在深化医改和推动医院发展方面具有重要的战略意义.驱动型绩效管理具有特别的绩效管理理念,能够产生驱动改革发展的良好效果.通过对北京市二龙路医院的驱动型绩效管理实施的案例研究,在验证改革效果的基础上进一步分析其战略平台效应和具体的传导机制,并对驱动型绩效管理中的关键问题作了讨论与总结.

健康中国战略建设是推进国家治理体系和治理能力现代化的重要组成部分,是一项复杂的系统性工程,需要构建良好的协同治理体系加以推进.文章基于协同治理理论,构建健康协同治理模型,区分了服务提供、健康政策、社会参与3个子系统,分析了子系统内部与子系统之间协同关系构建的关键问题,并进行总结与进一步讨论.

目的:分析家庭医生签约对于社区居民自付医疗费用的影响,探讨签约对缓解居民医疗费用负担的成效.方法:2019年7—9月在厦门、杭州、上海、北京分别选择两个社区卫生服务中心所在街道的居民,根据调研时最新的家庭医生签约率,采用多阶段整群随机抽样的方法获取样本1508人.医疗费用以基层医疗卫生机构次均就诊费用、次均住院费用以及年医疗总费用(均为自付)为指标,采用两部模型分析家庭医生签约对医疗费用的影响.结果:签约家庭医生的社区居民相较于未签约居民医疗服务利用率(尤其是基层医疗机构服务利用率)显著提高,但是没有显著影响次均就诊费用和年医疗总费用;降低了住院服务利用率,并且次均住院费用减少了673元.结论:家庭医生可以促使基层首诊、分级诊疗格局的形成,但是其作为医疗费用守门人的职责还需进一步加强.这需要进一步提升基层医疗机构和家庭医生服务能力,加强团队间的协作,完善与上级医疗机构或者专科医生的合作机制,突出医疗保险的杠杆作用.

合理的家庭医生执业规模是保障签约群体获取基本医疗保障、提高医疗服务利用效率的有效方式.基于2019年在厦门、杭州、上海以及北京等地对在岗和可远程参与诊疗的420名家庭医生的调查发现:家庭医生执业规模上升,则其每日接诊人数、签约居民就诊次数占总门诊比例、月接诊患者总费用和接诊患者次均费用呈增加趋势,但平均接诊时间在减少;相同执业规模对于不同机构的家庭医生诊疗行为以及接诊患者的医疗费用的影响也有差异.所以,家庭医生执业规模应设计在一个相对合理的区间,从而保证生产率和服务质量的平衡.另外,家庭医生的执业规模应该与医疗保险补偿相联系,以减轻患者疾病经济负担,提高基本医疗保障水平.

目的:解决跨区域政策性人口迁移带来的医疗保障权益损失、保障待遇衔接不顺及基金区域平衡等问题.方法:根据"以支定收"原则进行测算,确定雄安新区职工医保筹资与待遇机制.结果:未来10年,雄安新区医保在"6+2"筹资标准模式下,医疗费用按照北京现行职工标准待遇支出能够可持续运行.结论:跨区域迁移人口可通过"以支定收"测算原则,充分考虑人口结构构成、经济社会发展和医疗保障功能定位等因素,尊重迁入职工的医疗保障权益,做好保障待遇衔接.

推进医疗服务价格改革是价格机制改革和深化医药卫生体制改革的重要内容.北京医耗联动综合改革是北京市医药分开综合改革的不断深化,是完善医疗机构补偿机制的又一次改革.从政策体系的多源理论视角,以政策制定过程中的3大来源(问题源流、政策源流和政治源流)为切入点,系统梳理和分析北京医耗联动综合改革政策的制定过程,为完善医耗联动综合改革政策提供参考.