目的:旨在探讨影响中医优势病种中药参与率及费用的相关因素,以期为更好发挥中医药优势提供参考.方法:数据选取自2019年1 月1 日—12月31 日北京市55家医院优势病种住院患者的信息.采用倾向性得分匹配法对提取的住院患者基本数据进行混杂消除,并运用χ2检验、logistic回归及贝叶斯网络模型统计方法分析中药参与率差异、影响因素以及影响程度.结果:共收集219 375例优势病种住院患者数据,其中有效例数193 810例.男性占比(54.10%)优于女性,41～80岁占比(61.27%)最高,患者以城镇职工基本医疗保险支付为主(45.22%),三级医院相较二级医院占比更高,住院0～7天患者占比(43.17%)最高;与不参与时相比,优势病种患者在有中成药参与时费用更高,有中药饮片参与时二级医院费用更低,三级医院更高;医院级别、类别、居住地、年龄、支付方式及住院日在4种中药参与率情况相比,差异具有统计学意义(P＜0.05);其中,医院类别、年龄和住院日是中药参与率的共同影响因素(P＜0.05).结论:优势病种中成药参与率及价格均高于饮片,两者占比不均衡,建议健全中医定价和补偿激励机制,并积极探索中医药特色诊疗技术,以提高中药使用率,并发挥其在中医优势病种治疗中的优势作用.

目的 建立可推广的公立医院财政分类精准补偿新机制,进而提高公立医院财政补偿的合理性、科学性.方法 假定拨款给公立医院的总财政资金一定,通过医院的规模、运营特点、盈亏情况、绩效考核计算医院财政拨款系数.综合规模值通过主成分降维得到,运营系数通过熵权TOPSIS综合评价得到,盈亏系数和绩效系数通过比例系数法得到.结果 运营系数大于 1 的医院类别有5类,分别为精神病医院(1.62)、老年医院(1.35)、传染病医院(1.15)、结核病医院(1.08)、妇产医院(1.03);盈亏系数大于 1 的医院类别有4类,分别为传染病医院(1.21)、妇产医院(1.03)、结核病医院(1.13)、精神病医院(1.02).结论 综合多方面因素,以系数化方法提出财政补偿新方案,符合高质量发展的政策需求.建议形成专门的财政补偿相关指标体系和财政补偿评估制度,实现科学、合理的财政精准补偿和动态调整机制.

目的:旨在比较中医优势病种在中医类医院和综合医院治疗的次均住院总费用的差异,探讨不同类型医疗机构住院治疗中医优势病种的费用特点.方法:数据选自北京市58家医院中出院时间在2016-01-01—2019-12-31 的优势病种住院患者信息,采用倾向性得分匹配法对提取的住院患者基本数据进行混杂消除.结果:共收集605 688例优势病种住院患者数据,结果发现中医优势病种整体上在综合医院的次均住院总费用高于中医类医院,中医优势病种在中医类医院的费用结构体现了中医诊疗的特点.结论:未来要积极推动中医优势病种按病种付费,充分考虑各病种特点,将费用结构调整重点放在医疗行为的调整和中医药优势的发挥上.

公立医院的公益性属性使其在控制医疗服务价格的同时还需保障医院的正常运营,因此,政府需要以多种形式对公立医院提供补偿.从我国公立医院补偿机制的现状出发,重点梳理了财政补偿、医疗保险基金、医疗服务价格之间的关系,并对比国外公立医院补偿机制,在总结我国公立医院补偿机制现存问题的基础上,对各项补偿之间的联动提出思考与建议.

This paper sorts out and analyzes the relevant policies of medical insurance payment in the field of traditional Chinese medicine issued by the national and regional health administrative departments, as well as the typical practices in various regions reported in newspapers, so as to provide a reference for deepening the reform of medical insurance payment methods in the field of traditional Chinese medicine. Retrieve documents on “reform of traditional Chinese medicine medical insurance payment”issued by various health administrative departments and news on “medical insurance payment of traditional Chinese medicine”and“payment of traditional Chinese medicine by disease type”published on the government website through the government website before January 15, 2022, and extract the key information from it. A total of 30provinces and cities have collected policy documents on traditional Chinese medicine medical insurance payment reform and typical practices in some regions. At present, the payment methods for traditional Chinese medicine diseases mainly include payment by disease, payment by diagnosis related groups, payment by diagnosis-intervention packet, and payment by curative effect value. There are differences in payment methods for different types of traditional Chinese medicine diseases. There are also some problems with different payment methods. It is recommended to strengthen research on price adjustment of traditional Chinese medicine, improve the disease database and surgical operation coding system with traditional Chinese medicine characteristics, and improve the positive incentive mechanism for medical institutions to provide traditional Chinese medicine services and medical insurance payments.

目的 在医疗服务项目成本数据的基础上,探讨公立医院政策性亏损补偿方案,提高补偿的科学性和精准性.方法 通过CRITIC权重和秩和比综合评价法对医疗服务项目展开综合评价,建立差异化补偿方案.结果 基于2017-2019年A市39家医院206 864个医疗服务项目的成本数据,分类后可见不同类别的医疗服务项目盈亏特点各异,护理类亏损项目占92.47%,而实验室诊断项目每服务量项均盈利4.56元.根据保本点、盈亏情况、成本价格偏离度、成本结构相关6项指标,各类项目政策性亏损补偿比例由高到低可划分为A、B1、B2、C 4个档次,据此展开分类补偿.结论 此补偿方案是对医疗服务项目成本的深化应用和政策性亏损精准补偿的有益探索,后续政策可根据补偿档次确定补偿比例,也可结合医院不同级别、类型亏损及自身管理差异继续完善.另外,建议整合医疗、医保、医药多方力量,实现财政补偿与价格政策协同联动,共同促进公立医院高质量发展.

目的 探究全国各级公立医院收入结构变化情况、财政补偿与盈余状况,为公立医院财政精准补偿提供数据参考.方法 运用结构变动度方法对2015-2021 年全国各级公立医院收入结构变化情况开展研究,并分析财政收入及盈余状况等信息,探索各级公立医院财政补偿特点.结果 从整体上看,2015-2021 年对我国各级公立医院总收入结构变动贡献最大的是医疗收入,其次是财政拨款收入.各级公立医院的财政拨款收入占总收入比重整体均呈现上升趋势,比重从大到小排序为一级医院、二级医院、三级医院.不含财政补偿的业务活动盈余的亏损程度总体上不断加剧,财政拨款收入对医院运营发挥着重要作用.结论 财政正逐渐加大对我国各级公立医院的补偿力度,应继续明确财政责任,在加大财政补偿力度的同时注重补偿效率的提升,重点对一、二级医院开展针对性的财政补偿,拓宽公立医院补偿渠道,加快配套措施改革.

Objective To provide a theoretical basis and decision-making reference for formulating,implementing,and adjusting policies of evaluation study of health financial policy.Methods This study used a policy modeling consistency(PMC)index model to conduct an empirical study of 15 selected health financial policies at the central level.Results Based on text mining,content analysis,expert argumentation,and relevant policy research results,this study constructed a PMC index model consisting of nine primary indicators and 40 secondary indicators.The empirical study found that the evaluation results of health financial policies were generally good,including 10 excellent and five qualified.Conclusion The health financial policies of China take into account various elements needed in the policy formulation process,including a rich variety of policy types,the use of multiple policy tools,and a high degree of policy standardization.However,there is still room for optimization.Therefore,this study puts forward relevant recommendations for the subsequent development and implementation of policies in China to be more scientific and effective.

目的:探讨中医实行按病种付费的研究现状、问题及路径,为中医药医保政策提供参考.方法:以"中医""按病种付费""按病种分值付费"或"DIP""按疾病诊断相关分组付费"或"DRG"为篇关摘,进行文献检索,剔除与本研究无关或相关性较弱的文献,梳理当前中医按病种付费的研究现状、存在的问题及建议,归纳总结中医按病种付费的实施路径.结果:现有研究探索了中医按病种付费的可行性,提出应探索符合中医特色的医保结算方式.目前我国多地试点中医DRG付费,但存在不少问题.未来可以对中医单病种付费展开深入探索,构建符合中医特色的DRG和DIP付费,多措并举实现中西医同病同效同价.结论:中医按病种付费能增加中医医疗机构提供中医药服务的动力,今后要在医保支付方式和病种分组方法中体现中医特色,推进中医医保支付方式改革.

目的:探究95个中医优势病种在综合医院和中医类医院(包括中医医院和中西医结合医院)的住院费用差异,为中医药医保支付方式改革提供数据参考.方法:收集2017—2019年47家医院的医保患者住院诊疗数据,根据ICD-10确定中医优势病种,统计中医优势病种在不同级别和类型医院中的总费用、住院天数和日均费用.结果:中医优势病种在综合医院的总费用高于中医医院、低于中西医结合医院,而住院天数低于中医类医院,日均费用高于中医类医院.中医优势病种的费用在不同类型、级别医院和不同病种之间存在差异.结论:由于医保支付方式对费用具有引导和控制的作用,建议在中医类医院施行DRG/DIP付费并且充分考虑医疗机构的实际情况.

目的:运用电子舌技术对炒制前后酸枣仁滋味进行定量表征,建立生、炒酸枣仁滋味判别模型.方法:采用电子舌技术对生、炒酸枣仁本身味道进行检测,通过配对t检验、主成分分析(PCA)、正交偏最小二乘法-判别分析(OPLS-DA)对获取的各味道特征值进行处理,分析酸枣仁炒制前后各味道的变化情况.结果:配对t检验显示,酸枣仁炒制对AHS(酸)、CTS(咸)、NMS(鲜)、ANS(甜)、CPS(通用)、SCS(苦)味值的变化均有影响,对PKS(通用)味值影响不明显,其中SCS、NMS、CPS、AHS、ANS味值上升,CTS味值下降,炒制对各滋味的影响程度为SCS>NMS>CPS>AHS>ANS>CTS>PKS;通过PCA可以区分酸枣仁与炒酸枣仁;通过OPLS-DA可以建立酸枣仁与炒酸枣仁滋味判别模型,该模型对X矩阵的解释率(R2X)=0.900、对Y矩阵的解释率(R2Y)=0.967、预测能力(Q2)=0.965,表明该模型拟合度、预测性良好.结论:电子舌技术可以从数值上客观化体现炒制对酸枣仁滋味的影响,可以对生、炒酸枣仁滋味进行鉴别,为生、炒酸枣仁差异研究提供数据参考.

为规范地方政府对当地食品安全的监管,我国于2019年提出地方特色食品的概念.通过对地方特色食品法规与欧盟相关政策进行比较发现,我国地方特色食品存在定义模糊的问题,建议将其定义修改为在我国部分区域存在30年以上传统食用习惯的、地方特有的食品原料或采用传统工艺生产的食品,包括涉及的食品安全指标或要求现有食品安全国家标准尚不能覆盖的食品.

目的 "互联网+医疗"政策对保障其产业的高质量发展具有重要指导意义,对产业政策的评价研究可以为政策进一步的制定和完善提供一定的借鉴和参考.方法 首先,利用RostCM6.0和VOSviewer软件对172项"互联网+医疗"政策文本进行挖掘分析,然后根据获得的高频词汇与高频词网络确定评价变量并构建政策一致性(pol-icy modeling consistency,PMC)指数模型.最后,对筛选出的14项具有代表性的政策进行实证研究,计算各自的PMC指数并绘制曲面图.结果 "互联网+医疗"政策总体制定较为合理,其中8项政策表现优秀,6项政策表现合格.结论 针对14项"互联网+医疗"政策存在的问题,本文着重从政策目标、政策工具和政策功能三方面进行具体分析并提出改进建议.

目的 文章基于政策工具,分析省级层面"公立医院高质量发展"政策文本特点,为政策优化完善提供参考.方法 构建基于政策工具、发展任务、中医涉及的三维分析框架,多维度结合进行量化分析.结果 纳入21份政策文本共形成2580条政策文本编码,供给型、环境型、需求型政策工具分别占22.44％、66.59％、10.97％;"激活公立医院高质量发展新动力""引领公立医院高质量发展新趋势""构建公立医院高质量发展新体系"3项任务中提及较多,分别占23.18％、20.89％、19.46％;明确提及中医的政策文本270条,占10.47％.结论 优化政策工具结构,提高均衡性、细致性;提高医院管理政策浓度,提升精细化水平;把中医的重要作用体现在政策条目上,提高重视程度.

Hepatocellular carcinoma (HCC) is the sixth leading cancer throughout the world and ranks fourth in cancer mortality. Necroptosis modulates tumorigenesis, metastasis, and treatment resistance. However, gene sets related to necroptosis in HCC are rarely analyzed. Hence, it is vital to assess the clinicopathological influence of necroptosis in a large HCC patient population. Our goal in this research was to develop a novel HCC prognostic indicator based on necroptosis. To that end, we examined 132 necroptosis related genes (NRGs) and recognized 36 differentially expressed NRGs (DE-NRGs) in the Cancer Genome Atlas (TCGA) cohort. Using both uni- and multivariate Cox regression models, we selected 4 NRGs, which can be employed to categorize HCC cases into low- or high-risk groups. Based on our survival analysis, the overall survival (OS) duration of high-risk cases was markedly shorter, in comparison with low-risk cases. We also verified using COX regression analysis that NRGs can serve as stand-alone prognostic indicators of HCC prognosis. Moreover, the area under the curve (AUC) of the combined prediction model was 0.807. Lastly, we also verified the validity of our model using the Gene Expression Omnibus (GEO) dataset. In summary, a state-of-the-art NRG-based HCC prognostic indicator is established to accurately predict the outcome of HCC cases to aid clinicians in the efficient planning and designing of personalized anti-HCC therapy.

This study adopted headspace-gas chromatography-mass spectrometry(HS-GC-MS) and electronic nose to detect volatile components from Myristicae Semen samples with varying degrees of mildew, aiming at rapidly identifying odor changes and substance basis of Myristicae Semen mildew. The experimental data were analyzed by electronic nose and principal component analysis(PCA). The results showed that Myristicae Semen samples were divided into the following three categories by electronic nose and PCA: mildew-free samples, slightly mildewy samples, and mildewy samples. Myristicae Semen samples with different degrees of mildew greatly varied in volatile components. The volatile components in the samples were qualitatively and quantitatively detected by HS-GC-MS, and 59 compounds were obtained. There were significant differences in the composition and content in Myristicae Semen samples with different degrees of mildew. The PCA results were the same as those by electronic nose. Among them, 3-crene, D-limonene, and other terpenes were important indicators for the identification of mildew. Bicyclo[3.1.0]hexane, 4-methylene-1-(1-methylethyl)-, terpinen-4-ol, and other alcohols were key substances to distinguish the degree of mildew. In the later stage of mildew, Myristicae Semen produced a small amount of hydroxyl and aldehyde compounds such as acetaldehyde, 2-methyl-propionaldehyde, 2-methyl-butyraldehyde, and formic acid, which were deduced as the material basis of the mildew. The results are expected to provide a basis for the rapid identification of Myristicae Semen with different degrees of mildew, odor changes, and the substance basis of mildew.

Background: Precision medicine provides medical solutions to stratified patients with personalised forecasting outcome as an important method of treatment in the medical field. This study aims at delivering a structured overview to carry out a bibliometric analysis of precision medicine retrospectively. Methods: The compilation of data and the use of bibliometric methods based on academic databases (Science Citation Index-Expanded and PubMed) from January 1, 2010, to December 31, 2019. Research outputs, countries, institutions, authors, major journals, cited papers, hot subject areas were analysed. Results: 8,566 papers related were identified (98.728% in English) covering 1,975 different journals. The papers were originated from 109 countries; the USA held the predominant contributors with 4,635 papers, China was on second with 925 papers. Conclusions: Precision medicine serves important purposes in clinical treatment, and widely used in the oncology, biochemistry, molecular biology field. The study summarised existing work and provided guidance for future research in this promising precision medicine area.