ISSN 2097-4205 CN 31-2200/R
Objective Based on Present Xi Jinping’s interpretation of high-quality development, which emphasizes five concepts as innovation, coordination, green, openness and sharing, this paper aims to define the connotation of high-quality development for public hospitals and provide policy recommendations to support the advancement of China’s healthcare system. Methods From August to November 2023, semi-structured interviews were conducted with 42 participants, including hospital executives, department heads, and frontline clinicians from three tertiary grade-3A public hospitals in Jiangsu and Shandong provinces. The interview data were then analyzed using grounded theory. Results A total of 81 initial concepts and 21 categories were identified through coding. These were further condensed into eight core categories: party building leadership, personnel incentives, clinical diagnosis and treatment, research and education, integration of medical care and public health, social responsibility, physician-patient experience, and regional status. Based on these categories, a pathway model for achieving high-quality development in public hospitals was constructed. Conclusions The connotation of high-quality development of public hospitals from the perspective of medical professionals can be categorized into three dimensions: party building leadership and personnel incentives as prerequisites; clinical diagnosis and treatment, research and education, integration of medical care and public health, together with social responsibility as action strategies; and the enhancement of the regional status and physician-patient satisfaction as target outcomes. Compared with the five concepts, this connotation reflects the requirements of “innovation” “coordination” and “sharing”, while the aspects of “green” and “openness” remain insufficiently represented.
Objective This study aims to analyze the establishment of weight management centers and outpatient clinics in China’s public hospitals, providing scientific evidence to enhance obesity prevention and control management. Methods A literature review and expert consultations were conducted together with the existing obesity management guidelines and policies to design a questionnaire. The online questionnaire survey combined with qualitative interviews were carried out then to explore the construction pathways and operational models of these centers and outpatient clinics in public hospitals. Results Among the 1 340 sampled hospitals, 20.0% had established weight management centers and clinics operated in three main models. Among these centers and clinics, 75.0% were weight management outpatient clinics; 17.9% were affiliated centers, and 7.1% were independent ones. Generally, independent centers were led by the Department of Surgery, while outpatient clinics and affiliated centers were mainly run by the Department of Endocrinology. The primary benefits of establishing weight management centers and clinics lied in promoting disciplinary development, enhancing hospital reputation, and increasing hospital revenue. The main obstacles for those hospitals failing in setting up weight management centers and clinics included the lack of construction standards, insufficient medical professionals, concerns about patient volume, unclear operational models, and restrictions from medical insurance reimbursement policies. Conclusions The establishment of weight management centers and outpatient clinics in China’s public hospitals stays in the exploratory phase. For future development, efforts could be made in policy support, hospital self-development, and assistance from enterprises.
Objective To establish a high-quality development evaluation index system for tertiary public hospitals in Shandong Province, quantitatively assess the development across 16 cities in the province, and formulate targeted optimization strategies for hospital quality improvement. Methods The literature review method and Delphi method were used to establish evaluation indicators for the high-quality development of tertiary public hospitals in Shandong Province. The entropy weight method was used to calculate their weights of these indicators, focusing on tertiary public hospitals across various cities in the province from 2019 to 2022, and the Technique for Order Preference by Similarity to Ideal Solution method was then applied to evaluate the high-quality development level of tertiary public hospitals across various cities in the province for 2022. Results An evaluation index system for the high-quality development of tertiary public general hospitals was established in Shandong Province, consisting of 6 primary indicators and 32 secondary indicators. Notably, the first-level indicator “leading new trends in high-quality development of tertiary public hospitals” accounted for the largest weight (48.49%). In the regional high-quality development ranking of tertiary public hospitals in Shandong Province, the eastern cities of QD, JN, and DY ranked 1st, 2nd, and 3rd, respectively, while the western cities of DZ and BZ ranked 15th and 16th. In the evaluation across three key dimensions— “leading new trends in high-quality development of tertiary public hospitals”, “building a new system for high-quality development of tertiary public hospitals” and “enhancing the efficiency of high-quality development”—JN ranked 1st, 3rd, and 1st; QD placed 4th, 1st, and 6th; ZB ranked 6th, 13th, and 13th; ZZ hit 3rd, 12th, and 16th; and DY came in at 15th, 2nd, and 9th, respectively. Conclusions The constructed evaluation index system for tertiary public hospitals’ high-quality development can be used to quantitatively assess the development level of tertiary public hospitals across regions in Shandong Province, where the high-quality development shows a decreasing trend from east to west. This evaluation index system provides a scientific framework for these hospitals’ high-quality development, and the results offer insights for the coordinated development of the regional healthcare system.
Under the Healthy China Strategy, the rapid aging of the population and the rising prevalence of chronic diseases have made the development of health security systems for individuals with pre-existing conditions a critical issue. This article explores the necessity of advancing pre-existing condition insurance by reviewing existing practices and research. It delineates the design logic of pre-existing insurance across four aspects: positioning, development foundation, risk control, and policy support, highlighting the necessity and feasibility of applying inclusive insurance principles and models. The paper identifies key challenges hindering the development of pre-existing condition insurance, including product availability, data accessibility, industry integration and policy support. It is recommended to optimize the development strategy of pre-existing condition insurance by encouraging product innovation and increasing supply, promoting data sharing and deeper integration between health insurance and the medical/healthcare sectors, leveraging technology to reduce operational costs, strengthening policy support, and elevating social recognition.
The speedy development of China’s data factor market gives the prominence to the value of healthcare data. However, the lack of foundational institutions and supporting mechanisms severely constrains the deeper exploitation of its value. This study analyzes the core issues in the opening and utilization of healthcare data from multidisciplinary perspective by systematically reviewing national and local policies, regulations, and exemplary data governance practices. It aims to construct a multi-dimensional collaborative governance framework and provide a reference for establishing China’s healthcare data governance system. The findings reveal five major challenges in current healthcare data governance: ambiguous definition of data ownership, lagging ethical governance mechanisms, weak security protection capabilities, unclear pathways to assetization, and the absence of equity distribution mechanisms. The paper proposes pushing the boundaries of the current fragmented, single-centered governance model to unleash the synergistic governance of multiple mechanisms including institutions, ethics, security, value, and incentives. The enhanced data circulation efficiency and public value outcomes require systematic coordination of institutional design, technological tools, and public governance.
Objective To explore the challenges of the coordinated development of health care big data in China and put forward optimization strategies, so as to provide a reference for further improving the empowerment of health care big data and improving medical service efficiency. Methods The data were collected through literature review, policy analysis, and key informant interview. Coding analysis was carried out in combination with the synergistic framework (SFIC model) and grounded theory, to construct a collaborative development model of health care big data in China, and explore the collaborative challenges in depth. Results After three levels of coding, 22 initial categories, 10 main categories and 4 core categories were summarized. The coding results, combined with the SFIC model, revealed that the collaborative development model of health care big data in China includes four aspects: starting conditions, facilitative leadership, institutional design, and collaborative process. The development of health care big data in China faces the following issues: difficulties in eliminating information barriers, a lack of high-quality talents and technologies, the need for stronger inter-agency cooperation, an imperfect power and responsibility mechanism, and challenges in policy implementation. Further, gradual improvement of top-level design but limited guidance from supporting policies, a lack of a multi-agent coordination mechanism, and poor integration across various stages are clear. Conclusion In response to the weak starting condition, insufficient facilitative leadership, imperfect institutional design, and collaborative challenges in the development of health care big data in China, the corresponding collaborative paths are proposed: focusing on the real data connectivity to consolidate the collaborative foundation; improving the power and responsibility mechanism to strengthen policy implementation; advancing top-level design to build a systematic and holistic supporting policy framework; optimizing the collaborative process at each stage to reinforce the supervision of the whole process.
Objective To analyze the characteristics and evolution of Shanghai’s palliative care policies, examine the current policy’s role and challenges, and offer recommendations for future policy development. Method A content analysis method was adopted to systematically review palliative care policies issued in Shanghai from 2006 to 2024, focusing on policy-issuing bodies and the policy instruments employed. Results The development of palliative care policies in Shanghai has progressed through four main stages: the initial stage, the self-exploration stage, the rapid development stage, and the adjustment stage. The responsible party for the policy were mainly the district-level health commissions (69.52%), with extensive participation from diverse stakeholders including universities and hospitals. The primary policy instruments identified were supply-oriented and environment-oriented ones, with emphasis on resource allocation (50.88%), technology and infrastructure (24.56%), legal supervision (27.41%), and entity collaboration (20.00%). Conclusions Shanghai’s palliative care policies have evolved from pilot stages to broader implementation and optimization, with a growing diversification in both policy instruments and implementation bodies. Future policies should prioritize technological innovation and inter-department collaboration to address the challenges posed by an aging population and rising healthcare demands.
Objective To examine the cognitive status and influencing factors of grief counseling within family doctor team members at community health service centers in Shanghai, and offer insights for refining palliative care services, enhancing grief counseling skills training, and establishing a multidisciplinary collaboration mechanism for community grief counseling. Methods A stratified random sampling method was adopted to select 20 community health service centers with over 10 palliative care beds for each. Standardized scales were used to assess grief counseling attitudes and skills among 337 family doctor team members (29 doctors and 308 nurses). Multiple linear regression analysis was applied to identify the influencing factors. Results The total score for grief counseling attitudes was 39.76 ± 8.82 (score rate: 79.6%), with primary factors including education level, frequency of contact with those bereaved, work years, professional title, and trainings (all P<0.05). The total score for grief counseling skills was 18.79 ± 4.78 (score rate: 59.2%), significantly influenced by education level, trainings, and frequency of contact with those bereaved (all P<0.05). Conclusions The grief counseling competency of family doctor team members requires improvement. Systematic training programs, multidisciplinary collaboration, and resource integration through community health service platforms are recommended to enhance service quality.
Objective To construct a scientifically rigorous and operationally feasible evaluation index system for sports and health cities, tailored to the characteristics of Shanghai as a megacity, in response to the Healthy China initiative. Methods Based on the“Integrated Theory of Health Behavior Change”, this study used a literature review to identify an initial set of 44 indicators for the evaluation index system. Using the Fuzzy Delphi Method(FDM) and Fuzzy Analytic Hierarchy Process (FAHP), questionnaires were designed and then distributed to experts for feedbacks, which was used to iteratively revise the indicators. The internal consistency of expert ratings was assessed using Cronbach’s α coefficient. The index system’s theoretical fit was validated with the Kaiser-Meyer-Olkin (KMO) test and Bartlett’s Test of Sphericity. Results Through two rounds of expert consultation, screening, and consistency testing, the study constructs an evaluation index system for Shanghai, consisting of 3 first-level, 11 second-level, and 37 third-level indicators. The weights for the three first-level indicators—Sport-Health Governance, Health-Enabling Urban Environment, and Social Health Ecology—are 20%, 50%, and 30%, respectively. Conclusion The proposed three-dimensional evaluation framework—“Sport-Health Governance, Health-Enabling Urban Environment, and Social Health Ecology”—aligns with national strategies, balances institutional rigidity with environmental flexibility, and provides a paradigm for health governance in densely populated cities.
Objective To understand the number of the Bill & Melinda Gates Foundation (hereinafter referred to as “Gates Foundation”) global health projects and the flow of funds, and to provide decision-making reference for China and other global health actors to better cooperate with the Gates Foundation in terms of funding investment and allocation. Methods The objectives, sectors, years, amount of funds, recipient countries, and themes of Gates Foundation global health projects from 1998-2022 were extracted from the Gates Foundation Committed Funds Database. Latent Dirichlet Allocation Clustering Analysis (LDA) was used to determine a new theme for each project. Based on this, a longitudinal and cross-sectional analysis was then conducted to analyze the number and fund amounts of projects. Results The amount of global health projects peaked at \$2.47 billion in 2015, followed by a significant decline. The majority of global health projects were allocated to tropical diseases in Africa (\$6.24billion, 19.7%), pandemic preparedness (\$6.19 billion, 19.5%), and AIDS and tuberculosis (\$6.13 billion, 19.3%). Low-income countries had the largest disparity in funds distribution across themes (27.9%), while high-income countries had the smallest disparity (10.2%).Conclusions The allocation of global health funds by Gates Foundation is volatile. The themes have gradually shifted from infectious diseases to pandemic preparedness. Variations in funding priorities across low- and middle-income countries may potentially pose challenges to global health equity. China should work toward developing a mature model through improved fund management, optimized cooperation strategies, strengthened project oversight, and enhanced multi-stakeholder collaboration, to support greater participation of developing countries in global health initiatives.
Objective To fully understand the maturity pattern of the domestic magnetocardiography (MCG) industry and predict its development trends, in order to inform the formulation of industrial development plans and provide recommendations. Methods A questionnaire-based industry maturity assessment was conducted to determine the development stage of MCG device maturity. Patent literature data on MCG devices were analyzed using the patent indicator evaluation method and the S-curve method of the technology life cycle. The maturity evaluation model was applied to assess the industrial development status of MCG devices in terms of technology, manufacturing, products, and markets. Results The domestic MCG product has reached the fourth stage of maturity—market-ready stage. Its market maturity remains at the first stage, indicating that engineering prototypes have entered the market and created a new market segment. The industrial maturity of domestic MCG instruments is at the second stage, signifying that competitive MCG products have been introduced to the market with high expectations. Domestic MCG devices entered their growth stage in 2019 and have not yet reached the maturity. Conclusions MCG products remain in the growth phase. The industry is still in the cultivation stage and requires supportive policies for further development.
Objective To explore the establishment of an evaluation index system of innovative medical equipment applicable to the scenarios of medical institutions from the perspective of medical engineering, in order to enhance the clinical application of innovative medical equipment from various dimensions, and to provide insights for the configuration of innovative medical equipment in medical institutions. Methods Through literature review, group discussion and expert consultation, a preliminary evaluation index system of medical engineering for innovative medical equipment was constructed, taking magnetocardiographic equipment as an example. Using the improved Delphi method, 13 experts in related fields were invited to judge the importance and weight of the indicators, and further improve the included indicators. Results The recovery rate of the questionnaires for the 2 rounds of expert correspondence was 100%, the expert authority coefficient (Cr) = 0.94, and the coefficient of variation of the expert ratings for all the indicators after the 2 rounds of correspondence was less than 0.25. The finalized evaluation index system of medical engineering for innovative medical equipment includes 6 first-level indicators (ease of use, reliability, applicability, technical service accessibility, product innovation, and readiness), 15 second-level indicators and 46 third-level ones. Conclusion The evaluation index system established by the improved Delphi method has a certain reliability, which provides an application tool for the evaluation of innovative medical equipment configuration in medical institutions.
China’s biopharmaceutical industry, a strategic emerging sector, is vital to national welfare, economic development, and security. Recent years have witnessed its rapid growth with the Yangtze River Delta region emerging as a key hub. This article analyzes the development models and competitiveness of the industry across the Delta region by examining their current status, spatial distribution, and policy orientations. The analysis reveals that the Delta’s biopharm industry presents a hierarchy pattern with the feature that Shanghai acts as a frontrunner;Jiangsu is a supporter; Zhejiang has achieved its breakthrough; and Anhui acts as a pursuer. Disparities exist in their industry scales. Consequently, the study proposes strategic recommendations to promote high-quality growth, including adopting a holistic regional development approach, strengthening intra-regional collaboration, establishing open and innovative platforms, enhancing governmental roles, and fostering coordinated industrial chain development and innovation ecosystems.
Objective To evaluate the effect of the surgical treatment model for benign breast tumors, particularly in terms of the safety, efficiency and cost-control of day surgery, and to promote its high-quality development. Methods Medical record front-page data of patients who underwent surgery for benign breast tumors in the Second Affiliated Hospital of Zhejiang University School of Medicine from January 1, 2019 to December 31, 2022 were collected. Propensity score matching was used to eliminate confounding factors and to assess the impact of day surgery on medical quality, efficiency and cost. Patients were divided into day surgery and conventional surgery groups. Ordinary least squares (OLS) regression was used to examine the impact of day surgery on medical expenses and efficiency, while logit and probit models were applied to analyze its impact on medical quality. Results After matching, the distribution of covariates between the day surgery and the conventional surgery groups achieved a good balance. A total of 868 valid cases were included. Compared with conventional surgery patients, those undergoing day surgery had 34.54% lower total medical cost, 13.1% higher consumable cost, a 1.4 days reduction in average hospital stay, and better clinical outcomes. Conclusions Day surgery for benign breast tumors significantly reduces medical costs, shortens hospital stays, and improves treatment outcomes, although it increases consumable costs. In order to promote the high-quality development of day surgery, it is essential to implement precise cost-control strategies, enhance postoperative follow-up, and adopt a refined collaborative rehabilitation model.
Objective To investigate the current status of human resource allocation of Shanghai’s immunization program, and provide a scientific basis for policy makers to optimize this allocation. Method Descriptive analysis method and agglomeration degree were used to assess the human resource allocation and equity in Shanghai’s immunization program in 2023. Results Among the human resources in Shanghai’s immunization program, females accounted for 91.15%, and approximately 70.90% of the staff were aged 20~39 years. Part-time staff accounted for 65.88%, while full-time staff accounted for 34.12%. Staff with senior professional titles made up 5.38%, whereas those with junior titles and below accounted for 55.59%. Over 60% of the staff held a bachelor’s degree; licensed physicians accounted for 21.94%, and nurses accounted for 76.56%. An analysis of the Human Resource Agglomeration Degree Index (HRADi) across Shanghai’s districts showed that 9 districts had HRADi values greater than 1, including all 7 urban districts. Among suburban areas, only Baoshan District and Pudong New District had slightly elevated HRADi values above 1, while the remaining 7 suburban districts were all below 1. Additionally, 8 districts showed a positive difference between HRADi and PADi (HRADi-PADi>0), with 5 in urban areas and 3 in suburban regions. Conclusions In Shanghai’s immunization planning workforce, female staff and nurses constitute the majority, with the overall workforce being relatively young. More than half of the personnel hold a bachelor’s degree and have primary or lower professional titles. The number of part-time workers far exceeds that of full-time staff. In general, the geographical distribution of immunization human resources in Shanghai is relatively equitable, but disparities in population accessibility remain significant, particularly between urban and suburban areas. In regional health planning, the government should allocate immunization human resources according to scientific and holistic standards, gradually improve input and management mechanisms, and ensure equitable distribution based on both population and geographical accessibility to support the healthy development of the city’s immunization planning.
The paper examines the implementation background, key contents, and potential impacts of the first round of patented prescription drug price negotiation under the U.S. Inflation Reduction Act (IRA) of 2022. Through a literature review, the paper analyzes the regulatory mechanism of the IRA on the prescription drug pricing of Medicare and its possible effects both on the U.S. healthcare system and the global pharmaceutical industry. The findings indicate that the implementation of the IRA marks a significant shift in U.S. drug price regulation policies, which may trigger a chain reaction in global drug pricing policies. Furthermore, it offers valuable insights for China’s healthcare price negotiations, such as the application of real-world evidence (RWE), transparent drug price negotiation procedures, and well-established incentive and penalty mechanisms.
After the Chinese government, along with the World Bank and World Health Organization, jointly released a medical reform report titled “Deepening health reform in China: building high-quality and value-based service delivery” in 2016, the concept of value-based health care (VBHC）was introduced to China for the first time. Since then, China has gradually explored VBHC’s potentials in areas such as innovative drug insurance coverage, medical insurance payment reform, and high-quality development of public hospitals. Given that a comprehensive value assessment framework for cancer treatment has not yet been established here, this study examines the origins and definitions of VBHC and analyzes the applications of high-value medicines, high-value healthcare services, and value-based payment methodologies in cancer treatment with case studies from the United States and European countries. This study also explores how these international experiences can be adapted to China. The aim is to provide reform recommendations for constructing an aligned value-based cancer treatment system with China’s national conditions.
The healthcare system, as a critical safeguard for human health, has emerged as a cornerstone in China’s socioeconomic green transition. Carbon emission contributed by the global healthcare sector is equivalent to the emissions of the world’s fifth-largest emitting country. The integration of sustainability principles into health systems is an international trend. To better understand global developments and enhance China’s role in climate and health governance, this paper systematically reviews international progress in building low-carbon healthcare systems and assesses China’s achievements and ongoing challenges in this sector. China is recommended to proactively seize this opportunity by strengthening both domestic and international coordination, advancing emissions accounting and evaluation, and improving policy incentives to drive a green transformation across the whole healthcare supply chain, thereby contributing to global health reform.
