ISSN 2097-4205 CN 31-2200/R
This paper applies the Donabedian model to construct an evaluation framework for new media in healthcare institutions, and develops the structure and content of normative guidelines through the articulation of objectives, guiding principles, and a theoretical model. The normative guidelines are organized around three dimensions of the framework: structure, process, and outcome. The structure dimension addresses the organizational elements that influence function, including governance, mechanisms, and resources; the process dimension covers the actions taken to achieve objectives, encompassing content management, quality control, and user experience; and the outcome dimension focuses on the effects of these actions, namely performance evaluation. The resulting normative guidelines hold both theoretical significance and practical value, and can serve as a reference for advancing high-quality new media development in healthcare institutions.
Objective This study attempts to evaluate the implementation effectiveness of Lean Six Sigma management and an integrated appointment platform in improving the operational performance of a digestive endoscopy center under a multi-campus model, and to provide empirical evidence for enhancing overall operational efficiency and patient satisfaction. Methods In April 2023, the hospital’s digestive endoscopy center implemented management reforms using the Lean Six Sigma model and an integrated appointment platform. Core indicators were collected from July 2022 to July 2025, including appointment waiting days, number of appointments, number of completed procedures, cancellation rate, and average daily completions per procedure room. The effects of these reforms were analyzed using an interrupted time series (ITS) model. Results Following the implementation of the management reforms, the appointment waiting days were immediately and significantly reduced by 4.86 days (β2 = −4.86, P = 0.006), with an additional monthly reduction of 0.44 days (β3 = −0.44, P<0.001). The trend in the number of completed procedures showed a significant positive shift (β3 = 263.15, P<0.001). The average daily number of completions per procedure room increased significantly by 1.58 immediately post-intervention (β2 = 1.58, P = 0.015), with upward trends observed both before and after the reform (β1 = 0.64, P<0.010; β3 = 0.18, P<0.001). After the intervention, both the number of cancellations (β3 = −15.27, P= 0.004) and the cancellation rate (β3 = −0.01, P<0.001) showed decreasing trends in slope, and the trend in completion rate improved (β3 = 0.62, P = 0.016). Conclusion The application of Lean Six Sigma management and an integrated appointment platform in a multi-campus digestive endoscopy center can substantially improve resource utilization, system throughput, and patient experience. This approach facilitates resource balance and efficiency enhancement across multiple campuses, providing empirical evidence for the homogenized and efficient operation of large multi-campus hospitals.
Objective This study aims to analyze the status of tertiary public hospitals in Shanghai from 2023 to 2025 across multiple dimensions, including construction of hierarchical diagnosis and treatment system, clinical diagnosis and treatment ability, medical quality and safety, rational medication use, medical service efficiency, information support, workforce structure, patient satisfaction, and medical staff satisfaction, and to compare the operation status of general hospitals and specialist hospitals, providing reference for the precision management and high-quality development of public hospitals. Methods A total of 57 tertiary public hospitals in Shanghai were included. Research indicators were selected with reference to the 2023 National Tertiary Public Hospital Performance Monitoring and Analysis Bulletin. Data of the Shanghai Healthcare Service Monitoring and Evaluation System (SHVMS) from 2023 to 2025 were extracted, bar charts and radar charts were used to visualize the operational status and trends of tertiary public hospitals in Shanghai. Results Tertiary public hospitals in Shanghai showed an overall positive development trend. The proportion of discharged patients undergoing surgery remained stable at approximately 39.40%; the proportion undergoing minimally invasive surgery increased from 24.79% to 26.55%; the mortality rate in the DRG low-risk group declined from 0.68‰ to 0.33‰; and the numbers of healthcare technicians and nurses increased by 6,000 and 3,900, respectively. General hospitals and specialist hospitals each demonstrated distinct strengths overall. The proportion of discharged patients undergoing grade IV surgery in general hospitals remained stable at approximately 24.50% over the study period, while the corresponding proportion in specialist hospitals ranged from 20.70% to 24.42%. The proportion of medical service revenue in total income decreased by 0.73% in general hospitals and by 7.82% in specialist hospitals from 2023 to 2024, with considerable fluctuation observed in both. The use intensity of antibiotics in general hospitals was 43.50 DDDs in 2023, higher than that in specialist hospitals (34.86 DDDs). Conclusions Tertiary public hospitals in Shanghai demonstrated an overall satisfactory operational status. This study recommends that future efforts focus on balancing the growth of total medical revenue with examination-related revenue, optimizing the outpatient appointment system, improving the hospital care environment, and promoting rational antimicrobial use, so as to further advance the high-quality development of tertiary public hospitals in Shanghai.
Objective This study aims to establish a scientifically sound and effective hospital data governance system centered on medical quality control, to improve medical data quality and resource management, and to provide decision support for clinical diagnosis and treatment. Methods Existing experiences on hospital data governance were synthesized through a literature review. A homogeneous data governance system for medical quality control indicators was constructed through brainstorming sessions. The system was further refined through expert consultation. Results An implementation pathway for hospital data governance was established: topic decomposition, indicator inventory, indicator analysis, standard formulation, indicator modeling, and indicator application. Four platforms were integrated to build a hospital medical quality control indicator platform system: the Unified Indicator Management Platform, the Intelligent Indicator Reporting Platform, the Open Data Service Platform, and the Medical Matrix Dashboard. This integration established a closed-loop governance framework encompassing standard governance, intelligent reporting, shared services, and analytical decision-making, enabling hospital data to be visualized, accessible, and manageable. Conclusions The hospital data governance system developed in this study, centered on medical quality control, can provide useful references for the homogenized management of multi-campus management, precision operational decision-making, and the routine monitoring and traceability verification required for hospital accreditation.
Objective This study aims to explore the development pathway of a refined energy management model and evaluate its practical effectiveness in a large public hospital. Methods A before-after study design was adopted, with the new campus of a tertiary public cancer hospital serving as the study site. The hospital developed and implemented a four-component integrated refined energy management model comprising: management responsibility, a metering system, precision control, and an information platform. Baseline energy consumption data spanning 2019 to 2023 were collected via energy audits and compared with data from 2024, following full implementation of the model. The primary outcome was energy consumption per ¥10 000 of medical revenue (kgce) assessed by comparing values between 2023 and 2024; all energy data were uniformly converted to standard coal equivalent (kgce). The primary outcome was energy consumption per ¥10 000 of medical revenue (kgce), assessed by comparing values between 2023 and 2024. All energy data were converted to standard coal equivalent (kgce). Results Following model implementation, total energy costs in 2024 decreased by 13.5% (saving ¥3.66 million) compared with 2023. The primary efficiency indicator, energy consumption per ¥10 000 of medical revenue, dropped by 23.7%, while standard coal consumption for natural gas, water, and electricity decreased by 13.1%, 27.1%, and 10.7%, respectively, meeting the initial energy-saving targets. Conclusions The refined energy management model reduces hospital energy consumption and operational costs, validating the synergistic effects of management optimization and technological improvements. This model offers a transferable framework for energy conservation and emission reduction in healthcare institutions.
Objective This study aims to analyze the current status of medical waste (MW) generation and management in community health service centers (CHSCs) in Shanghai, and to inform the city’s “Zero-Waste Hospital” initiative. Methods A total of 100 CHSCs in Shanghai were selected via random sampling. A questionnaire, developed through a literature review, was administered in 2024 to collect data on infrastructure, service capacity, and MW generation for the year 2023. A questionnaire, designed based on literature review, was distributed in 2024 to collect data on infrastructure, service scale, and MW generation for the year 2023. Meanwhile, field investigations were conducted at three CHSCs to track the entire process of MW management, including classification, collection, transfer, temporary storage, and disposal. Origin software was employed to fit the correlation between outpatient volume and total MW generation in CHSCs without inpatient departments, and to calculate the average MW generation per outpatient visit. The MW generation coefficient per bed was then derived. These two indicators are used to measure the MW generation intensity. Results A total of 83 questionnaires were returned, of which 82 were valid. The data fitting results revealed a linear correlation between outpatient volume and MW generation across the surveyed CHSCs, with an average of 1 kg of MW generated per 58 outpatient visits and the MW generation coefficient per bed was 0.35 kg/(bed·day). The estimated MW generation coefficient per bed was 0.35 kg/(bed·day), with a 95% confidence interval (CI) of 0.24-0.46 kg/(bed·day) and a 99% CI of 0.20-0.50 kg/(bed·day). Field investigations found that all surveyed CHSCs had established MV collection, transfer, and temporary storage facilities based on available resources, with information technology systems equipped throughout to record MW information. Conclusions CHSCs in Shanghai demonstrated a solid foundation in MW management, a high level of digitalized administration, and a relatively low MW generation intensity compared with other regions in China. However, deficiencies were identified in management standardization and precision, as well as limited awareness and implementation of the “Zero-Waste” concept. This study suggested to strengthen the linkage mechanism of the whole society, improve the full cycle traceability system, and establish a diversified supervision and incentive mechanism to promote the “Zero-Waste Hospital” initiative in Shanghai.
The rapid expansion of the healthcare sector has contributed to a sustained increase in hospital waste generation, raising urgent concerns about its environmental impacts. This paper clarifies the connotation of “Zero-Waste Hospital” construction and synthesizes practical experiences from domestic and international implementations. The analysis reveals three emerging trends in “Zero-Waste Hospital” development: a shift in hospital waste metabolism toward circular economy models, a transition in hospital waste management toward comprehensive intelligent systems, and a move in “Zero-Waste Hospital” construction toward multi-stakeholder collaborative development. Based on these findings, the paper proposes policy recommendations across four dimensions: top-level design, hospital management, technological innovation and the integrated development of industry-university-research.
Objective This study aims to assess the current status of medical waste (MW) informatization management in Shanghai, identify existing issues, and propose recommendations for improvement. Methods Drawing on the China Health Statistical Yearbook (2023), a survey was carried out with a stratified random sample of 101 healthcare institutions at various levels. The survey covered questions on management approaches, data statistical hierarchy, informatization equipment configuration, status of in-hospital MW platform construction, and platform maintenance approaches. Descriptive statistical analysis was performed on the collected data. Results Regarding in-hospital MW platform construction, 40.59% of institutions had adopted standardized platforms, while 22.77% had developed their own systems. Regarding informatization equipment configuration, the adoption rates of label printers, MW scales, waste transport carts, barcode scanners, mobile personal digital assistants (PDAs), and floor scales were 97.03%, 99.01%, 98.02%, 91.09%, 87.13%, and 46.53%, respectively. For data statistical levels, 75.25% of institutions detailed MW data at the departmental level. In terms of platform maintenance, 33.66% of institutions relied on internally trained technical staff, 63.37% relied on third-party services, and 8.91% lacked dedicated maintenance personnel. Conclusions Despite advancements in informatization equipment adoption and data granularity, the informatization of MW management in Shanghai continues to face challenges including wide variation in management approaches, low uptake of self-developed systems, and shortages of qualified technical personnel. This study recommends fostering collaborative information sharing and information infrastructure development, enhancing standards and guidelines, and boosting talent development and infrastructure capacity to support the “Zero-Waste Hospitals” initiative.
Objective This study intends to establish a scientifically grounded and feasible evaluation index system for “Zero-Waste Hospital” construction, and to provide reference for hospital assessment and evaluation. Methods Based on a review of relevant national and Shanghai municipal policies and regulations, a preliminary index system was constructed using the Balanced Scorecard as the theoretical framework. The Delphi method was used to conduct two rounds of consultations with 20 experts in hospital logistics management and public health. The analytic hierarchy process (AHP) was then applied to calculate the indicator weights, and the expert authority coefficient and coordination coefficient were used to assess the expert authority and the degree of consensus. Results The final index system comprised 5 first-level indicators (institutional guarantee, hospital performance, construction outcomes, sustainable development, and energy conservation and innovation), 6 second-level indicators, and 35 third-level indicators. The expert authority coefficient across both consultation rounds was 0.945, and the coordination coefficient was statistically significant (P<0.01). The weights of indicators at all levels passed the consistency ratio test (CR<0.1). Conclusions The evaluation index system developed in this study is relatively scientifically grounded, capable of reflecting the core requirements for “Zero-Waste Hospital” construction in Shanghai at the current stage, and provides reference for relevant evaluation work.
Objective This study aims to explore the feasibility and application outcomes of restructuring inpatient day-care chemotherapy into an outpatient day-care chemotherapy model. Methods Using the Eliminate-Combine-Rearrange-Simplify (ECRS) method, the existing inpatient day-care chemotherapy workflow at a tertiary specialized hospital in Shanghai was systematically reviewed and redesigned to establish an integrated, intelligent outpatient day-care chemotherapy model. Patients with thoracic tumors undergoing day-care chemotherapy in May 2024 (pre-redesign) and August 2024 (post-redesign), along with medical staff at the same hospital involved in day-care chemotherapy services, were enrolled as study participants. Pre- and post-redesign comparisons were made for patient length of stay, overall patient satisfaction, overall medical staff satisfaction, and the case mix index (CMI). Results A total of 125 medical staff were enrolled, along with 458 patients in the control group(pre-redesign), and 458 patients in the intervention group(post-redesign). Regarding the total length of stay of thoracic cancer patients, the intervention group (154.13 ± 15.89 min) was shorter than that of the control group (194.87 ± 36.92 min). In terms of overall patient satisfaction, the intervention group (95.85%) was higher than the control group (81.66%). and overall satisfaction among medical staff increased from 82.40% (pre-redesign) to 95.20% (post-redesign), with all differences being statistically significant (P<0.05). Following the workflow redesign, the hospital’s CMI increased to 1.18, representing an increase of 0.23 from the pre-redesign level of 0.95. Conclusions The integrated outpatient day-care chemotherapy model established using the ECRS methodology reduces patient waiting time and enhances satisfaction among both patients and medical staff. By diverting clinically stable patients to outpatient settings, this model liberates inpatient medical resources, redirects the inpatient services toward complex and critical cases, and indirectly optimizes hospital management. It then contributes to the efficient allocation and utilization of overall healthcare resources.
Objective This study attempts to systematically review empirical studies on the shift from inpatient to outpatient services induced by diagnosis-related group (DRG)-based payment reforms, and to provide insights for further deepening medical payment system reform in China. Methods A systematic search was conducted in PubMed, Web of Science, CNKI, Wanfang, and other databases for empirical studies on the shift from inpatient to outpatient services, spanning from database inception to January 1, 2025. Two researchers independently screened the literature, extracted data, This study employs descriptive analysis method to conduct qualitative analysis on the included studies. Results A total of 11 studies were included with research periods primarily concentrated in the early stages of payment system reform. Some studies focused on specific diseases or surgical procedures. The main research indicators encompassed three aspects, total volume, costs, and efficiency of inpatient and outpatient services. Particular attention was paid to changes in outpatient service utilization before and after hospital admission and discharge, including outpatient visit rates, frequency, and costs within specific timeframes (e.g. 14 days, 30 days) before and after admission/discharge. The majority of included empirical studies suggested that DRG-based payment tends to induce a shift from inpatient to outpatient services. From a deeper mechanistic perspective, the institutional structuring capacity of medical insurance payment system reform and the separate payment incentives for inpatient and outpatient services constitute the underlying behavioral drivers. Conclusions The reform of DRG-based payment has influenced the structure of healthcare service utilization and is associated with a risk of shift from inpatient to outpatient care. It is recommended to further advance multi-component medical insurance payment reform, explore innovative outpatient payment strategies, and strengthen dynamic monitoring of service shifting behaviors.
Objective This study attempts to review advances in the application of machine learning to medical insurance risk adjustment, and to provide reference for its application in China’s medical insurance system. Methods A systematic search was conducted across Chinese and English databases including Web of Science, PubMed, Embase, CNKI, Wanfang and SinoMed using “risk adjustment”, “machine learning”, “artificial intelligence”, “medical insurance” and “medical insurance payment” as search terms, covering the period from database inception to January 31, 2025. The basic characteristics of the included studies were systematically described, their methodological quality was assessed using the IJMEDI checklist, and a review was conducted on studies applying machine learning to the construction, evaluation, and interpretation of medical insurance risk adjustment models. Results A total of 16 studies were included, of which 6 (37.5%) were rated as high quality. The studies were predominantly published between 2016 and 2024, with a greater proportion originating from high-income countries. The sample sizes ranged from 5 000 to 10 million participants. Machine learning algorithms, including penalized linear regression, random forests, and neural networks, were widely applied to identify risk adjusters and predict healthcare expenditures, with multiple model performance metrics employed. Conclusions The application of machine learning to health insurance risk adjustment can improve the predictive performance of risk adjustment models. However, research on the interpretability of machine learning models remains limited, which constrains their application in medical insurance policy-making.
Reforming the medical insurance payment system of Traditional Chinese Medicine (TCM) is a lever in advancing the preservation and innovation of TCM and an important guarantee for the sustainable operation of TCM hospitals. Despite the Central Committee of the Communist Party of China put strong emphasis on reforming TCM medical insurance payment system, the overall progress has remained slow, owing to the distinct nature of TCM services. Findings from current pilot programs indicate that cities like Nanjing City and Liuzhou have achieved some progress in implementing DRG-based payment for TCM. To accelerate the reform of TCM medical insurance payment system, this paper analyzes the main practices and outcomes of DRG-based payment in representative pilot cities and proposes policy suggestions to promote broader adoption.
Objective This study aims to evaluate the cost-containment effects of DRG payment reform on medical costs for hospitalized children with acute lymphoblastic leukemia at a tertiary children’s hospital in Suzhou, and to provide reference for further optimizing payment reform in pediatric hospitals. Methods Data were collected from hospitalized children with acute lymphoblastic leukemia (C91.000) at a tertiary children's hospital in Suzhou from January 2021 to June 2024. Directed acyclic graphs (DAGs) was used to identify the minimum sufficient adjustment set confounders, based on which a conditional difference-in-differences (DID) model was constructed. This model was used to compare cost indicators between locally insured children in Suzhou (the experimental group) and non-locally insured children in Suzhou (the control group) before and after the DRG reform. Model reliability and stability were verified through parallel trend tests and placebo tests. Results The DAG identified four control variables: age, other diagnoses, surgical or procedure status, and length of stay. The DID analysis showed that DRG payment reform significantly reduced the growth rate medical expenses in most categories (P<0.05), but had limited effectiveness in controlling drug costs and medical consumable costs (P>0.05). Conclusions Hospitalization costs for pediatric patients with acute lymphoblastic leukemia show an overall upward trend, and DRG payment reform is generally effective in containing the growth rate of these costs. However, its effectiveness in controlling drug costs and medical consumable costs remain limited. This study recommends establishing a pharmaceutical and medical consumable cost management system tailored to pediatrics, continuously optimizing DRG clinical pathways and medical insurance reimbursement policies, and developing individualized solutions for pediatric patients.
Objective This study aims to summarize the main practices and latest progress of the Medicare Drug Price Negotiation Program under the US Inflation Reduction Act, and to provide reference for China in formulating price control mechanisms and related policies. Methods Based on a literature review, the practices and mechanisms of the Medicare Drug Price Negotiation Program and representative cases were systematically reviewed, followed by a comparative analysis with the relevant mechanisms in China. Results The Medicare Drug Price Negotiation Program covers four procedural components including the selection of eligible drugs, the submission of an initial offer, the negotiation process, and the implementation and enforcement of negotiated prices. Two rounds of negotiation plan guidelines have been released and the 10 drugs selected in the first round along with their negotiated prices have been publicly announced. Following negotiations, most drugs achieve substantial price reductions, which are projected to generate savings in Medicare expenditures. Conclusions It is recommended that China build a multi-party participation and communication mechanism in drug price regulation, prioritize the management of high-expenditure drugs, and maintain a dynamic balance between price regulation and the protection of pharmaceutical companies' early-stage returns. In parallel, attention should also be paid to the potential challenges identified in the Medicare Drug Price Negotiation Program to explore a drug price regulation mechanism suitable for China’s national context.
Objective This study aims to evaluate the cost-effectiveness of telemedicine for patients with acute ischemic stroke and assess its affordability under given budget constraints, providing a quantitative basis for payment policy development and healthcare resource allocation. Methods A Markov model was constructed from payer’s perspective to calculate the incremental cost-effectiveness ratio (ICER) of the telemedicine strategy for acute ischemic stroke patients over a lifetime horizon. One-way and probabilistic sensitivity analyses were performed. Affordability was assessed using affordability curve and cost-effectiveness affordability curve. Results The incremental cost of the telemedicine strategy was ¥1 475.431, the incremental quality-adjusted life-year (QALY) was 0.014, and the ICER was ¥105 387.929/QALY, falling below the threshold of three times the GDP per capita. Sensitivity analyses confirmed robustness of these findings. Affordability analysis showed that for a cohort of 100 000 patients, the strategy was not affordable at an annual budget below ¥44 million, but fully affordable at a budget of ¥327 million. Conclusions The telemedicine strategy is cost-effective for patients with acute ischemic stroke, supporting its broader adoption in clinical practice in China.
Objective This study aims to investigate the prevalence and determinants of turnover intention among young nurses (aged ≤35 years) in Shanghai municipal hospitals, and to provide a theoretical basis and decision-making support for improving nursing workforce stability. Methods Based on the Price-Mueller (2000) turnover model, a turnover antecedent model for young nurses was developed. A cross-sectional survey was conducted in December 2024 among nurses aged ≤35 years from 14 Shanghai municipal hospitals, collecting data on demographic characteristics and turnover antecedents. Independent t-tests and one-way ANOVA were used for univariate comparisons of turnover intention across subgroups, and multiple linear regression was performed to identify determinants. Results Of the 804 questionnaires returned, 725 were valid. Among the 725 respondents, the mean overall turnover intention score was 2.35±0.84. A total of 301 nurses (41.5%) reported some degree of turnover intention, of whom 30 (4.1%) indicated strong turnover intention. Statistically significant differences in turnover intention were observed across hospital type, sex, educational level, nursing rank, years of work experience, health problems, night shift frequency, and overtime hours (all P < 0.05). Multiple linear regression identified several determinants of turnover intention: external opportunities (β = 0.281, P<0.001), general training (β = 0.121, P<0.001), training load (β = 0.075, P = 0.040), and job routinization (β = 0.154, P<0.001) were positive predictors, while positive affect (β = −0.260, P<0.001) and family support (β = −0.081, P = 0.012) were negative predictors. The model explained 61% of the variance in turnover intention (R² = 0.61). Conclusions Turnover intention is highly prevalent among young nurses in Shanghai municipal hospitals. This study recommends that hospital administrators optimize career development pathways, enhance the perceived benefits of training, reduce workload burden, implement family-friendly policies, and pay attention to psychological well-being, in order to improve nursing workforce stability.
Objective This study explores the role of job crafting and perceived error-management climate in developmental human resource management practices (D-HRMPs) and well-being of medical staff. Methods From May to October 2023, healthcare workers from 14 medical institutions including secondary hospitals, tertiary hospitals, and community health service centers in Shanghai, were selected by convenience sampling. A survey questionnaire was used to collect data on D-HRMPs, employee well-being, job crafting and error management climate. Correlation analysis, mediation analysis, and moderated mediation analysis were performed to examine the mediating role of job crafting between D-HRMPs and employee well-being, along with the moderating role of perceived error management climate. Results A total of 311 valid questionnaires were returned. The mean well-being score of employees was 3.79 ± 0.62, indicating an above-moderate level. Statistically significant differences in job crafting were found across both job categories and departments (all P<0.05). Among job categories, significant differences were also observed in employee well-being, perceived D-HRMPs, and perceived error management climate (all P<0.05). Perceived D-HRMPs were significantly and positively correlated with employee well-being (r = 0.557, P < 0.01). Mediation analysis showed that job crafting partially mediated the relationship between D-HRMPs and well-being, accounting for 38.07% of the total effect. Perceived error management climate significantly moderated the association between D-HRMPs and job crafting (β = 0.045, P < 0.05). Conclusions This study provides evidence that perceived D-HRMPs are an important determinant of employee well-being, and that D-HRMPs generate a “secondary gain” in well-being by stimulating job crafting—a pathway that is fully realized only within a high error-tolerance context. The findings offer healthcare organizations evidence-based, multi-pronged intervention strategies: optimizing developmental support, encouraging employees to proactively redesign their work, and cultivating an error-tolerant organizational culture. Such approaches can convert human resource management investments into sustainable well-being among medical staff and, ultimately, higher-quality patient care.
Objective This study aims to analyze the evolution and patterns of China’s health and wellness services policies from a policy instrument perspective, and to provide guidance for formulating future relevant policies in line with national conditions. Methods A total of 47 national-level related to health and wellness services policy documents issued from 1990 to 2024 analyzed using word frequency analysis and content analysis across three dimensions: policy instruments, temporal stages, and policy targets. Results The evolution of China’s health and wellness services policies has progressed through three distinct stages: the germination stage of ideas (1990-2001), the initial stage of theory development (2001-2013), and the practical exploration stage (2013-2024). The three stages exhibited distinct characteristics. During the germination stage of ideas, incentive policies predominated (61%, 14/23 documents), with supply-oriented instruments accounting for the largest share (46%, 75/164 coded segments). During the initial stage of theory development, strategic policies were dominant (79%, 11/14 documents), with demand-oriented instruments comprising the largest share (46%, 184/471 coded segments). During the practical exploration stage, incentive-based policies again prevailed (60%, 6/10 documents), with supply-oriented instruments again leading (39%, 310/792 coded segments). Conclusions China’s health and wellness services policies are have evolved in close alignment with national conditions, reflecting the country’s shifting development priorities across stages, with an underlying logic of moving from localized “incremental adaptation” toward comprehensive “systematic structuring”. To optimize these policies, it is imperative to not only develop a precise and coordinated policy toolkit but also to reinforce top-level design and strategic foresight. Such enhancements are crucial to ensure policy-socioeconomic congruence and to provide effective scientific guidance for health and wellness service practices.
Objective This study aims to examine the poverty-reducing effects of government health expenditure on middle-aged and elderly people, providing reference for the government to adjust the level of health investment. Methods The panel data from the China Family Panel Studies (CFPS) spanning 2012 to 2022 were employed. And a multidimensional health poverty measurement system was constructed by selecting eight indicators across three dimensions, physical health, mental health, and socio-economic status. and determining their weights via principal component analysis (PCA). A fixed-effects ordinary least squares (FE-OLS) model was used to empirically analyze the poverty-reducing effect of government health expenditure on multidimensional health poverty among middle-aged and elderly individuals. Results Government health expenditure significantly reduces the risk of multidimensional health poverty among middle-aged and elderly individuals (β = −0.015, P<0.05). Among individual characteristic variables, employment status has a negative and significant impact on the multidimensional health poverty status of middle-aged and elderly people (β = −0.034, P<0.05), indicating that those who were employed are less likely to fall into multidimensional health poverty. Compared with the elderly, government health expenditure exhibits a more significant poverty reduction effect in middle-aged people (β = −0.026, P<0.01). Compared with their rural counterparts, government health expenditure exhibits a more pronounced poverty reduction effect among their urban middle-aged and older adults (β = −0.014, P<0.05). Conclusion Government health expenditure in China exerts a poverty reduction effect, with notable heterogeneity observed across age groups and between urban and rural populations.
Objective This study aims to evaluate the structural characteristics and distributional balance of national and local Internet healthcare policies, and to provide a theoretical basis for policy optimization. Methods A total of 120 policy documents issued at the national level and from five provincial-level administrative regions between January 2014 and May 2025 were analyzed. A three-dimensional analytical framework encompassing policy instruments, participating entities, and policy content was constructed for quantitative analysis, comparing differences in overall planning and evolutionary characteristics between the exploration and standardization period (2014-2017) and the deepening development period (2018-present). Results During the exploration and standardization period, supply-oriented instruments predominated (49%), followed by environment-oriented (27%) and demand-oriented instruments (24%). During the deepening development period, environment-oriented instruments became dominant (51%), followed by supply-oriented (32%) and demand-oriented instruments (17%). Systematic differences between national and local policies are identified across three dimensions. In terms of policy instruments, the national approach shifted from supply-oriented focus to environment-oriented dominance, with standardization measures continuously strengthened (from 24% to 41%). Ningxia consistently emphasized environment-oriented tools, initially centered on standardization (75%) and later shifting toward objective planning (30%). Other regions followed national trends but demonstrated diversified approaches in areas such as infrastructure development and healthcare service delivery models. Regarding participating entities, medical institutions remained central at both levels, but local policies increasingly incorporated healthcare security departments and patients during the deepening development period. Regarding policy content, national policies consistently focused on policy support and regulation (approximately 40% in each period), while local policies placed greater emphasis on service system development and model innovation. Cross-dimensional analysis further indicates that national policies are highly concentrated on the triad of “standardization-medical institutions-policy support and regulation”, while local policies exhibit differentiated, context-specific collaborative pathways. Conclusions The current policy landscape is characterized by strong regulatory frameworks at the national level and exploratory approaches at the local level, while facing challenges including insufficient incentive mechanisms, limited multi-stakeholder collaboration, and inadequate depth in key policy areas. This study recommends that future policies strengthen flexible regulation and systematic incentives at the national level, while encouraging context-specific collaboration and scenario-driven innovation at the local level, so as to collectively advance internet healthcare toward a development trajectory that is orderly, integrative, innovative, and governed by multiple stakeholders.
Drawing on the perspective of medical-preventive integration and grounded in the embeddedness theory and network governance theory, this paper analyzed the pilot practices of the disease control supervisor system in medical institutions across Pudong New Area, Changning District, and Jiading District of Shanghai. The whole-chain management practices in personnel selection, deployment, training, duty performance, and performance assessment were systematically reviewed. The pilot areas gradually formed management mechanisms including multi-level and multi-department collaborative management, internally and externally linked dual-track supervision, problem-oriented supervision, and dynamic cyclical talent management. Three operational models have also been identified: the medical alliance integration model, the grid-based collaborative model, and the point-to-surface combined model. These practices have yielded positive outcomes in promoting the embedding of public health functions into medical institutions and enhancing disease prevention and control capacity. However, room for improvement remains in selection channels and criteria, definition of responsibility, assessment and evaluation system, and information system development. Shanghai's experience with the disease control supervisor system offers valuable practical insights for further strengthening this system in medical institutions and promoting medical-preventive integration.
Objective This study aims to analyze the impact of antenatal care (ANC) visits on the utilization of intermittent preventive treatment in pregnancy (IPTp) for malaria among pregnant women in Senegal. Methods Data from the Senegal demographic and health surveys (DHS) conducted between 2012 and 2023 were used to describe trends in ANC visit frequency and IPTp utilization among pregnant women. A Heckman sample selection model was applied to analyze the impact of ANC visits on IPTp utilization. Interaction terms were included to analyze the influence of policy changes on the model results and prediction of IPTp utilization was made when ANC visits reached 4 and 8—the thresholds recommended by the WHO’s previous and current guidelines, respectively. Results A total of 39 053 pregnant women were included in this study, of whom approximately 17% had not attended any ANC. The mean number of ANC visits was 2.98, and the mean number of IPTp received was 1.73. From 2012 to 2023, the mean number of IPTp received showed an overall upward trend, and pregnant women who attended four or more ANC visits received a higher number of IPTp than those who attended fewer than four visits. After correcting for sample selection bias, each additional ANC visit was associated with an average increase of 0.15 IPTp doses received (95%CI: 0.14-0.16).The main effect of ANC visit frequency on IPTp utilization was significantly positive (β = 0.17, 95%CI: 0.16-0.18), while the interaction term between ANC visit frequency and ANC policy phase was significantly negative (β = −0.04, 95%CI: −0.05 to −0.04), indicating a negative moderating effect. Each additional ANC visit was associated with an average of 0.17 more IPTp during 2012-2016 (95%CI: 0.16-0.18) and 0.13 more IPTp during 2017-2023 (95%CI: 0.12-0.14). Within the same year, marginal predicted values of IPTp were consistently higher for pregnant women attending eight ANC visits than for those attending four. Conclusions Both ANC visits and IPTp utilization remain low in Senegal. Women who participate in a greater number of ANC visits are more likely to receive more IPTp. Therefore, governments should prioritize expanding the coverage of ANC among pregnant women. In response to WHO’s new policy, governments should take into account local health resources availability, set rational policy goals, and progressively improve the frequency of ANC visits, so as to enhance IPTp utilization.
Objective This study aims to investigate the health status and living conditions of patients with isolated methylmalonic acidemia (MMA) and propionic acidemia (PA) in China. Method A survey was conducted using online questionnaires supplemented by telephone follow-up interviews, covering diagnosis and treatment, health status, family impact, and disease burden among patients with isolated MMA and PA. Results A total of 276 valid cases were included, of which 218 cases were isolated type of MMA (78.99%), and 58 cases were PA (21.01%). Among 276 cases, 87.33% of patients were diagnosed within the first year of life. Among the 29 patients who presented with acute onset or chronic symptoms, 24.58% had experienced misdiagnosis. Among patients with secondary acute and chronic hyperammonemia, N-carglumic acid was used by 25.93% and 12.66%, respectively. The specific carbamoyl phosphate synthetase 1 (CPS1) activator carglumic acid was used by 25.93% and 12.66% of patients with acute/chronic hyperammonemia, respectively. Health-related quality of life (HRQoL) metrics were as follows: EQ-5D utility value 0.773 and visual analog scale (VAS) scores 68.66, and the PedsQL™ total mean score 50.24. Moderate-to-severe feeding difficulties affected 82.35% of children aged 1-6 years. Caregivers EQ-5D utility value was 0.845, and VAS scores was 68.33; confirmed depressive symptoms were identified in 71.01% of caregivers. The mean annual direct medical cost per patient in 2024 was ¥55 648.68, with an out-of-pocket proportion of 81.93% and mean out-of-pocket payment of ¥45 593.88. The mean annual direct non-medical cost and indirect cost per patient were ¥4 745.84 and ¥39 015.69, respectively. The mean annual total economic burden per patient was ¥89 355.41, and the incidence of catastrophic health expenditure was 65.58%. Conclusions Patients with isolated MMA/PA and their caregivers demonstrated notably poor HRQoL, inadequate disease-related health coverage, and a substantial economic burden. This study recommends promoting prenatal screening for pathogenic gene carriers, expanding newborn screening coverage, establishing disease-specific multidisciplinary care networks, accelerating the development and introduction of drugs and foods for special medical purposes, strengthening collaboration between clinicians and patient communities, and improving multi-level medical insurance coverage.
Objective This study examines the influencing factors associated with cross-regional emergency coordination for public health emergencies in the Yangtze River Delta, and to provide policy recommendations for strengthening regional emergency coordination in response to these emergencies. Methods The cross-regional emergency coordination matrix for public health emergencies in the Yangtze River Delta was used as the dependent variable, and seven indicators including disparities in healthcare development levels were taken as independent variables. The quadratic assignment procedure (QAP) was then applied to conduct correlation analysis and regression analysis of the factors associated with cross-regional emergency coordination. Results Geospatial adjacency, administrative hierarchy disparity, cooperative organizations network affiliation, and administrative subordination are all significantly correlated with cross-regional emergency coordination for public health emergencies among cities in the Yangtze River Delta (P<0.05), with correlation coefficients of 0.492, 0.092, 0.338, and 0.181, respectively. A multivariate linear regression model incorporating geospatial adjacency, cooperative organization network affiliation, and administrative subordination well explain the cross-regional emergency coordination relationship of public health events in the Yangtze River Delta (standardized regression coefficients are 0.270, 0.073 and 0.071, respectively; R2 = 0.294). Conclusions Adjacent administrative regions, belonging to a common urban cooperative organization network, located within the same provincial administrative region, or exhibiting greater administrative hierarchy disparities are influencing factors for cross-regional emergency coordination in public health incidents within the Yangtze River Delta. This study recommends that cities steadily advance cross-regional emergency coordination by leveraging these factors, and encourages the establishment of multi-level, multi-domain, and multi-modal cross-regional emergency coordination networks for public health emergencies.
