ISSN 2097-4205 CN 31-2200/R
Objective This study aims to construct a scientific and systematic indicator system for factors influencing multi-disciplinary team (MDT) pricing, in order to provide a theoretical basis and methodological support for advancing value-based pricing of MDT services. Methods An initial indicator framework was constructed based on literature research. The Delphi method was then adopted to establish the indicator system for MDT pricing factors, and the analytic hierarchy process was applied to determine the weights of indicators at all levels. Results A MDT pricing indicator system comprising 2 primary indicators, 5 secondary indicators, and 28 tertiary indicators was established. Both supply-side and demand-side factors exerted a substantial influence on MDT pricing, with higher weights assigned to indicators such as provider institutional characteristics, provider service attributes, and patient disease characteristics. Conclusions This study has preliminarily established an indicator system for factors influencing MDT pricing, featured by a comprehensive structure and clearly defined weightings. The system offers a reference for establishing value-based pricing mechanisms for MDT in China, facilitating service standardization and promoting a more reasonable reflection of medical staff’s labor value.
Objective To construct the China Health Resource Development Index (HRDI), measure the index, and evaluate the current status of health resource development in various provinces (autonomous regions, and municipalities directly under the central government), and provide data support for optimizing health resource allocation and formulating regional health policies. Methods Based on an input-output model, the indicator system was developed through a literature review, focus-group discussions, and Delphi consultation; indicator weights were determined using the analytic hierarchy process. Relevant data were obtained from the China Statistical Yearbook and the China Health Statistics Yearbook, and the HRDI was calculated using the weighted geometric mean. Results An indicator system comprising 2 first-level indicators, 4 second-level indicators, and 22 third-level indicators was constructed. The calculated average value of China’s HRDI was 84.89. There was no statistically significant difference among the eastern, central, and western regions. The average values of the health human resources development index and the facilities and equipment resources development index were 78.72 and 88.28, respectively. In terms of the facilities and equipment resources input index, the western region had the highest value (84.18 ± 10.00), followed by the central region (81.50 ± 5.06);both were significantly higher than the eastern region (60.34 ± 13.34, P<0.001). Moreover, the facilities and equipment resources input index was significantly negatively correlated with the output index in the western region (r = −0.640,P = 0.025). Conclusions Regional disparities and input-output mismatches exist in China's health resource development. The western region has seen rapid growth in health resource inputs, but its output efficiency needs improvement.
Objective To analyze the impact of multidimensional poverty status on self-rated health and its pathways, and propose policy recommendations to improve health outcomes for multidimensionally impoverished populations. Methods Based on the data from the China Family Panel Studies (CFPS) 2018 and 2020, multidimensional poverty incidence via the Alkire-Foster (A-F) dual cutoff method was calculated. Ordinal logistic regression models were employed to assess the impact of multidimensional poverty on health outcomes. A two-way fixed effects model analyzed the relationship between multidimensional poverty and health capability deprivation, while the Karlson-Holm-Breen (KHB) mediation model tested the mediating role of health capability deprivation. Results Multidimensional poverty exerts a negative impact on self-rated health. For every one-unit increase in the multidimensional deprivation score, the odds of individuals reporting higher levels of health status decrease by 18.1%(P<0.05). An increase in individual multidimensional poverty deprivation score exerts a significant positive effect on health capability deprivation. Residents experiencing multidimensional poverty are significantly more likely to suffer health capability deprivation. For every 1-unit increase in multidimensional poverty deprivation score, the probability of failing to seek medical care when experiencing physical discomfort in the past two weeks rises by an average of 4.5 percentage points(P<0.05). Furthermore, health capability deprivation plays a significant mediating role in the effect of multidimensional poverty status on self-rated health(P<0.05), explaining 12.35% of the total effect through its mediating pathway. Conclusions The deepening of multidimensional poverty leads to a decline in self-rated health status and an increased deprivation of health-related capabilities. Health-related capability deprivation plays a significant mediating role in the negative impact of multidimensional poverty on self-rated health status. To reduce the incidence and severity of multidimensional poverty, it is crucial to enhance its recognition and identification, and to implement effective assessment and monitoring mechanisms. Prioritize interventions targeting health capability deprivation, and optimize multi-tiered social security policies to mitigate multidimensional poverty’s cascading health risks.
Objective To explore the coordinated development and spatial distribution of coupled supply and demand of healthcare resources in 14 prefectures of Xinjiang, and to provide reference for promoting balanced development of medical resources. Method On the basis of constructing the medical resources supply and demand index system, the coupled coordination degree model, relative development degree, and spatial autocorrelation and other analytical methods are comprehensively applied to examine the coupled coordination of medical resources supply and demand and the degree of spatial agglomeration of medical resources in Xinjiang’s prefectures and cities in 2023. Results The overall level of coupling coordination between medical resource supply and demand in Xinjiang was relatively low, with most (12) prefectures and cities at a low level of coordination (D<0.4), and only two at a moderate level (D≥0.4). Three regions showed synchronized development of supply and demand, seven had supply ahead of demand, and four lagged behind in supply. The Moran’s I was −0.257 (P = 0.121, Z = −1.149), indicating a random spatial distribution of the two subsystems—supply and demand. Conclusions Medical resource supply and demand are imbalanced across Xinjiang’s 14 prefectures and cities, with poor coordination, insufficient demand-side development, and weak spatial agglomeration. It is recommended to strengthen government leadership and implement macro-level regulation to restructure the system; adhere to demand-oriented strategies, leverage medical assistance programs for Xinjiang, and promote expansion and equitable allocation of high-quality medical resources; enhance resource utilization efficiency through integrated supply-demand coordination, and advance regional medical collaboration.
Objective To assess the degree of economic-related inequity in health-related quality of life (HRQoL) among urban and rural residents in Heilongjiang Province, and to provide evidence-based basis for improving regional health equity. Methods Based on the data from the 7th National Health Service Survey in Heilongjiang Province, EQ-5D-5L health utility values were used as the outcome indicator. Concentration index (CI) and horizontal inequity (HI) were calculated to systematically analyze the economic-related health inequity among urban and rural residents. Additionally, Tobit model was employed to decompose CI, aiming to explore the contribution of variables such as individual characteristics, health behaviors, and situational characteristics to health inequity. Results The overall EQ-5D-5L health utility value of urban and rural residents in Heilongjiang Province was 0.933, with 0.970 for urban residents and 0.896 for rural residents. The CI of health utility value stood at 0.028 (0.007 for urban areas and 0.031 for rural areas), and the HI was 0.031 (0.008 for urban areas and 0.033 for rural areas). Tobit model decomposition indicated that age, marital status, employment status, hypertension, physical exercise, and educational level were the main factors affecting HRQoL equity, with contribution rates of −12.86%, 11.08%, −7.03%, −6.94%, 5.03%, and 4.67% to health inequity, respectively. Conclusions The health equity of HRQoL among urban and rural residents in Heilongjiang Province is relatively favorable, yet it still leans toward populations with higher economic status. It is suggested to construct a multi-dimensional collaborative governance system and optimize systematic mechanisms to comprehensively improve residents’ HRQoL and promote the precise realization of health equity.
Objective To assess the current status of first-visit medical institution choice among patients within tight county medical communities in Jiangsu Province, and to identify the key factors influencing patients’ preference for primary care first visits. Methods This study included 490 outpatient and 646 inpatient first-visit patients from the county medical communities in Jiangsu. Descriptive analysis and binary logistic regression were conducted from the perspectives of predisposing, enabling, and need factors to explore determinants of first-visit medical institution choice. Results Among outpatient patients, 69.18% chose primary medical institutions as their first visit, whereas only 17.48% inpatient patients chose primary medical institutions as their first visit. Logistic regression indicated that age, education level, region, catastrophic health expenditure, and perceived disease severity significantly influenced outpatient first visits to primary care (P<0.05). Age, education level, region, supplementary medical insurance, catastrophic health expenditure, and length of hospital stay for less than one week affected inpatient first-admission choices (P<0.05). Conclusions A preliminary preference for primary care first visits has emerged within Jiangsu’s county medical communities; however, regional disparities persist, and the perceived capacity and recognition of primary medical institutions require further enhancement. Strengthening primary first-visit functions should focus on optimizing the operation of county medical communities, improving the perceived capacity of primary medical institutions, refining coordinated medical insurance payment mechanisms, and enhancing chronic disease management and family doctor contract services, thereby promoting the effective implementation of hierarchical medical care.
Driven by the evolving complexity of public emergencies, there is an urgent need to extend the emergency medicine supply system towards full-lifecycle management. To explore optimization pathways for this system, this study employs literature reviews and cross-case studies, utilizing the 4R model to comparatively analyze the specific measures and implementation pathways of emergency medicine supply in China and Japan. The findings reveal that Japan has established a well-defined legal framework underpinned by the Basic Act on Disaster Management and the Pharmaceuticals and Medical Devices Act (PMD Act). Leveraging the synergy between the Ministry of Health, Labour and Welfare (MHLW) and the Pharmaceuticals and Medical Devices Agency (PMDA), Japan has developed a full-chain, modular management mechanism, demonstrating remarkable advantages in information system development, public-private collaborative stockpiling, and targeted allocation. Conversely, while China has initially constructed a legal framework and IT infrastructure for its emergency medicine supply system, further improvements are required regarding dynamic legal adaptability, the penetration and coverage of technological applications, and regional collaborative mechanisms. In light of these findings, this paper suggests that China can critically draw upon Japan's experience. To promote the construction of China's emergency drug supply security system, future optimizations should focus on: constructing a resilient framework featuring dynamic legislation and decentralized collaboration; enhancing technological penetration and closed-loop management; establishing a phased governance mechanism with well-defined responsibilities; and perfecting an institutionalized evaluation and recovery system.
Objective This study introduces the failure mode and effects analysis (FMEA) model into the internal control risk assessment system of supply, processing, distribution (SPD) medical consumables management in public hospitals. It aims to construct a quantifiable and traceable risk identification mechanism, explore its applicability and methodological innovation within hospital internal control systems, and provide theoretical support and empirical reference for refined management and risk prevention in public hospitals. Methods Taking Hospital L as the research object, this study employed literature review to identify key risk links in SPD-based medical consumables management. Critical control points were screened to construct an FMEA risk assessment model covering four dimensions: consumables control authority, supplier management, information security management, and physical verification management. Quantitative risk priority numbers (RPN) were obtained through expert questionnaires, and targeted improvement measures were implemented and verified. Results The analysis shows that the top five risks with the highest RPN values under the SPD model are unclear selection scope of consumable suppliers and distribution suppliers (RPN = 153.6), insufficient control over SPD system data interaction (RPN = 150.5), lack of a dynamic adjustment mechanism for consumable catalogs (RPN = 136.0), discrepancies in scanning and billing of sanitary materials (RPN = 97.7), and improper segregation of incompatible duties (RPN = 93.1). Mitigation strategies include signing tripartite agreements to clarify responsibilities, implementing data classification and encryption meanwhile shortening security assessment cycles, and establishing a dynamic catalog adjustment mechanism. Identified risks were effectively reduced. Conclusions The FMEA model can systematically identify high-priority internal control risks in SPD-based medical consumables management. Through a closed-loop mechanism of “risk identification-quantitative assessment-measure optimization,” it effectively enhances the refinement and risk governance capabilities of hospital consumables management, providing a replicable paradigm for internal control innovation and operational management improvement in public hospitals.
Objective To systematically explore the practical mechanism and implementation path of Party building leading the high-quality development of public hospitals, and to provide a theoretical explanation and practical paradigm for resolving the phenomenon of disconnection between Party building and professional work. Methods Integrating W. Richard Scott’s “Three Pillars of Institutions” theory and a value co-creation perspective, an integrated analytical framework of “institutional empowerment-value internalization” was constructed. A longitudinal single-case study of Shanghai Chest Hospital was employed for empirical testing. Results The hospital systematically established a practical mechanism for high-quality development led by Party building through a 3-year cycle model of “Management Year - Culture Year - Service Year.” At the regulative level, checklist-based decision-making and closed-loop supervision were used to establish authoritative order. At the normative level, the “Double Leaders” system and “Party Building + Projects” approach promoted the integration of values with professional work. At the cultural-cognitive level, value identification was cultivated through spiritual shaping and care systems. Monitoring data showed that in 2024, the hospital’s case mix index (CMI) increased by 0.18 compared with the previous year; inpatient surgical cases exceeded 30 000, of which major cardiothoracic surgeries grew by 7.8% year-on-year. Conclusions The “institutional empowerment-value internalization” framework reveals the transformational pathway of Party building from external institutional embedding to internal value-driven dynamics. It provides a systematic theoretical explanation and practical references for achieving high-quality development in public hospitals.
Objective To Analyze the effect of the reform of payment based on therapeutic value for the dominant diseases of traditional Chinese medicine (TCM), and provide a reference for improving the medical insurance payment mechanism that conforms to the characteristics of traditional Chinese medicine. Methods The medical insurance settlement data of 7 914 inpatients with the dominant TCM diseases in L city were collected from January 2022 to December 2024. With April 2023 as the reform intervention point, interrupted time-series analysis (ITS) analysis was used to analyze the changing trends of each indicator before and after the reform from three dimensions: resource consumption and patient burden, cost structure and characteristics of traditional Chinese medicine, and efficacy and quality. Results The ITS analysis results showed that the reform had a significant impact on the average hospitalization fee (β3 = −44.742), patient out-of-pocket ratio (β3 = 0.364), drug fee ratio (β3 = −1.538), and inspection and examination fee ratio (β3 = 1.606) (all P<0.05). The ITS analysis results of different hospital types show that the reform has a significant impact on the average length of stay (β3 = −0.118), patient out-of-pocket ratio (β3 = 0.796), drug fee ratio (β3 = −1.495), examination and inspection fee ratio (β3 = 1.434), and comprehensive medical service fee ratio (β3 = -0.247) in TCM hospitals (all P<0.05). It has a significant impact on the average hospitalization fee (β3 = −80.131), the proportion of drug fees (β3 =−1.752), and the proportion of inspection fees (β3 = 1.937) in non-TCM hospitals (all P<0.05). The ITS analysis results of the pilot disease type distal radius fracture show that the reform has a significant impact on the proportion of consumable expenses (β3 = −0.083) in the pilot disease type, and the impact on other indicators is basically consistent with the overall ITS analysis results. Conclusions The reform can effectively control the total hospitalization costs of pilot diseases, reduce patient burden, optimize the cost structure, and better apply TCM-specific diagnosis and treatment techniques. Short-term efficacy and quality are not affected, and long-term medical quality requires continued attention. The effects of the reform are heterogeneous among different hospital types, and the development of pilot diseases is uneven. The reform still needs to expand coverage, increase efficiency, and improve quality.
Objective To quantitatively elicit the preferences of Chinese health insurance experts regarding the reimbursement and access of rare disease drugs, and to provide empirical evidence for improving reimbursement evaluation criteria. Methods From July to November 2024, an online discrete choice experiment (DCE) survey was conducted among health insurance decision-making experts in China. Six attributes were analyzed using a conditional logit model to estimate their effects on reimbursement preferences, calculate relative importance (RI) and willingness-to-pay (WTP) for each attribute, and conduct scenario simulations. Results A total of 102 valid responses were collected. Except for the attribute “catastrophic expenditure”, all others significantly influenced experts’ preferences. Health benefit (RI = 33.4%) was the most influential factor; experts were willing to accept an increase of 5.46 Yuan per person per year in insurance funding to raise the health benefit of reimbursed rare disease drugs from 0.01 to 4 QALYs. Increases in insurance funding (RI = 18.9%), life expectancy without treatment (RI = 18.6%), and whether similar drugs were already covered by insurance (RI = 17.5%) also had substantial effects, while quality of life without treatment (RI = 8.1%) had a relatively smaller impact. Conclusions Health insurance experts preferred drugs with greater health benefits, smaller increases in funding, targeting patients with shorter life expectancy without treatment and drugs not yet covered by insurance for the disease. The revealed preference structure provides empirical evidence to improve evaluation criteria for rare disease drug reimbursement, optimize negotiation strategies, and enhance policy transparency in China.
This paper study compares reimbursement access and payment mechanisms for innovative medical devices in the United States, the United Kingdom, France, Japan, and Germany, and analyzed their institutional design and operational characteristics. These countries generally establish coordinated multi-sectoral management frameworks integrating regulation, assessment, and payment; implement transitional coverage pathways combining evidence development and re-evaluation; and adopt payment mechanisms incorporating both clinical and economic value, thereby promoting the accessibility and value translation of innovative technologies. Drawing on international experience, China should improve transitional reimbursement pathways, strengthen evidence development and real-world data application systems, enhance cross-sector coordination, and promote payment mechanisms based on clinical and economic value assessment, and strengthen support for the clinical adoption of these devices by healthcare institutions, thereby improving reimbursemen access efficiency and the level of clinical application of innovative medical devices.
With the rapid development of immersive technologies such as virtual reality (VR) and augmented reality (AR), the medical metaverse has become an important extension of digital healthcare. However, the regulatory approval, post-market evaluation, and medical insurance payment pathways for related products remain unclear. Focusing on AR/VR medical devices, this study reviews the experience of the United States from the perspectives of health technology assessment and full life-cycle governance. The findings show that the United States implements risk-based and classified market access through pathways such as 510(k), De Novo, and PMA, with reviews emphasizing safety, effectiveness, human factors engineering, and data security. Real-world evidence has become an important basis for continuous regulation, reassessment, and payment decision-making, while payment is mainly achieved through durable medical equipment and medical service item pathways. In comparison, China still faces challenges in product classification boundaries, evidence translation, and coordination with payment systems. It is recommended that China improve classification standards and early communication mechanisms, establish a pathway combining device approval, service pricing, and payment pilots, and develop a dynamic expansion mechanism based on real-world evidence and health technology assessment, so as to enhance patient accessibility and promote industrial innovation.
Digital technology is rapidly reshaping various industries, including healthcare. An increasing number of countries and regions are imposing legal regulations on digital health. Among them, South Korea has formulated the world’s first dedicated legislation for digital medical products, the “Digital Medical Product Act”. As we accelerate the development of new productive forces, strengthening the legalization of digital health is also a key issue facing China. This article delves into the content of South Korea’s digital medical product legislation, analyzes the current situation and dilemmas of legal regulation on digital medical products in China, and proposes suggestions for gradually advancing the legalization of digital medical products from aspects such as exploring the formulation of a separate law for digital health, unifying the concept of digital medical products, clarifying the responsibilities of the government in supporting the development of digital medical products, and improving the content of the digital medical product system, in order to ensure the healthy development of China’s digital health industry.
Objective Against the backdrop of advancing tightly integrated county-level medical consortia, this study analyzes the institutional connotations, operational logic, and practical effects of flexible mobility of county-level health personnel, explores its role in addressing the structural shortage of talent in primary healthcare institutions, and provides references for personnel system reform in county-level health systems. Methods This study employed a combination of literature review, policy text analysis, and comparative case study methods. Domestic and international research findings and policy documents related to county-level medical consortia, primary healthcare workforce allocation, and talent mobility management were systematically reviewed. On this basis, an analytical framework was constructed around staffing coordination, post mobility, post linkage, and incentive support. Following the principles of representativeness, policy completeness, and data availability, Anhui, Zhejiang, and Weihai in Shandong Province were selected as typical cases for comparative analysis. Results Flexible mobility of health personnel within county-level medical consortia is mainly reflected in two mechanisms: coordinated staffing allocation and bidirectional mobility-based deployment. The former improves the efficiency of staffing resource allocation in primary healthcare institutions through a cycle of “centralized coordination-demand-based adjustment-staff-post linkage-dynamic recovery,” while the latter promotes the orderly flow of professional personnel between county and township institutions through downward support, rotational exchange, and dual appointment or part-time arrangements. Under the support of fiscal coordination, unified recruitment, performance-based incentives, and medical insurance policies, the two mechanisms generate synergistic effects. However, regional differences remain in terms of institutional integration, governance capacity, and sustainability of support. Conclusions The mechanism of flexible talent mobility in county-level medical consortia provides a feasible pathway for optimizing county-level health workforce allocation and alleviating persistent problems in primary healthcare institutions, namely difficulties in recruitment, retention, and effective utilization of talent. In the future, it is necessary to further strengthen cross-departmental policy coordination, improve fiscal and medical insurance support mechanisms, and promote the standardization, legalization, and long-term institutionalization of related reforms.
Objective To develop an evaluation system for community-based traditional Chinese medicine (TCM) health service capacity from the perspective of collaborative governance, identifying current challenges and offering policy recommendations. Methods Integrating the structure-process-outcome (SPO) model and Bryson’s cross-sector collaboration model, an indicator pool was constructed through policy analysis, literature review, and grounded theory. The final system was determined via two rounds of Delphi expert consultation, with weights assigned using the analytic hierarchy process (AHP). Data were collected from 16 community health service institutions in Zhejiang and Anhui provinces. Weighted summation and TOPSIS methods were applied to comprehensively assess the community TCM health service capability. Results The system included 5 first-level, 15 second-level, and 41 third-level indicators. Average capacity scored 62.982, strengths include leadership responsibility, collaboration willingness, and basic public health services, whereas main weaknesses lie in human resource allocation, TCM technological achievements, digital use, and staff satisfaction. Conclusions Challenges include insufficient high-quality resources, limited collaborative capacity, and regional disparities, necessitating collaborative environments, governance structures, operational processes, and constraint mitigation.
Objective To conduct a systematic quantitative analysis of home-based hospital bed policies in Shanghai, examining the distribution of policy tools, policy goals, and policy strength, in order to identify existing strengths and gaps and provide evidence-based recommendations for policy optimization. Methods Policy documents related to home-based hospital bed services issued up to December 30, 2024, were retrieved. Using content analysis, individual policy items were treated as the minimum unit of analysis. A three-dimensional analytical framework encompassing policy tools, policy objectives, and policy strength was constructed. All valid policy items were coded, quantified, and analyzed using descriptive statistics and cross-dimensional analysis. Results A total of 43 policy documents and 119 valid policy items were included. Among the policy tools, demand-based tools were most frequently used (47.90%), followed by supply-based tools (32.77%) and environment-based tools (19.33%). In terms of policy goals, the greatest focus was placed on service content expansion (44.54%) and service capacity enhancement (27.73%), while institutional safeguard construction received limited attention (8.40%). The average policy strength score was 3.26, with relatively few high-authority or interdepartmental policies. Cross-dimensional analysis revealed limited alignment between policy tools and policy objectives, as well as a structural mismatch between policy strength and the strategic importance of policy goals, resulting in weak policy synergy. Conclusions The current policy system for home-based hospital bed services in Shanghai demonstrates structural imbalance, marked by overreliance on demand-based tools, underutilization of environment-based tools, and insufficient attention to institutional safeguards. The lack of systemic coordination among policy tools, objectives, and strength constrains overall policy effectiveness. Future policy development should strengthen top-level design, optimize policy tool combinations, enhance policy support intensity, and improve interdepartmental coordination to promote a more coherent, standardized, and sustainable development of home-based hospital bed services.
Objective This study aims to construct a competency model for personnel in disease prevention and control agencies in China, providing a basis for scientifically diagnosing the current competency status of disease prevention and control agency personnel and identifying competency gaps. Method Guided by the United Nations Development Programme (UNDP) conceptual model of competency and based on the iceberg model framework, this study derived the competency dimensions for disease prevention and control agency personnel in response to new policy requirements for the disease control and prevention system and disease prevention and control agencies in the new era, and further refined and validated the model through two rounds of the Delphi method. Result Taking into account the competency requirements for disease prevention and control agency personnel in the new era, particularly in public health emergency response, multi-sectoral collaboration, decision support and other aspects, and after two rounds of expert consultation, the finalized competency model comprises 3 first-level dimensions (knowledge, skills, professionalism), 14 second-level dimensions (e.g. preventive medicine knowledge, social medicine and health management knowledge), and 20 third-level dimensions (e.g., health hazard monitoring, decision support). Conclusions The competency model developed in this study focuses on the new requirements for high-quality development of the disease control system in the new era. It provides a reference framework for diagnosing the general basic competencies of disease prevention and control agency personnel and formulating improvement strategies.
Objective Based on a competency model for disease control personnel, this study conducted a comprehensive analysis of the training needs of staff in Shanghai’s disease prevention and control agencies, providing a scientific basis for developing a competency-oriented training curriculum. Methods Using personnel from municipal- and district-level disease prevention and control agencies in Shanghai as the study population, a stratified voluntary sampling method was employed. Training needs were assessed across knowledge, skills, and professionalism dimensions, taking into account staff tenure and the distribution of different job types, and influencing factors were subsequently analyzed. Results The overall score for on-the-job training needs among staff at disease prevention and control agencies in Shanghai was (3.31 ± 0.81). The scores for training needs in professional ethics, skills, and knowledge were (3.40 ± 1.00) (3.34 ± 0.87), and (3.21 ± 0.90), respectively. Within the knowledge category, the highest demand was for preventive medicine knowledge, with a score of (3.58 ± 1.03). Among the skills-based courses, the highest demand was for public health emergency response, with a score of (3.51 ± 0.97). Multivariate analysis of factors influencing training needs revealed that educational attainment (β = −0.101, P = 0.012), (β = −0.155, P = 0.015), and years of work experience (β = −0.091, P = 0.001) were significantly associated with overall training needs. Conclusions The training of knowledge should prioritize core competencies in preventive medicine while also incorporating management‐related and interdisciplinary knowledge. Skill-oriented training needs to address substantial demands in public health emergency response, as well as competencies in integrated assessment and decision support. Professionalism-oriented training is likewise essential. Given that training needs vary across individual and institutional characteristics, training strategies should be designed with corresponding specificity and precision.
Objective To comprehensively analyze pediatric healthcare utilization and health expenditure in Shanghai, identify existing problems and provide evidence-based recommendations for optimizing the multi-level pediatric health insurance system. Methods Multi-source data on the utilization and costs of children's medical services in Shanghai from 2018 to 2023 were collected. Descriptive statistical analysis was used to analyze the number of children's visits, the out-of-pocket ratio for outpatient and hospitalization, and the cost of disease types. Multivariate linear regression analysis was used to analyze the influencing factors of the out-of-pocket ratio for hospitalization expenses. Results Children tend to visit tertiary hospitals in Shanghai (in 2022, the proportion of outpatient visits of children in tertiary hospitals was 61.00%, and the proportion of hospitalization was 88.00%). The level of hospitalization insurance is much higher than that of outpatient (in 2023, the out-of-pocket ratio for hospitalization was 35.76%, and the out-of-pocket ratio for outpatient was 64.33%). There are differences in insurance among different disease types, with the out-of-pocket ratio for pneumonia being 28.45%, and the out-of-pocket ratio for osteosarcoma in rare diseases reaching 73.41%. The influencing factors of children had a higher out-of-pocket ratio were visiting tertiary hospitals, not participating in the “double insurance”, sufferring from rare diseases, and high-burden diseases (P<0.05). Conclusion Shanghai children’s healthcare system fac es structural deficiencies, such as unequal service tier distribution, imbalanced outpatient-inpatient benefits, and inadequate rare disease coverage, we should actively promote pediatric hierarchical diagnosis and treatment, optimize the reimbursement treatment for outpatient, appropriately expand the coverage of supplementary medical insurance, to meet the multi-level medical insurance needs, and further improve the health level of children.
