Promoting the coordinated development and governance of medical services, medical insurance, and pharmaceuticals is a concrete practice in advancing the modernization of the national governance system and enhancing governance capacities. It is an inevitable requirement for implementing the strategy of prioritizing health development and an important part in deepening the healthcare system reforms. Currently, the coordinated development and governance of medical treatment, medical insurance, and pharmaceuticals still face numerous challenges. Healthy China Research Network, incorporating evidence-based scientific data, expert insights, and practical experience, has formulated the “Expert Consensus on the Coordinated Development and Governance of Medical Services, Medical Insurance, and Pharmaceuticals,” exploring the connotations, significance, and goals. The consensus proposed that, to promote the coordinated development and governance of medical treatment, medical insurance, and pharmaceuticals, it is essential to adhere to the comprehensive leadership of the Communist Party of China, and center the focus on people’s health. Upholding fundamental principles and breaking new ground, prioritizing institutional development, and following the systematic principle are critical as well. Accordingly, corresponding institutional mechanisms and supportive measures are proposed, aiming to provide references for policymakers, decision-makers, practitioners and researchers in the field of healthcare.

Objective To clarify the current situation and existing problems of the unified needs assessment service system for elderly care in Shanghai, to propose feasible recommendations for improvement, and to provide a reference for optimizing the system. Methods An institutional survey was conducted on assessment institutions at both the municipal and district levels in Shanghai, alongside key informant interviews with managers of Shanghai and district-level health commissions, medical insurance bureaus, civil affairs departments, and the heads of assessment institutions. The existing problems were analyzed using the WHO health system framework and thematic framework analysis. Results The unified needs assessment service system for elderly care in Shanghai has a large scale of service provision, a substantial number of assessors, and a generally well-established information platform, fund mechanism, and organizational structure. There are still some challenges such as the need to strengthen the top-level coordination, the small scale of assessment institutions, instability of the assessor workforce, low assessment costs, unreliable operation of the information platform, and underutilization of assessment results. Conclusion The future development of the unified demand assessment service system for elderly care in Shanghai should further strengthen the following aspects: clarifying the positioning and improving the top-level design, enhancing the overall departmental and industrial coordination, promoting the sustainable development of the industry, improving the professionalism of assessment institutions and personnel, refining operational mechanism, and increasing awareness of policy standards.

Objective To examine the policy design of long-term care insurance in China and optimize its practical implementation path. Method The PMC index model was used to quantify the policy texts from 12 cities in China’s first and second pilot projects, followed by a differential analysis of the policy content. Results The policy level in each pilot city is at or above the “good” level, with an overall positive outcome. However, improvements are needed in areas such as incentives and constraints, policy timeliness, and institutional indicators. Moreover, remarkable differences and fragmentation exist among pilot cities in terms of insurance payment, service models, and standards for benefits and payment. Conclusions The pilot phase of China’s long-term care insurance system has yielded initial results, but substantial room for improvement remains. There are notable differences in long-term care insurance among pilot cities, and there is a pressing need for coordinated planning. A sound financing mechanism is the key to the sustainable development of the system.

Objective This study aims to explore the factors influencing health information avoidance behavior in the elderly, providing theoretical support and practical guidance for constructing a comprehensive, multi-dimensional health management system for them and improving age-friendly health information services. Methods A systematic review was conducted across 11 databases, including CNKI, Wanfang, Embase, EBSCO, PubMed, and WOS, to identify empirical studies related to health information avoidance behaviors in the elderly. The search period was set to end on September 30, 2024. Eligible empirical studies were selected for meta-analysis. Publication bias was assessed using funnel plots, Egger’s regression test, and fail-safe N. Heterogeneity was examined through Q-tests and I-squared statistics, followed by an analysis of the overall effect size and moderator variables. Results The factors influencing health information avoidance behavior among older adults can be categorized into two types: individual factors and situational factors. Among the individual factors, health information avoidance behavior is positively correlated with perceived risk (r = 0.265), negative emotions (r = 0.389), and fatalism (r = 0.146), while they are negatively correlated with self-efficacy (r = −0.309). The situational factors related to health information avoidance behavior include technological barriers (r = 0.405), information overload (r = 0.247), information credibility (r = −0.268), intergenerational support (r = −0.326), and stigma (r = 0.101). Gender, region, educational level, and negative emotions also play a moderating role. Conclusion The findings suggest that the optimization of health information services for older adults can be achieved by establishing fine-grained intergenerational support networks to enhance the self-efficacy of the elderly; raising the entry threshold for health service channels to improve the quality of health information content; and developing age-friendly health information services to eliminate barriers related to digital technology.

Ethical assessment is an essential component of health technology assessment (HTA). With the development of HTA, numerous methods for ethical assessment have emerged. Among them, axiology effectively integrates ethical methods and tools into HTA, facilitating better decision-making. This article describes and discusses the methods of axiology and guidelines that have been applied internationally, including the Socratic method, the HTA core model, and the ethical assessment guidelines for health technologies in Sweden, Spain, and France. Axiology analyzes health technologies through a set of ethical questions. It provokes ethical reflection, explores the ethical consequences of using the technology, and guides decision-makers in making decisions regarding using or adopting the technology after they weigh the pros and cons. Moreover, this paper systematically organizes the ethics-related issues of health technologies from the aforementioned methods and guidelines, aiming to develop an ethics checklist that is tailored to the national context of China. It also seeks to construct a distinctive axiological method guideline that reflects the unique characteristics of China, thereby promoting the healthy development of health technologies.

Objective To explore the use of Best-Worst Scaling (BWS-1, object case) in the attribute selection process of stated preference research, providing methodological guidance for researchers. Methods A BWS-1 questionnaire was created using a balanced incomplete block design. The study surveyed depressed and depression-prone individuals online to assess their preferences for antidepressant selection. Data were analyzed using counting methods and a conditional logit model. The preference heterogeneity was also examined. Results The BWS-1 results obtained from the counting method and modelling approach showed high consistency. Liver or kidney injury (both ranked first in importance), headache or dizziness (ranked second and third, respectively) and relapse rates (ranked fourth and second, respectively) were highly prioritized by both depressed patients and depression-prone respondents. Monthly out-of-pocket costs exhibited substantial preference heterogeneity in both groups. Based on qualitative research and BWS-1 quantitative findings, six attributes were ultimately included in the subsequent stated preference study: the risk of liver or kidney injury, the risk of headache or dizziness, the risk of gastrointestinal adverse effects, sleep disturbances, remission rate, and monthly out-of-pocket costs. Most of these attributes were highly ranked in the BWS-1 results. Conclusions BWS-1 can provide valid and reliable evidence for attribute selection in stated preference research. However, it should be complemented by qualitative research that considers research questions, decision-making contexts, and stakeholder opinions to address attributes not covered by BWS-1, thereby enhancing the study’s rigor.

Objective To systematically evaluate the effectiveness of the Bispectral Index (BIS) in monitoring anesthesia depth. Methods CNKI, Wanfang, VIP, SinoMed, Ovid-MEDLINE, Cochrane Library, PubMed, Web of Science and Embase databases were searched, and all relevant randomized controlled trials were collected according to inclusion and exclusion criteria. Literature screening, data extraction, and methodological quality were assessed independently by two evaluators. R 4.0 software was used for analysis. Results A total of 92 studies were included. Compared to traditional depth monitoring of anesthesia, BIS monitoring significantly reduced the incidence of postoperative delirium (RR = 0.56, 95% CI: 0.42 ~ 0.75, P<0.01), intraoperative awareness (RR = 0.51, 95% CI: 0.36 ~ 0.74, P<0.01), and postoperative cognitive impairment (RR = 0.77, 95% CI: 0.67 ~ 0.89, P<0.01). Additionally, it substantially shortened the time to eye opening (MD = −2.55, 95% CI: −3.75 ~ −1.35, P<0.01), recovery time to orientation (MD = −5.38, 95% CI: −8.94 ~ −1.82, P<0.01), extubation time (MD = −5.65, 95% CI: −7.13 ~ −4.17, P<0.01), and post-anesthesia care unit stay time (MD = −9.47, 95% CI: −13.50 ~ −5.43, P<0.01), while also reducing the amount of anesthesia drugs used (SMD = −1.02, 95% CI: −1.37 ~ −0.67, P<0.01). There were no significant differences between the use of BIS monitoring and traditional depth monitoring of anesthesia in postoperative nausea and vomiting, the incidence of abnormal blood pressure, mortality, operation time, and predicted recovery of consciousness. Conclusion The use of BIS monitoring in anesthesia can significantly improve the effectiveness of clinical anesthesia management, contributing positively to ensuring both the safety of patients undergoing anesthesia and he safety of surgeries.

The establishment of an integrated delivery system (IDS) marks a significant reform in healthcare service provision, representing a critical trend in global healthcare reforms, and serving as a crucial framework for achieving the Healthy China initiative. Reducing transaction costs is key to the successful implementation of this new system. Guided by the Williamson-Steven Cheung transaction cost analysis paradigm, this study decomposes transaction costs into planning and decision-making costs, operational collaboration costs, specific investment costs, and supervision costs, thereby constructing a micro-measurement model for IDS transaction costs. Leveraging actor-network theory, the study proposes strategies to enhance awareness of transaction costs, establish cost-saving institutional provisions, refine compensation and incentive mechanisms, and create pathways for collective action among stakeholders. These strategies aim to reduce IDS transaction costs and facilitate the resilient and sustainable operation the system.

Objective To assess the perception of transaction costs on the provider side within integrated delivery systems (IDS) and propose strategies to enhance understanding, thereby increasing the motivation to achieve policy goals within IDS. Methods Guided by the Williamson-Steven Cheung analysis paradigm, this study decomposed the transaction costs of the integrated health service system into planning and decision costs, specific investment costs, operational collaboration costs, and supervision costs. J District in Z City of Henan Province, N County of Shandong Province, and D Prefecture of Qinghai Province were selected as the research objects using typical sampling method. Questionnaire surveys were administered to collect demographic and relevant information from provider-side staff. A cognitive assessment scale was employed to measure their perception of IDS transaction costs. Propensity score matching (PSM) was utilized to verify differences in cognitive abilities across different provider- ide groups, and multiple linear regression models were used to analyze the factors influencing cognitive ability. Results A total of 936 staff members participated in the survey. The average score on the transaction cost cognitive scale was 12.59 ± 3.22. Furthermore, 53.42% of respondents perceived planning and decision-making costs as high or very high, 75.11% rated specific investment costs as average or below, 92.52% considered operational collaboration costs to be average or above, and 77.14% evaluated supervision costs as average or below. Before and after PSM, cognitive ability scores were higher among staff in leading hospitals than those in member units. Factors such as age, educational level, organization nature, and position significantly influenced the provider side staff’s perception of transaction costs (all P<0.05). Conclusions Staff on the provider side generally perceive transaction costs in IDS to be moderate, particularly concerning planning and decision-making, and operational collaboration costs. Perceptions of transaction costs vary among different provider side groups in IDS, influenced by factors such as age, ethnicity, educational level, working years, organization type, and position. Future efforts should focus on raising awareness of the hidden and pervasive nature of transaction costs and establishing a cost-saving institutional framework to improve provider side perceptions and boost confidence in achieving policy goals within IDS.

Objective To examine patients’ awareness of the transaction costs of the “referral mechanism” in integrated medical and health service system, measure and compare the differences in transaction costs between urban and rural patients, and provide evidence to support the sustainable development of the mechanism. Methods A typical sampling method was used to select the hospitalized patients with hypertension and diabetes who turned up or down in the compact county-level medical community in D City of Haixi Prefecture, Qinghai Province, the urban medical group in J District of Zhengzhou City, Henan Province, and the health management union in N county of Dezhou City, Shandong Province, and patients’ awareness of transaction costs was investigated. Based on the Williamson-Steven Cheung analysis paradigm, a method for transaction cost calculation was established to measure the average transaction cost per referral, and the transaction costs of urban and rural patients were compared by propensity score matching. Results A total of 915 referred patients were investigated, and the average transaction cost per referral was 647.68 CNY, including 348.61 CNY for the time cost and 299.07 CNY for special input cost. Over 29.29% of the referred patients considered that the cost of each part of the referral to be low or very low, while nearly 50% of the patients regarded them as moderate. The transaction costs were higher for male, younger, rural, highly educated, employed patients, those with longer referral transportation time, and those transferred both up and down. These differences were statistically significant (P<0.05). Before and after propensity score matching, the transaction costs of urban patients (600.24 CNY and 547.87 CNY) were lower than those of rural patients (671.51 CNY and 934.74 CNY), with the differences being statistically significant (P<0.001). Conclusions Patients have limited awareness of referral transaction costs, and the cost they incur in the process of referral is high, particularly for rural patients, whose costs are much higher than those of urban residents. To address transaction costs effectively, it is recommended that the healthcare providers streamline referral channels; the demand side should recognize the characteristics of transaction costs and seek medical treatment in an orderly manner; and the healthcare insurers should establish compensation and incentive measures.

Objective Based on the perspective of the actor network, this study aims to construct an implementation path for reducing the transaction costs of the integrated delivery systems, providing references for reducing IDS transaction costs. Methods A typical sampling method was used to select 92 staff members from integrated delivery systems in three places: N County in Dezhou, Shandong Province, J District in Zhengzhou, Henan Province, and D City in Haixi Prefecture, Qinghai Province, as interview objects. The grounded theory was used to summarize the categories of the interview data, the theoretical framework was constructed based on the deduction method in the real situation, and policy recommendations were put forward through induction. Results A total of 3 680 minutes of interviews were conducted, resulting in 552 800 words. After systematic organization, 134 original statements were extracted. Open coding formed 19 first-level categories, axial coding formed 7 second-level categories, and selective coding led to two research levels of human actors and non-human actors, the theoretical framework of an actor-network model for reducing transaction costs in an integrated delivery systems is constructed from three aspects: actors, translation of actions, and objectives. Conclusions IDS consists of the government, lead organizations, member organizations, patients and other participants and the policy environment, socio-economic environment and geographic environment. Transaction costs within IDS are prevalent among all actors. In the next stage, measures such as improving the system construction, optimizing the resource allocation, promoting the coordination of interests among multiple actors, and strengthening patient cultivation should be taken to reduce the institutional transaction costs.

Objective To investigate the Chinese physicians’ cognition and support attitude regarding the benefits and risks of artificial intelligence (AI)-assisted diagnostic technology for breast cancer pathological slides, and to provide decision-making basis for the development and clinical application of this technology in China. Methods A questionnaire survey was conducted among physicians responsible for clinical diagnosis and treatment of breast cancer, as well as medical technical support, in nine tertiary hospitals in Shanghai, Hubei and Gansu. The chi-square test was used to compare physicians’ cognition and support for AI-assisted diagnostic technology for breast cancer pathological slides. Results A total of 278 physicians were included. According to the physicians’ cognition, the top three benefits of AI-assisted diagnostic technology for breast cancer pathological slides were “reducing the workload of pathologists” (77.70%), “improving diagnostic efficiency” (76.26%), and “reduce the need for pathologists’ allocation” (48.20%). The top three risks were “increasing the risk of misdiagnosis” (66.55%), “increasing the risk of missed diagnosis” (56.47%), and “lack of standardized diagnostic criteria” (50.00%). Additionally, 68.71% of physicians supported or somewhat supported AI-assisted diagnostic technology for breast cancer pathological slides, with differences in support rate across regions and hospital types. Conclusion China sould establish a standardized medical imaging database and implement safety certification to promote the maturity and improvement of AI-assisted diagnostic technology for breast cancer pathological slides, thereby increasing physicians’ trust and support.

Objective To evaluate the impact of the “Si Jiexiao” health management model on behavioral changes in chronic disease patients (using diabetes mellitus patients as an example), and to provide scientific evidence and practical guidance for developing grassroots health management model in the new era. Methods The study included a total of 477 diabetic patients as research subjects through convenience sampling. Data from a questionnaire survey were matched with a county-level public health system database information. Patients were divided into the experimental group (n = 226) and the control group (n = 251) according to whether they had received the “Si Jiexiao” health management model. The initial follow-up data in 2023 were taken as the baseline, and the follow-up results of glycemic control at the end of the year, adherence to regular follow-up, frequency of exercise, medication adherence, medical compliance, psychological adjustment, and other indicators were compared and analyzed. Results The “Si Jiexiao” health management model was found to be effective in promoting behavioral changes in chronic disease patients. Specifically, the proportion of patients with poor blood sugar control in the experimental group (58.85%) was significantly lower than the control group (77.69%); the compliance rate of regular follow-up reached 62.83%, which was remarkably higher than the control group (51.79%), and the proportion of patients who exercised more than three times a week in the experimental group (52.21%) was notably higher than the control group (29.08%). The rate of regular medication adherence in the experimental group was significantly improved, reaching as high as 85.84%, which had a vital advantage over the control group (77.69%); at the same time, the proportion of patients with good compliance to medical advice (46.46%) was significantly higher than the control group (31.88%). However, no statistically significant difference was observed in psychological adjustment between the two groups. Conclusions The “Si Jiexiao” health management model has obvious effects on improving the behavior of chronic disease patients, especially in regular follow-up, exercise frequency, medication adherence, and medical compliance; and the model also shows a positive potential trend in influencing psychological adjustment.