Objective To analyze the characteristics of inclusive voluntary health insurance (IVHI) that has been operating continuously for many years, and to offer insights for its sustainable development. Methods Taking the IVHI that has been in continuous operation from 2021 to 2023 in China as the research subject, this study analyzed its evolution in terms of security capability, security level and operating results. The development index of IVHI was utilized to measure the development level of each sustainable IVHI in 2021-2023, and the Sankey diagram was used to visualize its evolution characteristics. Results A total of 74 (55.22%) IVHI continued to operate in 2021-2023. In parallel, 53 (71.62%) kept the same annual financing amount. 68 (91.89%) IVHI retained the same or expanded scope of the coverage, and the percentage of IVHI subject to government guidance rose from 81.08% to 87.84%. 82.61% of IVHI enrollment rates either maintained stable or increased. The average deductible remained at 12 200 CNY, while the average reimbursement rate decreased by 5%, and the overall benefit cap increased by 800 000 CNY. The development index increased from 70 to 75 (out of 100). The Sankey diagram illustrated the notable increase in the percentage of IVHI with high security capacity and high security levels from 17.57% to 39.19%. In 2023, 35.14% of IVHI exhibited a combination of high security capacity and low security levels or low security capacity and high security levels, either of which was not conducive to sustainable development. Conclusions Sustainable IVHI has a stable financing standard and participation scale, established support from the government, a comprehensive scope of the coverage, a steady increase in reimbursement level, and a relatively high development index. However, the IVHI is facing the challenges of imbalance between security capability and security level. It is recommended to leverage the power of multiple parties to jointly increase the participation rate, optimize the design of coverage, and promote the synergistic development of security capability and security level.

Objective With growing substantial retirement-related medical burdens and strained healthcare fund expenditures, to investigate the impact of retirement on inpatient service utilization and hospitalization costs. Methods This study utilized urban employee medical insurance claims data from City G from 2021 to 2022, employing a fuzzy regression discontinuity design to empirically analyze the effects of retirement on inpatient service utilization and costs among male employees. Disease-specific and procedure-based mechanisms were further explored. Results Retirement substantially increases hospital admissions for male employees by 22.63% (P<0.01), while no significant impact on total hospitalization costs is observed (P>0.1). Retirement increases admissions by 26.24% (P<0.01) for diabetes mellitus patients and 25.12% (P<0.01) for coronary heart disease patients, with corresponding total hospitalization costs rising by 31.65% (P<0.01) and 23.37% (P<0.01), respectively. For elective treatments (e.g., knee/hip replacement and inguinal hernia repair), admissions increase by 20.08% (P<0.05), though cost increases remain statistically insignificant (P>0.1). Conversely, retirement reduces admissions by 30.79% (P<0.01) and total hospitalization costs by 42.25% (P<0.05) for stress-related conditions like peptic ulcers. Robustness checks, including continuity tests, alternative retirement age thresholds, and bandwidth adjustments, have been conducted to confirm the reliability of the findings. Conclusions Retirement elevates hospitalization frequency among male employees without significantly altering overall costs. The results reveal that after retirement, urban employees in City G have retirement effects such as leveraging higher inpatient reimbursement rates, pursuing elective treatments, and reduced occupational stress.

Objective To examine the impact of cognitive impairment on functional limitations and the role of socioeconomic status (SES) and healthy lifestyles in moderating this relationship, and to provide references for improving the care system for elderly population. Methods This study used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2002 to 2018, with ability of activities of daily living (ADL) and instrumental activities of daily living (IADL) selected as the dependent variables. Random effect logistic models were used to analyze the influence of cognitive impairment on functional limitations in different birth cohorts and the moderating roles of SES and healthy lifestyles. Results A total of 61 115 survey data were obtained from 53 278 respondents, of whom 14.18% had cognitive impairment, 21.41% had ADL limitations, and 62.35% had IADL limitations. Cognitive impairment increased higher risk of ADL limitations in the later-born birth cohort (1931-1949) (OR = 3.39, 95%CI: 2.56~4.50) than in the early-born birth cohort (1912-1930, OR = 1.45, 95%CI: 1.26~1.66). All differences were statistically significant(P<0.001). SES and healthy lifestyles played moderating roles in the relationship between cognitive impairment and ADL limitations (1912-1930, OR = 1.38, 95%CI: 1.19~1.60; 1931-1949, OR = 2.90, 95%CI: 2.10~3.99). Conclusions Cognitive impairment increases the risk of functional limitations. Older adults with cognitive impairment in later-born cohorts might be more likely to experience functional limitations and have a greater need for related care services. Social and economic development and lifestyle interventions can contribute to functional limitation prevention and control.

Objective To comprehensively analyze the relationship between chronic diseases and disability from the perspective of health inequalities, providing evidence to support effective responses to population ageing. Methods This study utilized data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) to examine the prevalence of disability across different chronic disease groups. A multiple cumulative risk model was employed to decompose the risk of disability. Additionally, health inequalities in chronic disease contributions were explored. Results From 2011 to 2018, the overall disability prevalence rate among the participants increased from 16.48% to 18.83%, and the difference was statistically significant (χ² = 47.44, P<0.001). Higher disease-specific disability rate and greater contributions of chronic diseases were identified among women, rural residents, and individuals with low socioeconomic status across all age groups. Among younger populations (aged 45~64), the largest relative contribution was from background factors (41.31%~58.57%), followed by arthritis (18.85%~31.28%). For populations aged 65 and above, arthritis accounted for the highest relative contribution (29.77%~40.80%). Conclusions The prevalence of disability shows inequality, particularly evident across different educational levels and between urban and rural areas. Reducing the risks associated with background factors and arthritis will help alleviate the burden of disability and promote healthy aging.

Healthy aging is a vital strategy in addressing population aging, and ensuring social security for older adults with disabilities is a key pillar in achieving this goal. This article reviewed the development of legal frameworks, financing mechanisms, and service systems for social security of disabled elderly individuals in the United Kingdom, Germany, and Japan, aiming to offer insights for disability policy in China’s aging society. The United Kingdom, Germany, and Japan have adopted financing models based respectively on taxation, social insurance, and a combination of the two. They have established comprehensive social security systems for older adults with disabilities, providing integrated services covering daily living, healthcare, housing, transportation, and other essential needs. The experience of these three countries highlights the importance of building a systematic and age-friendly legal framework, establishing a diversified financing system with active societal participation, and developing a people-centered service system that supports both community-based and family-based care.

Objective To explore the association between adverse childhood experiences (ACEs) and catastrophic health expenditure (CHE) among middle-aged and older adults in China, and to analyze the mediating role of health status (self-rated health, chronic diseases, depression, and cognitive function) in the association. Methods The data was sourced from four phases of the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, as well as the Chinese Resident Life Course Special Survey in 2014. A generalized estimating equations model was used to analyze the association between different types of ACEs and CHE, identify the potential mediating factors, and further conduct gender subgroup analysis. Results Individuals who experienced ACEs had a higher risk of CHE (P<0.05). When the self-rated health scores, chronic disease, depression scores, and cognitive function scores were added to the model, the association between 3 types of ACEs (socioeconomic disadvantage, parental trauma, and parenting behavior trauma) and CHE significantly decreased, reflecting the mediating role of health status in the association. The results of gender subgroup analysis indicated that women were more susceptible to socioeconomic disadvantage (OR=1.09, 95%CI: 1.03~1.15), while men were more susceptible to parenting related behavioral trauma (OR=1.11, 95%CI: 1.03~1.20). Conclusions ACEs exacerbated the risk of CHE, with health status (self-rated health, chronic diseases, depression, and cognitive function) playing a mediating role, and it emphasized the importance of multi-party collaboration among government, society, schools, and families, as well as interventions such as mental health support and chronic disease management. The study provides empirical evidence for formulating targeted policies and intervention measures.

Objectives Using clinical diagnostic data in disease monitoring and early warning to explore specific paths for medical prevention integration, and a system for disease monitoring and early warning with multi-point triggering mechanisms, and to enhance early disease monitoring and early warning capacities. Method Taking the medical data of pneumonia residents in Gansu Province as an example, the comprehensive medical data of pneumonia and pneumonia-associated diseases in Gansu Province in 2023 was retrieved from a big data platform to reveal the epidemic situation of pneumonia in Gansu Province, and diseases data highly related to pneumonia were screened to establish the relationship between pneumonia and these related diseases. Results The clinical diagnostic data profile the prevalence of pneumonia in general. In addition, pneumonia-associated diseases align with pneumonia in epidemic. 2023 witnessed a rising number of people seeking medical treatment for pneumonia in Gansu Province, with four peak visits throughout the whole year. After September, the number of pneumonia inpatients continued to rise. The number of visits for males is higher than that for females. Children in the 0~4 age group hit the highest hospital visits, and the difference is statistically significant (χ² = 8916.909, P<0.05). Lanzhou, Qingyang, and Linxia Autonomous Prefecture recorded the highest visits. Addtionally, notable differences in the number of pneumonia visits across different regions (χ² = 55318.633, P<0.05) were identified. Pneumonia shows a moderate positive correlation with fever (P<0.01), with a correlation coefficient of 0.561; a strong positive correlation with chickenpox (P<0.01) and bronchitis (P<0.01), with a correlation coefficient of 0.764 and 0.903, respectively. Conclusions Clinical diagnostic data has significant indicative value in disease monitoring and early warning. The interrelationships between diseases comprehensively reveal the epidemic trends of monitored diseases. A group of diseases highly associated to pneumonia maintain similar epidemic characteristics and trends to pneumonia, which can be served as important influencing factors and references for pneumonia monitoring and early warning. The establishment of a pneumonia monitoring system should also take the characteristics and epidemic trends of digestive system diseases into consideration. Leveraging big data advantages to screen highly pneumonia-associated diseases will substantially enrich the pneumonia monitoring and early warning system.

Objective To explore the effect of exercise self-efficacy on college students’ physical activity level, and to analyze the mediating role of exercise behavior intention between the two and the moderating effect of depression. Methods A multi-stage stratified random sampling method was used to select college students in Jiangsu Province as the research objects, and the data were collected using the exercise self-efficacy scale, the International Physical Activity Questionnaire (IPAQ) short paper, the exercise behavior intention questionnaire and depression scale based on the theory of planned behavior. Quantitative methods such as Pearson correlation analysis and moderated mediating effect analysis were used to analyze the relationship between exercise self-efficacy, depression, exercise behavior intention and physical activity level and the significance of the mediating effect, and the Bootstrap sampling method was used to validate the mediating effect. Results After controlling for gender, grade, age, major, and region, exercise self-efficacy significantly positively predicted the level of individual physical activity (β = 0.283, P<0.001). Exercise behavior intention can mediate the relationship between exercise self-efficacy and physical activity level. The mediation effect accounted for 35.76% of the total effect. Depression moderates the relationship between exercise self-efficacy and physical activity level, and regulates the intensity of the relationship between the two. Conclusion Exercise self-efficacy not only directly affects the physical activity level of college students, but also indirectly affects the physical activity level of college students through the mediating effect of exercise behavior intention and the moderating effect of depression.

In order to improve the quality of cervical cancer diagnosis and treatment, it is important to summarize the good multidisciplinary practices of cervical cancer both at home and abroad, and to build a comprehensive diagnosis and treatment center for cervical cancer based on its standardization and continuous optimization of the procedure. The study reviews the construction practice of Shanghai’s Comprehensive Center of Cervical Cancer from elements of the whole life cycle of cervical cancer including prevention, screening, diagnosis, treatment, rehabilitation, follow-up, clinical research, health education and popularization of science and technology, in order to provide reference for the construction of comprehensive oncology centers.

Objective To evaluate the operational efficiency of clinical departments in a tertiary public hospital in Shanghai and provide decision-making references for optimizing healthcare resource configuration in tertiary public hospitals. Method Data Envelopment Analysis (DEA) with a BCC model was applied to assess the operational efficiency and input redundancy of 53 clinical departments in a tertiary public hospital in Shanghai. Results The mean values of comprehensive efficiency, pure technical efficiency, and scale efficiency were 0.651, 0.773, and 0.842, respectively. Clinical departments were categorized into four efficiency quadrants: scale-driven, technology-leading, compound inefficient, and high-efficiency types. Surgical departments predominantly clustered in the high-efficiency and technology-leading categories. Non-DEA-efficient departments exhibited significantly higher output slack(S+). Conclusions Operational efficiency in clinical departments is more substantially influenced by pure technical efficiency, with distinct variations across specialties. Most departments demonstrated output insufficiency, highlighting critical areas for hospital-wide improvement. To enhance overall operational efficiency, hospitals should transition from “quantity-driven expansion” to “quality-driven development,” while deepening medical consortium collaboration and advancing payment reforms. These strategies will accelerate the operational efficiency of hospitals as a whole.

Objective This paper is to study the current situation of medical staff’s willingness to report medical adverse events in a specialized hospital in Shanghai, and to analyze the influencing factors. Method A total of 459 medical staff from a specialized hospital were surveyed by using convenient sampling method with a questionnaire from April to June 2023. Results The average score of nurses was higher than that of the clinical physicians and medical technicians in the dimensions of information, behavioral attitude, and subjective norms (P<0.01). The average score of medical staff with less than 5 years of work experience was lower than those with longer working years in the dimension of perceived behavioral control (P<0.05). The average score of medical staff with junior professional titles was higher than those with deputy senior titles and above in the dimension of information (P<0.01). The average score of medical staff with administrative positions was higher than those without positions in the dimension of willingness to report (P<0.01). More than 70% of medical staff knew about medical safety adverse events. Over 90% agreed that reporting adverse events was meaningful. And over 40% perceived obstacles and had concerns in the process of reporting. The dimensions of information (r = 0.32, P<0.01), behavioral attitude (r = 0.28, P<0.01), and subjective norm (r = 0.43, P<0.01) were positively correlated with the score of reporting willingness. The hierarchical regression analysis showed that the information dimension (β = 0.12, P<0.01), subjective norm dimension (β = 0.13, P<0.01) and administrative positions (β = 1.10, P<0.01) had a positive effect on report willingness. Interaction item showed perceived behavioral control had a positive moderating effect between information dimension scores and reporting intention scores. Conclusions The willingness of medical staff to report adverse events still needed to be improved. It was necessary to strengthen the training of personnel in various positions, perfect the systems, and optimize the reporting procedures to enhance their willingness.

Objective To explore the influencing factors of internet medical service satisfaction in counties. Method Hospital H was employed as an example, service quality (SERVQUAL) model was used as a survey tool to investigate the internet medical service user satisfaction of hospital H, and structural equation modeling and fuzzy set qualitative comparative analysis were utilized to explore single-factor influence and group influence effects. Results Tangibles (medical service hardware construction, β = 0.406, P<0.001), assurance (trustworthiness, β = 0.226, P<0.001) and empathy (providing personalized services for patients, β = 0.178, P = 0.002) had a significant positive effect on internet medical service satisfaction. The grouping analysis yielded five grouping results, which were categorized into three grouping path. Medical service hardware construction, service level, trustworthiness, and personalized services were identified as the core factors triggering high Internet medical service satisfaction. Conclusions Strategies such as developing internet medical service based on physical hospitals, strengthening the construction of basic services of internet healthcare platforms and developing outreach programs. Further, improving the services of internet healthcare platforms through multiple-subjectscoordination to give full play to the combination effect promote the satisfaction of internet healthcare.

Objective By analyzing the polypharmacy data of elderly patients with chronic diseases under the home-based elderly care model in the urban area of Xuzhou City, this study aims to identify the influencing factors of polypharmacy behavior in this population, propose measures to improve polypharmacy behavior, and thereby reduce the health damage caused by irrational medication use and improve the quality of life of the elderly. Method A two-stage mixed sampling method, together with a self-established questionnaire was employed to investigate the polypharmacy situation among home-based elderly individuals in the urban area of Xuzhou City. Results The polypharmacy rate among elderly patients with chronic diseases under urban home-based elderly care in Xuzhou City was 9.70%. The following factors were associated with polypharmacy behavior: without a spouse (OR = 0.42, 95%CI: 0.20~0.86), medication costs exceeding economic affordability of individuals or families(OR = 0.40, 95%CI: 0.19~0.85), medical insurance for employees (OR = 18.88, 95%CI: 5.29~67.40), seeking medical care at municipal or higher-level hospitals (OR = 3.93, 95%CI: 1.96~7.89), multimorbidity with over 5 chronic diseases (OR = 50.04, 95%CI: 12.02~208.42), adverse drug reactions records (OR = 0.18, 95%CI: 0.07~0.46), medication use guided by physicians (OR = 0.10, 95%CI: 0.02~0.48), good medication compliance (OR = 10.13, 95%CI: 3.82~26.87), coronary heart disease (OR = 2.60, 95%CI: 1.11~6.06), and arthritis (OR = 3.05, 95%CI: 1.48~6.30). Elderly patients with chronic diseases with these factors were more prone to polypharmacy Conclusion Efforts should continue to popularize and promote medication education, strengthen guidance on medication use for elderly patients with chronic diseases, enhance awareness of scientific administration, and optimize basic healthcare services for community residents.

Objective To empirically analyze the main challenges and influencing factors in supervisor-student relationships during medical graduate education, and to provide feasible policy recommendations for mitigating supervisor-student conflicts and promoting the connotative development of graduate education. Methods A two-way questionnaire survey was conducted, through Wenjuanxing platform, using a non-open online questionnaire, between supervisors and their graduate students across various disciplines in a medical school of a comprehensive university. The study compared the overall satisfaction levels of both parties regarding supervisor-student relationships and the discrepancy between the expectations and the reality. Results Supervisors reported higher overall satisfaction with supervisor-student relationships (91.68%) than that of postgraduates (81.07%). A higher proportion of postgraduates (90.79%) expressed a desire for an intimate or harmonious relationship with their supervisors, compared to those who have actual feelings (69.44%). Both differences were statistically significant (all P<0.01). 83.55% of supervisors communicated with their postgraduate students at least 1~3 times per month. 1.59% of postgraduates reported tense supervisor-student relationships. 4.89% of supervisors adjusted their communication frequency tailored to individual students. Postgraduates’ age, work experience, and academic year apparently correlated with their satisfaction (all P<0.05). Both supervisors (68.22%) and postgraduate students (65.25%) identified the supervisor’s research/professional competence as the most critical factor in building a positive relationship, followed by the supervisor’s care for students (45.23% and 55.65%, respectively). Conclusions Supervisors exhibit higher satisfaction with supervisor-student relationships than their students. Compared to reality, postgraduate students desire more frequent communication and a more equal mode of interaction. Influencing factors are diversified. It is recommended to clarify the boundaries of supervisor-student relationship through institutional construction, improve the matching degree between students and supervisors through multiple channels. Further, strengthening supervisors’ research and communication skills via various forms could help mitigate the conflicts between them.

Objective To measure the economic burden of assisted reproductive technologies (ART) from the patient's perspective and assess affordability. Methods Economic burden in this study includes direct medical burden, direct non-medical burden and indirect burden. Medical cost data were collected from five medical institutions nationwide offering ART services to calculate the direct medical economic burden.A patient questionnaire was delivered to gather direct non-medical economic burden and indirect economic burden. the respondents were characterised using frequencies and percentages, while economic burden was described using median and quartile. The Kruskal-Wallis test was applied to compare differences in economic burden. Affordability was evaluated based on the proportion of direct medical economic burden to per capita disposable income. Results A total of 524 patients were surveyed. The proportion of patients undergoing artificial insemination by husband (AIH) was 7.06%, artificial insemination by donor (AID) was 9.54%, in vitro fertilization-embryo transfer (IVF-ET) was 57.25%, and intracytoplasmic sperm injection (ICSI) was 26.15%. The median of direct medical economic burden per cycle for AIH, AID, IVF-ET, and ICSI was 7,842 CNY, 12,048 CNY, 35,985 CNY, and 39,685 CNY, respectively. The median of direct non-medical economic burden per cycle was 7,900 CNY, 7,550 CNY, 20,765 CNY, and 24,800 CNY, respectively. The median of indirect economic burden per cycle was 1,075 CNY, 1,880 CNY,2,794 CNY, and 2,149 CNY, respectively. The economic burden of IVF-ET and ICSI was significantly higher than that of AIH and AID, but no statistically significant differences(P>0.05) was identified in economic burden between AIH and AID, or between IVF-ET and ICSI. The proportion of direct medical costs per cycle to the annual per capita disposable income was 20%, 31%, 92%, and 101%, respectively. The median of direct medical costs per cycle was accounted for 9%, 13%, 40% and 44% of the per capita GDP, respectively. Conclusions The economic burden of IVF-ET and ICSI is substantial. Listing these treatments in medical insurance could reduce the direct medical economic burden. Other measures, such as forming specialized alliances across regions, promoting hierarchical medical treatment, providing fertility subsidies, and precisely identifying high-burden patients are needed to further reduce direct non-medical and indirect economic burdens.

Objective To analyze the effect of inpatient cost control and cost transfer path of hospitals of Chinese medicine before and after the reform of ‘DIP’ (diagnosis-intervention packet) by taking lung cancer inpatients in these hospitals as an example, in order to provide references for further improvement of policies related to health insurance payment in traditional Chinese medicine. Methods Including 1 833 patients in hospitals of Chinese medicine which underwent DIP payment reform in City Z from January 2020 to December 2022 as the treatment group and 610 patients in hospitals of Chinese medicine in City G and City C that did not implement the reform during the same period as the control group, this study collected information of these hospitals of Chinese medicine, lung cancer, and inpatients with lung cancer. The dual machine learning algorithms was applied using patients’ total single hospitalization medical costs as a proxy variable to assess the cost control effect, and the out-of-pocket costs of and their percentage in Category B, together with the payment of and its percentage in Category C as proxy variables for transfer cost, to explore the impact of DIP payment reform on the hospitalization costs of lung cancer patients in Chinese hospitals. Results After the implementation of DIP payment reform in the treatment group, the total hospitalization costs of lung cancer patients decreased by 12.20% (P<0.01), the out-of-pocket costs of Category B did not change significantly, the percentage of out-of-pocket costs of Category B increased significantly by 0.73% (P<0.01), the cost of Category C decreased sharply by 47.84% (P<0.01), and the percentage of cost of Category C decreased by 1.50% (P<0.01). Heterogeneity analysis revealed that tertiary hospitals had a better effect on cost control than secondary hospitals, and private hospitals had a more notable trend of transfer cost than public hospitals. Conclusion DIP payment reform apparently reduced the total single hospitalization costs of lung cancer patients in hospitals of Chinese medicine, while there was a prominant cost-transferring effect, with the transfer to out-of-pocket costs of Category B rather than to Category C.