In the context of the digital era, artificial intelligence (AI) serves as an important driving force for a new round of technological revolution and industrial transformation. The recent phenomenal development and application of the DeepSeek large model, in particular, have brought new opportunities for the digital transformation of medical institutions. Following the local deployment of DeepSeek in medical institutions, AI technology has been widely involved in various medical affairs, including AI-assisted medical image interpretation, auxiliary diagnosis and treatment, and the administrative management of medical institutions. However, while the development of AI technology has brought unprecedented opportunities, it has also presented unseen risks and challenges. The application of AI in medical institutions also poses several risks, for example, the absence of dedicated AI regulation system in medicine and the potential for invalidating the informed consent right of patients. This, in turn, which introduces the uncertainty into the doctor-patient relationships and medical affairs. To accelerate a new generation of AI and achieve the high-quality development of medical institutions, it is essential to effectively regulate AI within the legal framework of "Tech for good". This requires adhering to a people-centered approach to adjust and construct the guidelines for medical affairs, thereby ensuring information right and data security of patients.

Objective To analyze existing theoretical models for the integrated management of chronic multimorbidity, providing a basis for constructing an integrated healthcare model for chronic multimorbidity in China. Methods This study performed a systematical literature review on theoretical models for the integrated management of chronic multimorbidity from CNKI, Wanfang, PubMed, Embase, and Web of Science. The search period covered from the inception of each database up to January 23, 2024. The retrieved literature was then screened and extracted. Results A total of eleven articles were included. Based on the complexity and heterogeneity of chronic multimorbidity, the study identified three common principles: patient-centeredness, continuity and coordination of services, and the emphasis on clinical guideline support and evidence-based practice. Seven core components were summarized: health service delivery, leadership and governance, human resources, financing and incentives, technology support and medical products, data collection and application, and monitoring and management. Conclusion Existing theoretical models for integrated chronic multimorbidity management focus on common modules, emphasize the micro-level, and require dynamic adaptation due to different scenarios. For China, it is recommended to prioritize the development of evidence-based multimorbidity guidelines, strengthen community workforce management, enhance the construction of close-knit medical consortia, leverage the power of technological innovation, and explore innovative payment mechanisms.

China’s urbanization rate surged from 50% (2011) to 64.72% (2021), with physical inactivity triggering a critical chronic disease burden. Within this context, Sports-Health Cities (SHCs) have emerged as pivotal vehicles for implementing the Healthy China strategy by reconstructing the “movement-space” nexus. This study aimed to explore effective strategies for advancing the development of sports and health cities and their evaluation frameworks in China, with the aim of guiding citizens toward adopting a healthy and active lifestyle and contributing to the Healthy China initiative. This study is grounded on the concept of health cities, with a focus on the current state of sports and health cities development and the challenges related to their evaluation systems. Since the implementation of the Healthy China initiative in 2016, approximately 16 provinces/municipalities have advanced sports-health city initiatives, creating differentiated local models. Furthermore, although some scholars have started to explore evaluation criteria for sports and health cities, issues persist, such as an excessive number of indicators, ambiguous interpretation of these indicators, and a lack of metrics that reflect the characteristics of key population groups. The absence of a solid research foundation has led to studies that often remain superficial and lack significant impact. The construction of sports and health cities is a systematic process that involves continuously identifying and solving problems. Future efforts must address the bottlenecks of the lack of interdisciplinary theoretical frameworks, a gap between resource allocation and effective utilization, and the insufficient scientific rigor and operational feasibility in evaluation system. It is recommended to incorporate health outcomes into government performance assessments, thereby shifting the governance paradigm from a focus on “facility provision” to “health benefits”, and deepening the development of a dynamic national-local, two-tiered evaluation index system.

Objective To analyze the impact of the first round of centralized volume-based procurement of Chinese patent medicine on the procurement structure of these medicines in public medical institutions of Hubei Province, and to provide a reference for improving this policy. Methods Obtain the procurement data of traditional Chinese patent medicines and simple preparations for public medical institutions in Hubei Province from 2021 to 2022 through the centralized procurement platform for drugs and medical devices in Hubei Province, setting April 2022 as the time point of policy implementation. An interrupted time series (ITS) model was used to analyze the changes in the defined daily doses (DDDs), procurement amount and defined daily dose costs (DDDc) of selected and non-selected products in different levels of public healthcare institutions before and after the collection. Results 1) Overall, the DDDs of the selected products in the centralized procurement increased by 89.82%, the procurement amount increased by 24.02%, and the DDDc decreased by 34.66%. And the DDDs of non-selected products decreased by 53.26%; their procurement amount decreased by 74.24%; and their DDDc decreased by 44.89%. 2)The DDDs of selected products in second and third level hospitals increased by 34.30% and 36.48% respectively, the procurement amount increased by 21.76% and 3.04% respectively; and the DDDs decreased by 28.05% and 36.94% respectively. Specifically, in primary healthcare institutions, the DDDs and procurement amounts for selected products increased by 777.29% and 658.89%, respectively, while DDDc decreased by 29.13%. Meanwhile, the DDDs of non-selected products in second and third level hospitals decreased by 79.94% and 75.69% respectively, the procurement amount decreased by 87.09% and 87.66% respectively, and the DDDc changed by 1.26% and −4.58% respectively. In primary care institutions, the DDDs and procurement amounts for non-selected products, increased by 561.85% and 1 007.74%, respectively, while the DDDc decreased by 2.58%. 3)The ITS immediate effect showed a significant increase in DDDs for the selected products (β₂ = 52.376, P = 0.016) and a significant decrease in their DDDc (β₂ = −3.796, P = 0.001). For non-selected products, however, the effects showed a decrease in DDDs (β₂ = −9.790, P = 0.060), but not statistically significant, and a significant decrease in DDDc (β₂ = −3.357, P = 0.024). The ITS short-term effects showed a decreased DDDs (β₃ = −4.301, P = 0.054) for the selected products, but not statistically significant and a remarkable increase their DDDc (β₃ = 0.620, P<0.001); for the non-selected products, a significant decrease in DDDs (β₃ = −2.002, P<0.001) and a slight increase in DDDc but not statistically significant (β₃ = 0.059, P = 0.590) were identified. Conclusions The purchasing behavior of the selected Chinese patent medicines shows a ‘rebound’ trend over time, with DDDs rising promptly and then falling after policy implementation, accompanied by a rise in DDDc. This may be related to the change in the procurement composition ratio of products with different specifications. The primary medical institutions procurement behavior differs from that of the secondary and tertiary hospitals, mainly reflected in immediate procurement of a large number of non-selected products after the policy implementation, and tend to choose products with higher DDDc. Therefore, supervision should be strengthened to guide rational procurement, stabilize corporate expectations, and embody the principle of quantity-price trade-off.

Recent years have seen the increase of research on health preferences across diverse scenarios, with well-established methodologies. However, it also faces issues of overgeneralized procedural studies and weak practical value. This study reviews the current state of health preference research and discusses its potential value risks from both theoretical and practical perspectives. From a theoretical perspective, health preference research may have limitations such as restricted research levels, designs detached from real world constraints, and methodological limitations. From a practical perspective, it may face challenges including discrepancies between the assumption of shared decision-making and reality, limited consideration of individual preferences in public policy, and ethical controversies. This paper proposes to optimize the health preference research by aligning these studies with real-world decision-making contexts, further expand the depth of exploratory research, and to incorporate policy perspective into these studies' theoretical significance and practical value.

Objective To explore the impact of national volume-based procurement of coronary stents on medical costs, stent usage, and health outcomes. Methods This study utilized an interrupted time series analysis to assess the effect of national volume-based procurement (VBP) policy for coronary stents, implemented in January 2021 on seven key indicators. Data came from a tertiary hospital in Hangzhou from January 2020 to December 2022, focusing on inpatients in DRG groups FM11, FM13, and FM15, who underwent percutaneous coronary stent implantation. The indicators included total hospitalization cost, number of stents used, stent-related expenditure, length of stay, proportion of inpatients using bid-winning stents, clinical improvement rate, and 28-day reoperation rate. Results A total of 3,132 patient-visits were included. Immediately following the policy implementation in January 2021, patients’ total hospitalization cost and stent-related expenditures decreased significantly by 27.92% and 91.65%, respectively (both P<0.001). The proportion of inpatients using tender-winning stents increased sharply by 50.13% (P<0.001), and the average number of stents implanted per case increased by 0.31 (P<0.001) at the time of policy implementation. No statistically significant immediate changes were observed in length of stay, disease improvement rate, or 28-day reoperation rate. The long-term trend showed a continuous decline in total hospitalization costs (P = 0.001), while no significant long-term changes were identified for the other indicators. Conclusions The implementation of national volume-based procurement policy for coronary stents led to a reduction in stent-related expenditures, achieving a notable cost-saving effect. The clinical usage pattern of coronary stents was reshaped, and patients’ health outcomes were not adversely affected. A short-term rise in the average number of stents implanted per case was observed, indicating potential adjustments in clinical practice. Continuous monitoring and systematic evaluation of the long-term effectiveness of bid-winning products are recommended.

Objective To analyze the current status and development trend of specific high-priced drug coverage of an inclusive commercial medical insurances (hereinafter referred to as ‘‘Huimin insurances’’) in China. Method This study systematically collected Huiminbao policy documents and their high-priced drug lists implemented across various provinces in 2022-2023, employing policy document analysis to extract and examine the categories of specific high-priced drugs and their coverage levels. Results From 2022 to 2023, the number of Huimin insurances schemes with specific high-priced drug in China increased from 148 to 193. A total of 29 provinces implemented the policy, up from 27. The scope of specific drug coverage expanded, with the average number of drugs included per scheme rising from 29 to 39, and a growing trend toward including drugs not on the national reimbursement drug list. In terms of coverage levels, the average deductible for these drugs decreased from 7,000 yuan to 6,700 yuan, and the average coverage amount increased from 968,500 yuan to 994,200 yuan, while the reimbursement ratio slightly declined. Additionally, restrictions on pre-existing conditions were relaxed, with the proportion of schemes excluding coverage for these conditions decreasing from 45.27% to 31.61%. Conclusions The specific high-priced drug covered by the Huimin insurances have exhibited a positive trend in terms of scope, drug quantity, and coverage level. However, challenges remain, including the accumulation of homogeneous drugs within the list and limited availability of some high-priced drugs. To promote the sustainable development of Huimin insurances, it is recommended to establish a basic list of specific drugs tailored to local conditions, optimizing the scheme design, and exploring the establishment of a multi-party co-payment mechanism for rare diseases.

Objective This study aims to analyze the development trends, implementation effectiveness, and existing challenges of an inclusive commercial medical insurance (hereinafter referred to as “Huimin insurances”) in Jiangsu Province, and to propose suggestions for its sustainable development. Method This paper reviewed Huimin insurances products launched nationwide from 2020 to 2024, and combined textual analysis, comparative analysis and semi-structured interviews to analyze the coverage situation of Huimin insurances in Jiangsu Province from the perspective of product design. Results Huimin insurances in Jiangsu Province achieves risk sharing through a multi-party co-insurance mechanism. It effectively supplements basic medical insurance by leveraging an inclusive model with “three no-restrictions” (no restrictions on age, occupation, or health status) and “low premiums with high coverage”. The program has also upgraded its list of specific high-priced drugs and expanded its coverage responsibilities on an on-going basis. However, challenges persist, including an imbalanced enrollment structure, inadequate coverage for rare diseases, prominent product homogenization, and ambiguous rules for the list of specific high-priced drugs. Conclusion Huimin insurances in Jiangsu Province has been developing steadily with a promising trend, yet it faces challenges such as structural imbalances and institutional deficiencies. To promote its sustainable development in Jiangsu Province, it is recommended to adopt measures including the structure optimization of insurance enrollees, coverage expansion for rare diseases, a more differentiated product design, and more standardized selection mechanism for specific high-priced drugs.

Objective To analyze the impact of the “One-Code for Children’s Medical Care” family mutual-aid medical insurance system, based on multiple identity authentication on children’s outpatient service utilization and healthcare costs, providing references for the promotion of similar innovative service models. Methods Endocrinology patients were selected as the study subjects. All their outpatient visit data, from one year before intervention to one year after the intervention, were collected through the hospital’s information system. A combination of propensity score matching (PSM) and difference-in-differences (DID) analysis was applied. Patients were divided into three groups: an intervention group that participated in basic medical insurance and joined the family mutual-aid system, and Control Group 1, who only participated in basic medical insurance, and Control Group 2, who did not participate in basic medical insurance. Results After joining the family mutual-aid system, pediatric patients experienced an average increase of 1.094 outpatient visits per year, and a 32.8% increase in outpatient costs. Compared with self-paying patients, the increases were 1.815 visits and 51.0%, respectively. Furthermore, a seasonal analysis indicated no significant changes in outpatient visits and costs in spring. However, costs decreased in summer, while both visit frequency and costs significantly increased in autumn and winter. Conclusion The “One-Code for Children’s Medical Care” family mutual-aid system, based on multiple identity authentication, effectively increased children’s outpatient visits and medical costs, thereby enhancing healthcare engagement and compliance for chronic disease patients.

Objective This study aims to develop a multidimensional evaluation system for visual health management that covers structural, procedural, and outcome-based capabilities. This system will be used to evaluate the management and service performance of district-level visual health institutions in Shanghai and to improve the city’s overall visual health management and service capacity. Methods An evaluation index pool was established through a literature review, policy research, and expert interviews. The Delphi method and analytic hierarchy process (AHP) were used to screen indicators and determine their weights. Result Following two rounds of expert consultation, an evaluation index system for vision health management and services at the district level in Shanghai was established, consisting of 3 primary indicators, 11 secondary indicators, 53 tertiary indicators, and 14 extended indicators. Conclusions The constructed evaluation index system for visual health management and services has high reliability. It aligns with policy requirements and practical work, providing a quantifiable basis for implementing visual health initiatives and optimizing related policies.

Objective To explore the status of depression, anxiety, and stress and influencing factors among pregnant and postpartum women. Methods A convenient sampling was used to survey pregnant and postpartum women from January 2023 to March 2024. A general data questionnaire, the Depression Anxiety Stress Scale-21 questionnaire, the Brief Resilience Scale questionnaire, and the Perceived Social Support Scale questionnaire were applied to collect data. Univariate analysis, correlation analysis, and multiple logistic regression analysis were used to analyze factors regarding their mental health. Results A total of 962 pregnant and postpartum women were included in the study. Among them, 16.01%, 27.34% and 8.52% showed depression, anxiety and stress, respectively. Multiple logistic regression showed that high education level and low-income level are risk factors for their negative emotions. Specifically, compared to those with a postgraduate degree, pregnant women with a bachelor’s degree or below were 0.461 times more likely to have depression (P = 0.039), and 0.544 times more likely to have anxiety (P = 0.016); women with a bachelor's degree were 0.497 times as likely to have anxiety (P = 0.011). Compared with pregnant and postpartum women with income level greater than 240 000, those with income level less than 80 000 were 2.117 times more likely to have depression (P = 0.023). Conversely, high social support level and high psychological resilience were identified as protective factors. Compared to women with high psychological resilience, those with low resilience were 14.195, 18.786 and 12.491 times more likely to experience depression, anxiety and stress, respectively. Similarly, compared to those those with high level of perceived social support, women with low level of perceived social support were 10.755, 5.456 and 5.165 times more likely to experience depression, anxiety and stress, respectively. Conclusions Education, income, perceived social support and psychological resilience are key influencing factors of depression, anxiety and stress during pregnancy. It is crucial to address the negative emotions of pregnant and postpartum women by analyzing related influencing factors to mitigate their negative emotions, and hence, to promote maternal and child health.

The global medical tourism industry is booming. As China’s public hospitals have allocated high-quality resources, developing international medical tourism represents an innovative approach to combine reform and opening up under the current regulatory system, and it is a key measure to stimulate the vitality of the health industry. This paper reviews the policy environment, the current development situation, and the challenges faced by public hospitals in China's international medical tourism sector. Based on this, it proposes suggestions including optimizing the environment and processes, focusing on cutting-edge medical technologies, and promoting the use of licensed and innovative drugs and medical devices. Moreover, a deeper cooperation with commercial insurance, stricter industry supervision and risk prevention and control are also important.

Objective To review and summarize the evolution of medical device evalution and approval practices in Shanghai in recent years, and to offer recommendations for the reform of medical device regulatory system. Methods Data were collected from the annual reports (2017-2024) of the Shanghai Municipal Medical Products Administration, the Shanghai Municipal Bureau of Statistics, and the Shanghai Medical Device and Cosmetics Evaluation and Verification Center. Core indicators, such as review timelines, registration of clinical trial institutions, number of first-time registrations, registrations of innovative medical device, and industrial output value were selected for analysis using both qualitative and quantitative methods. Results The average review time of Class II medical devices in Shanghai was shortened from 300 calendar days in 2017 to 99 calendar days in 2024. The number of first-time registrations of Class II and Class III medical devices increased from 211 and 273 in 2017 to 429 and 286 in 2024, respectively. By the end of 2024, Shanghai had registered 57 innovative medical devices, accounting for 18.1 % of the national total (N = 315). In 2023, the total output value of Shanghai 's medical device industry reached 49.06 billion yuan, with new product sales in the medical equipment manufacturing sector amounting to 17.89 billion yuan, and exports totaling 2.79 billion yuan. Conclusions Although the efficiency of medical device evaluation in Shanghai has significantly improved, the growth in registration number has slowed; the number of marketing approvals has declined; and the industry remains relatively small with insufficient innovation. It is recommended to focus on strategic emerging industries, and promoting policy coordination within the medical device industry in the Yangtze River Delta, and support interdisciplinary collaboration to enhance the commercialization capacity of new products.

Objective This study aims to establish a set of influencing factors for the effectiveness of cross-regional medical cooperation under the context of integrated development in the Yangtze River Delta (YRD), to quantitatively identify and analyze key factors, and to provide evidence for the in-depth and effective implementation and operational management of medical cooperation in the YRD. Methods Taking a tertiary hospital in Shanghai and its three closely regional cooperative branches as examples, this study constructed a structure-process-outcome three-dimensional model and applied the decision making and trial evaluation laboratory (DEMATEL) method to conduct a questionnaire survey among the main participants of the cooperation. The relationships among the influencing factors of medical cooperation effect in the YRD were quantitatively analyzed. The influencing degree, influenced degree, centrality, and causality of each dimension and factor were calculated. Results A set of influencing factors for medical cooperation effectiveness in the YRD was constructed, which included three dimensions and 14 influencing ones. Among them, the centrality of the ability and willingness of both the undertaking and exporting parties are the highest, 13.086 and 12.433, making them important influencing factors. Again, the latter has a high degree of causality (0.791), playing a crucial role in driving the cooperation. The core factor is the homogeneity of clinical services between hospitals, with a high degree of centrality (12.319) and a causality close to zero. The policy environment has a positive causality with the highest value of 1.400 and a relatively low centrality (10.490), making it is an important causal factor that can significantly promote cooperation. The causality of medical quality and safety, and medical teaching quality are negative and have the highest absolute values, making them two important outcome factors that directly reflect the effectiveness of medical cooperation. Conclusions The effectiveness of medical cooperation in the YRD is influenced by multiple interacting factors. Building a multi-dimensional incentive mechanism, promoting the homogeneity of medical services, and leveraging relevant policy advantages can continuously optimize the effectiveness of cooperation.

Objective To assess the current status of job satisfaction and its influencing factors among pre-hospital emergency service personnel in Shanghai, aiming to provide scientific evidence for enhancing their job satisfaction and promoting the high-quality development of pre-hospital emergency services. Methods In May 2024, frontline pre-hospital emergency care personnel from 10 medical emergency centers in Shanghai were selected as study subjects. Data were collected using an online questionnaire covering two aspects: general demographics and job satisfaction. Job satisfaction Items were quantified using a 5-point Likert scale, and the total scores were standardized. Single-factor analysis of general characteristics was performed using t-tests and chi-square tests, while multiple regression analysis was used to examine the relationships between different factors and job satisfaction. The scores of each item within the job satisfaction questionnaire were then ranked. Results A total of 2 248 frontline pre-hospital emergency personnel participated in the survey, and 2 167 valid questionnaires were collected. The employing institution, years of work experience, position, professional title, reasons for choosing pre-hospital emergency service, monthly number of effective dispatches, annual income, and the frequency of experiencing verbal and physical violence were identified as independent influencing factors of job satisfaction (all P<0.05). Conclusions Job satisfaction among pre-hospital emergency personnel is influenced by factors such as employing institution, years of work experience, professional title, position, workload, reasons for choosing the profession, income, and exposure to workplace violence. This study suggests optimizing the compensation system, implementing tiered management, improving resource allocation, and establishing violence prevention mechanisms to enhance satisfaction, stabilize the workforce, and advance the high-quality development of the pre-hospital emergency care sector.

Objective To explore the occupational satisfaction and influencing factors of medical workers in public hospitals in Minhang District, Shanghai and to provide reference for the refined of personnel management in the high-quality development of district-owned public hospitals. Methods A questionnaire survey was conducted among 1 000 medical workers from three tertiary public hospitals, two secondary public hospitals, and one community health service center in Minhang District. The survey assessed job satisfaction across seven dimensions: current job satisfaction, alignment with long-term career goals, hospital resource support, salary satisfaction, hospital culture satisfaction, satisfaction with physical space and platform conditions, and satisfaction with training opportunities. Spearman correlation analysis was used to examine the relationship between participants’ satisfaction and their gender, age, education level, professional title, and years of work experience. Hierarchical regression analysis was adopted to analyze the factors influencing job satisfaction. And to compare the satisfaction differences among medical workers. Results The average score of job satisfaction among 751 medical workers was 3.53 ± 0.86. Salary satisfaction had the lowest score of 3.16 ± 0.91 among different dimensions. Medical workers with >10~15 years and over 20 years of work experience, together with doctors and nurses, reported lower job satisfaction scores. There were statistically significant differences in job satisfaction scores among medical workers of different genders, ages, professional titles, work experience, and job positions (P<0.05). The result of hierarchical regression analysis revealed that gender, work experience, and job position significantly impacted their job satisfaction (P<0.05). Conclusions Work experience, professional title, education, and job position all influence the satisfaction of medical workers. Focusing on the satisfaction of those with >10~15 years of work experience will be a priority for human resources in regional public healthcare institutions moving forward.

This paper analyzes and summarizes the multimorbidity management models and experience for older adults in some developed countries and provides suggestions for improving in China’s management model. In Japan, the effectiveness of community-based multimorbidity management is enhanced through an assessment mechanism, while also emphasizing disease prevention and promoting early awareness and prevention among patients; Singapore establishes primary care and geriatric care-center networks to meet the multimorbidity care needs of older people. It also improves informatized management of electronic health records to strengthen multimorbidity monitoring and prevention; Canada advocates for patients to enhance self-management and disease awareness to improve the efficiency of multimorbidity diagnosis and treatment, integrates a multicultural approach to improve patient compliance; The UK applies multimorbidity guidelines as a basis for planning individualized treatment pathways and enhances scientific rigor of multimorbidity management through in-depth research. Currently, China adopts a community-based management system, but there are still certain deficiencies in the construction of comprehensive geriatric assessment. This study suggests strengthening the training of general practitioners in China, incorporating positive reinforcement into assessment system, improving sustainability of multidisciplinary team treatment plans in the community, optimizing the effectiveness of comprehensive assessment system at the community level, and cultivating patients’ self-management capability, and to provide more holistic and practical health protection for older adults.