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.

Textual data has emerged as a significant source of evidence for health policy research, with its application value increasingly recognized. This paper systematically examines the current applications, challenges, and future prospects of text analysis methods in health policy research. The study delineates the theoretical foundation of health policy research and traces the evolutionary trajectory of text analysis methods from traditional qualitative approaches to artificial intelligence-driven analysis. The goal is to establish a text analysis framework based on policy research paradigms followed by the elaborations on the key steps of text analysis in health policy documents, including research design, data collection and processing, and information extraction. Currently, text analysis in health policy research encounters notable challenges regarding data accessibility and representativeness, standardization of textual processing, and interdisciplinary integration. In response, sound sampling methodologies to establish representative datasets, standardized preprocessing protocols with the aid of a domain-specific dictionary, and multidisciplinary research collaborations to facilitate knowledge synthesis should be developed. Future directions include expanding classic policy research approaches, enhancing information extraction capabilities, promoting integration with conventional research methods, and strengthening the translation of research findings into policy practice.

The speedy development of China’s data factor market gives the prominence to the value of healthcare data. However, the lack of foundational institutions and supporting mechanisms severely constrains the deeper exploitation of its value. This study analyzes the core issues in the opening and utilization of healthcare data from multidisciplinary perspective by systematically reviewing national and local policies, regulations, and exemplary data governance practices. It aims to construct a multi-dimensional collaborative governance framework and provide a reference for establishing China’s healthcare data governance system. The findings reveal five major challenges in current healthcare data governance: ambiguous definition of data ownership, lagging ethical governance mechanisms, weak security protection capabilities, unclear pathways to assetization, and the absence of equity distribution mechanisms. The paper proposes pushing the boundaries of the current fragmented, single-centered governance model to unleash the synergistic governance of multiple mechanisms including institutions, ethics, security, value, and incentives. The enhanced data circulation efficiency and public value outcomes require systematic coordination of institutional design, technological tools, and public governance.

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.

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 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.

Under the Healthy China Strategy, the rapid aging of the population and the rising prevalence of chronic diseases have made the development of health security systems for individuals with pre-existing conditions a critical issue. This article explores the necessity of advancing pre-existing condition insurance by reviewing existing practices and research. It delineates the design logic of pre-existing insurance across four aspects: positioning, development foundation, risk control, and policy support, highlighting the necessity and feasibility of applying inclusive insurance principles and models. The paper identifies key challenges hindering the development of pre-existing condition insurance, including product availability, data accessibility, industry integration and policy support. It is recommended to optimize the development strategy of pre-existing condition insurance by encouraging product innovation and increasing supply, promoting data sharing and deeper integration between health insurance and the medical/healthcare sectors, leveraging technology to reduce operational costs, strengthening policy support, and elevating social recognition.

Objective This study aims to analyze the establishment of weight management centers and outpatient clinics in China’s public hospitals, providing scientific evidence to enhance obesity prevention and control management. Methods A literature review and expert consultations were conducted together with the existing obesity management guidelines and policies to design a questionnaire. The online questionnaire survey combined with qualitative interviews were carried out then to explore the construction pathways and operational models of these centers and outpatient clinics in public hospitals. Results Among the 1 340 sampled hospitals, 20.0% had established weight management centers and clinics operated in three main models. Among these centers and clinics, 75.0% were weight management outpatient clinics; 17.9% were affiliated centers, and 7.1% were independent ones. Generally, independent centers were led by the Department of Surgery, while outpatient clinics and affiliated centers were mainly run by the Department of Endocrinology. The primary benefits of establishing weight management centers and clinics lied in promoting disciplinary development, enhancing hospital reputation, and increasing hospital revenue. The main obstacles for those hospitals failing in setting up weight management centers and clinics included the lack of construction standards, insufficient medical professionals, concerns about patient volume, unclear operational models, and restrictions from medical insurance reimbursement policies. Conclusions The establishment of weight management centers and outpatient clinics in China’s public hospitals stays in the exploratory phase. For future development, efforts could be made in policy support, hospital self-development, and assistance from enterprises.

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.

China’s biopharmaceutical industry, a strategic emerging sector, is vital to national welfare, economic development, and security. Recent years have witnessed its rapid growth with the Yangtze River Delta region emerging as a key hub. This article analyzes the development models and competitiveness of the industry across the Delta region by examining their current status, spatial distribution, and policy orientations. The analysis reveals that the Delta’s biopharm industry presents a hierarchy pattern with the feature that Shanghai acts as a frontrunner;Jiangsu is a supporter; Zhejiang has achieved its breakthrough; and Anhui acts as a pursuer. Disparities exist in their industry scales. Consequently, the study proposes strategic recommendations to promote high-quality growth, including adopting a holistic regional development approach, strengthening intra-regional collaboration, establishing open and innovative platforms, enhancing governmental roles, and fostering coordinated industrial chain development and innovation ecosystems.

Objective To calculate the per-bed-day charging prices for HPC services in medical institutions at different levels, and to provide empirical basis for price policy. Methods The typical institution survey method was chosen to carry out the study in 15 selected HPC institutions in Shanghai. The service frequency, average duration, service team composition, salary income of HPC service projects from 2023 to 2024 were collected. Based on the time coefficient allocation method, the average labor time of the society and the actual time consumption of various services, the direct labor cost of HPC services was identified. Combined with the standardized accounting of inpatient examination fees and graded nursing fees, the price protocol of HPC medical services was finally determined. Results A total of 8 community health service centers and 7 secondary hospitals were investigated. Combining with expert advice, the median of the measured direct labor costs for HPC services items was used as the basis for pricing, HPC services price standards were determined: 313 CNY/d at community health service center, and 446 CNY/d at secondary hospital. According to the ratio of hospitalization cost of secondary hospital and tertiary hospital, the price of HPC medical services of tertiary hospital is calculated to be 778 CNY/d. In the calculation of direct labor costs for HPC services, the lowest single-item costs were all for social needs assessment, life review, and end-of-life preparation. The single-item costs of adjuvant therapy, multidisciplinary team meetings, and family meetings in surveyed secondary hospitals were higher than those in community health service centers. Conclusion This study calculates HPC service prices across institutions using direct labor cost, examination fees, and graded nursing fees, providing a scientific basis for policy implementation and standardized HPC development.

Objective To explore the challenges of the coordinated development of health care big data in China and put forward optimization strategies, so as to provide a reference for further improving the empowerment of health care big data and improving medical service efficiency. Methods The data were collected through literature review, policy analysis, and key informant interview. Coding analysis was carried out in combination with the synergistic framework (SFIC model) and grounded theory, to construct a collaborative development model of health care big data in China, and explore the collaborative challenges in depth. Results After three levels of coding, 22 initial categories, 10 main categories and 4 core categories were summarized. The coding results, combined with the SFIC model, revealed that the collaborative development model of health care big data in China includes four aspects: starting conditions, facilitative leadership, institutional design, and collaborative process. The development of health care big data in China faces the following issues: difficulties in eliminating information barriers, a lack of high-quality talents and technologies, the need for stronger inter-agency cooperation, an imperfect power and responsibility mechanism, and challenges in policy implementation. Further, gradual improvement of top-level design but limited guidance from supporting policies, a lack of a multi-agent coordination mechanism, and poor integration across various stages are clear. Conclusion In response to the weak starting condition, insufficient facilitative leadership, imperfect institutional design, and collaborative challenges in the development of health care big data in China, the corresponding collaborative paths are proposed: focusing on the real data connectivity to consolidate the collaborative foundation; improving the power and responsibility mechanism to strengthen policy implementation; advancing top-level design to build a systematic and holistic supporting policy framework; optimizing the collaborative process at each stage to reinforce the supervision of the whole process.

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.

After the Chinese government, along with the World Bank and World Health Organization, jointly released a medical reform report titled “Deepening health reform in China: building high-quality and value-based service delivery” in 2016, the concept of value-based health care (VBHC）was introduced to China for the first time. Since then, China has gradually explored VBHC’s potentials in areas such as innovative drug insurance coverage, medical insurance payment reform, and high-quality development of public hospitals. Given that a comprehensive value assessment framework for cancer treatment has not yet been established here, this study examines the origins and definitions of VBHC and analyzes the applications of high-value medicines, high-value healthcare services, and value-based payment methodologies in cancer treatment with case studies from the United States and European countries. This study also explores how these international experiences can be adapted to China. The aim is to provide reform recommendations for constructing an aligned value-based cancer treatment system with China’s national conditions.

Objective Based on Present Xi Jinping’s interpretation of high-quality development, which emphasizes five concepts as innovation, coordination, green, openness and sharing, this paper aims to define the connotation of high-quality development for public hospitals and provide policy recommendations to support the advancement of China’s healthcare system. Methods From August to November 2023, semi-structured interviews were conducted with 42 participants, including hospital executives, department heads, and frontline clinicians from three tertiary grade-3A public hospitals in Jiangsu and Shandong provinces. The interview data were then analyzed using grounded theory. Results A total of 81 initial concepts and 21 categories were identified through coding. These were further condensed into eight core categories: party building leadership, personnel incentives, clinical diagnosis and treatment, research and education, integration of medical care and public health, social responsibility, physician-patient experience, and regional status. Based on these categories, a pathway model for achieving high-quality development in public hospitals was constructed. Conclusions The connotation of high-quality development of public hospitals from the perspective of medical professionals can be categorized into three dimensions: party building leadership and personnel incentives as prerequisites; clinical diagnosis and treatment, research and education, integration of medical care and public health, together with social responsibility as action strategies; and the enhancement of the regional status and physician-patient satisfaction as target outcomes. Compared with the five concepts, this connotation reflects the requirements of “innovation” “coordination” and “sharing”, while the aspects of “green” and “openness” remain insufficiently represented.

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 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 the characteristics and evolution of Shanghai’s palliative care policies, examine the current policy’s role and challenges, and offer recommendations for future policy development. Method A content analysis method was adopted to systematically review palliative care policies issued in Shanghai from 2006 to 2024, focusing on policy-issuing bodies and the policy instruments employed. Results The development of palliative care policies in Shanghai has progressed through four main stages: the initial stage, the self-exploration stage, the rapid development stage, and the adjustment stage. The responsible party for the policy were mainly the district-level health commissions (69.52%), with extensive participation from diverse stakeholders including universities and hospitals. The primary policy instruments identified were supply-oriented and environment-oriented ones, with emphasis on resource allocation (50.88%), technology and infrastructure (24.56%), legal supervision (27.41%), and entity collaboration (20.00%). Conclusions Shanghai’s palliative care policies have evolved from pilot stages to broader implementation and optimization, with a growing diversification in both policy instruments and implementation bodies. Future policies should prioritize technological innovation and inter-department collaboration to address the challenges posed by an aging population and rising healthcare demands.

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 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.

Medical artificial intelligence (AI) has shown remarkable advantages in improving diagnostic efficiency and the quality of patient care. However, with the rapid adoption of AI technology in the medical industry, various tort cases have emerged frequently. In China, controversies exist regarding the determination of liability in medical AI tort cases, which are mainly reflected in the unclear legal status of the subjects of liability, the difficulty in determining the cause of the tort, and the uncertainty of liability imputation principles. This paper summarizes and analyzes domestic and foreign views on the subjects of AI liability and the suggestions regarding the regulatory dilemmas of medical AI tort liability in China. Drawing on the advanced experience and explorations of the United States, the European Union, Japan, and other countries, this paper proposes that China should improve the legal liability imputation system for medical damage on the basis of clarifying the legal status of medical AI. China should gradually clarify the legal status of liable subjects and refine the liability imputation principles for different scenarios, so as to balance the interests and responsibilities among patients, medical personnel, medical institutions, and designers and manufacturers of medical AI.

Objective To establish a high-quality development evaluation index system for tertiary public hospitals in Shandong Province, quantitatively assess the development across 16 cities in the province, and formulate targeted optimization strategies for hospital quality improvement. Methods The literature review method and Delphi method were used to establish evaluation indicators for the high-quality development of tertiary public hospitals in Shandong Province. The entropy weight method was used to calculate their weights of these indicators, focusing on tertiary public hospitals across various cities in the province from 2019 to 2022, and the Technique for Order Preference by Similarity to Ideal Solution method was then applied to evaluate the high-quality development level of tertiary public hospitals across various cities in the province for 2022. Results An evaluation index system for the high-quality development of tertiary public general hospitals was established in Shandong Province, consisting of 6 primary indicators and 32 secondary indicators. Notably, the first-level indicator “leading new trends in high-quality development of tertiary public hospitals” accounted for the largest weight (48.49%). In the regional high-quality development ranking of tertiary public hospitals in Shandong Province, the eastern cities of QD, JN, and DY ranked 1st, 2nd, and 3rd, respectively, while the western cities of DZ and BZ ranked 15th and 16th. In the evaluation across three key dimensions— “leading new trends in high-quality development of tertiary public hospitals”, “building a new system for high-quality development of tertiary public hospitals” and “enhancing the efficiency of high-quality development”—JN ranked 1st, 3rd, and 1st; QD placed 4th, 1st, and 6th; ZB ranked 6th, 13th, and 13th; ZZ hit 3rd, 12th, and 16th; and DY came in at 15th, 2nd, and 9th, respectively. Conclusions The constructed evaluation index system for tertiary public hospitals’ high-quality development can be used to quantitatively assess the development level of tertiary public hospitals across regions in Shandong Province, where the high-quality development shows a decreasing trend from east to west. This evaluation index system provides a scientific framework for these hospitals’ high-quality development, and the results offer insights for the coordinated development of the regional healthcare system.

Objective To comprehensively investigate the current status of medical students’ professional values, analyze the association between professional values and their career goals, and provide scientific suggestions for medical colleges and universities to cultivate medical students’ professionalism, shape their professional values, and establish correct career goals in a targeted way. Methods A stratified random sampling method was used to conduct an online questionnaire survey among students majoring in medicine-related disciplines at Shanghai Medical College of Fudan University. A total of 2 892 valid questionnaires were collected. Results The scores of different dimensions of medical students’ professional values were, in descending order, positive pursuit, influence of medical atmosphere, and negative avoidance mentality. The score of social contribution ranked the top in career goals, followed by personal goal. The main factors affecting career goals at the social contribution level were gender (β = 0.056, P<0.001), positive pursuit (β = 0.275, P<0.001), and influence of medical atmosphere (β = 0.349, P<0.001); and at the level of personal goals, the main factors were gender (β = 0.113, P<0.001), major (β = 0.060, P<0.001), educational level (β = 0.109,P<0.001), positive pursuit (β = 0.040, P = 0.023), negative avoidance mentality (β = −0.378, P<0.001), and influence of medical atmosphere (β = 0.288, P<0.001). Conclusions The professional values and career goals of medical students are affected by multiple factors, among which career goals and professional values are highly linked with each other. Colleges and universities should attach importance to the inculcation of medical atmosphere, optimize the medical education environment, strengthen the education of professional values, further inspire the professional pursuit of medical students, and provide a solid talent foundation for the development of medical career.

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.

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 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.

The healthcare system, as a critical safeguard for human health, has emerged as a cornerstone in China’s socioeconomic green transition. Carbon emission contributed by the global healthcare sector is equivalent to the emissions of the world’s fifth-largest emitting country. The integration of sustainability principles into health systems is an international trend. To better understand global developments and enhance China’s role in climate and health governance, this paper systematically reviews international progress in building low-carbon healthcare systems and assesses China’s achievements and ongoing challenges in this sector. China is recommended to proactively seize this opportunity by strengthening both domestic and international coordination, advancing emissions accounting and evaluation, and improving policy incentives to drive a green transformation across the whole healthcare supply chain, thereby contributing to global health reform.

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.

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 This study takes a tertiary Grade A hospital in Shanghai as an example to conduct a comprehensive evaluation of disease groups under the DRG system, exploring refined management strategies. Methods Cases within the DRG settlement scope of a tertiary Grade A hospital in Shanghai in 2021 were selected as the research subjects. The study utilized 3 indicators-the case mix index (CMI), medical insurance payment rate, and the newly introduced technical labor index-to conduct an in-depth analysis of the complexity, economic benefits, and resource consumption of each disease group. Based on these indicators, the key disease groups in the hospital were classified into 8 categories, and specific management strategies were proposed for each category. Results A total of 100 disease groups and 36 011 cases were included. The study identified 3 main issues: the quality of medical records needed improvement; the proportion of low-complexity disease groups was relatively high; and the scale of cost overruns was significant, with suboptimal cost structures in some disease groups. According to the characteristics of different categories of disease groups, corresponding management strategies were proposed. For example, dominant disease groups should continue to receive support, with a focus on strengthening key specialty development; potential disease groups require optimization targeting weak indicators; vulnerable disease groups should prioritize improving one relatively easier-to-enhance weak indicator; and disadvantaged disease groups need in-depth analysis of causes and issues, followed by corrective measures. Conclusions Hospitals should leverage the value of technical labor as a key driver to optimize disease group structures, strictly control the use of pharmaceuticals and consumables, strengthen information system construction and medical record management, and refine incentive and restraint mechanisms to enhance the development momentum of clinical departments. Additionally, specialized task forces should be established to strengthen cross-departmental collaboration, ensuring the comprehensive implementation of DRG management. This will facilitate the transition of hospitals from scale expansion to quality and efficiency improvement, achieving high-quality, connotative development.

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 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.

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.

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 construct a scientifically rigorous and operationally feasible evaluation index system for sports and health cities, tailored to the characteristics of Shanghai as a megacity, in response to the Healthy China initiative. Methods Based on the“Integrated Theory of Health Behavior Change”, this study used a literature review to identify an initial set of 44 indicators for the evaluation index system. Using the Fuzzy Delphi Method(FDM) and Fuzzy Analytic Hierarchy Process (FAHP), questionnaires were designed and then distributed to experts for feedbacks, which was used to iteratively revise the indicators. The internal consistency of expert ratings was assessed using Cronbach’s α coefficient. The index system’s theoretical fit was validated with the Kaiser-Meyer-Olkin (KMO) test and Bartlett’s Test of Sphericity. Results Through two rounds of expert consultation, screening, and consistency testing, the study constructs an evaluation index system for Shanghai, consisting of 3 first-level, 11 second-level, and 37 third-level indicators. The weights for the three first-level indicators—Sport-Health Governance, Health-Enabling Urban Environment, and Social Health Ecology—are 20%, 50%, and 30%, respectively. Conclusion The proposed three-dimensional evaluation framework—“Sport-Health Governance, Health-Enabling Urban Environment, and Social Health Ecology”—aligns with national strategies, balances institutional rigidity with environmental flexibility, and provides a paradigm for health governance in densely populated cities.

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.

The paper examines the implementation background, key contents, and potential impacts of the first round of patented prescription drug price negotiation under the U.S. Inflation Reduction Act (IRA) of 2022. Through a literature review, the paper analyzes the regulatory mechanism of the IRA on the prescription drug pricing of Medicare and its possible effects both on the U.S. healthcare system and the global pharmaceutical industry. The findings indicate that the implementation of the IRA marks a significant shift in U.S. drug price regulation policies, which may trigger a chain reaction in global drug pricing policies. Furthermore, it offers valuable insights for China’s healthcare price negotiations, such as the application of real-world evidence (RWE), transparent drug price negotiation procedures, and well-established incentive and penalty mechanisms.

Objective To fully understand the maturity pattern of the domestic magnetocardiography (MCG) industry and predict its development trends, in order to inform the formulation of industrial development plans and provide recommendations. Methods A questionnaire-based industry maturity assessment was conducted to determine the development stage of MCG device maturity. Patent literature data on MCG devices were analyzed using the patent indicator evaluation method and the S-curve method of the technology life cycle. The maturity evaluation model was applied to assess the industrial development status of MCG devices in terms of technology, manufacturing, products, and markets. Results The domestic MCG product has reached the fourth stage of maturity—market-ready stage. Its market maturity remains at the first stage, indicating that engineering prototypes have entered the market and created a new market segment. The industrial maturity of domestic MCG instruments is at the second stage, signifying that competitive MCG products have been introduced to the market with high expectations. Domestic MCG devices entered their growth stage in 2019 and have not yet reached the maturity. Conclusions MCG products remain in the growth phase. The industry is still in the cultivation stage and requires supportive policies for further development.

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.

A robust healthy city indicator system can scientifically evaluate the health level of the city, provide guidance and basis for urban construction, and promote its high-quality development of the city. Based on the evolving health connotations, the development trajectory of healthy city evaluation indicators is sorted out. This study selects representative healthy city evaluation indicators from both China and abroad, and conducts a comparative analysis from three aspects: the dimensional level of the indicator system, the indicator level, and the application value. Suggestions are made for further advancement of the healthy city construction in parallel, so as to promote the overall health of residents and help build a healthy China.