Medical large language models (LLMs) are expected to improve the efficiency and quality of modern medical services by offering new tools. Robust and rational evaluation methodologies are essential to support scientific medical decision-making. Although the development of the domestic medical LLMs has closely follows the international advancements, research and practical experience in their evaluation method remains limited. This study reviews the current progress of the LLMs’ evaluation tools, summarizes the evaluation approaches, and analyzes key difficulties, aiming to provide a foundation for improving the evaluation framework.

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

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

The clinical comprehensive evaluation of drugs based on real-world data is a vital approach for assessing the clinical value of drugs, including effectiveness, safety, and cost-effectiveness, in real-world healthcare settings. Currently, most real-world studies in China have yet to establish standardized quality control management protocols. The drug clinical comprehensive evaluation team should develop the Quality Control Standards for Real-World Research in Clinical Comprehensive Evaluation of Drugs (hereinafter referred to as the "Standards"), emphasizing scientific rigor, compliance, and reliability. These Standards provide operational guidelines for researchers, ensuring that studies are standardized, homogeneous, and possess a high degree of external validity. They systematically cover key aspects such as research objectives, study design, data sources and preprocessing, statistical analysis, and result interpretation. The Standards serve as a benchmark for quality control management of drug clinical evaluations based on real-world research, aiming to enhance the quality of such research and provide robust scientific support for drug supply security decisions and clinical treatment decision-making.

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

Objective To analyze the current status and trends of high-priced drugs covered by inclusive voluntary health insurance (IVHI) in China, and provide evidence for its high-quality development. Methods The benefit designs of IVHI in China and its high-priced drug lists from 2021 to 2023 were systematically collected. A comparative study was conducted to examine the provisions of coverage, the scope and level of coverage, and reimbursement trends for these drugs. Results Between 2021 and 2023, 112 (83.58%), 165 (86.84%), and 184 (85.58%) IVHI plans provided coverage for high-priced drugs. The average number of drugs listed in the high-priced drug catalog rose from 22.1 to 38.7, with oncology drugs being the most common. During this period, the median deductible and cap for high-priced drug coverage remained at 0 RMB and 1 million RMB, respectively, while the median reimbursement ratio declined slightly from 80% to 75%. The reimbursement ratio for individuals with pre-existing conditions was, on average, over 30% lower than that for the general population (P<0.001). As the number of high-priced drugs increased, so did the proportion of high-priced drug reimbursement relative to total reimbursement. Conclusions From 2021 to 2023, the number of drugs listed in the high-priced drug catalog increased annually, with oncology drugs being the primary focus of coverage. The scope and level of coverage for high-priced drug remained stable, but for individuals with pre-existing conditions, it was lower than for the general population. It is essential to maintain high-priced drug coverage as a core responsibility of IVHI and to further optimize the selection and payment mechanisms for these drugs to enhance coverage effectiveness.

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

The development and use of in-house in vitro diagnostic (IVD) reagents developed by public hospitals play a vital role in the clinical diagnosis and treatment, which represent an important pathway toward high-quality development. This study reviewed and compared the regulatory policies regarding IVD reagents both domestically and internationally, and summarized the implementation of pilot programs in domestic hospitals following the enactment of the Regulation on the Supervision and Administration of Medical Devices (revised in 2021), with a focus on experience from Ruijin Hospital. Challenges identified in the current practice process include limited institutional testing capabilities, unclear verification standards, underdeveloped product commercialization and inadequate pricing mechanism. At the same time, it proposes policy recommendations such as developing practical guidelines, building a quality management system, enhancing the role of medical institutions, and exploring the commercialization pathways of in-house IVD reagents.

Objective To analyze and compare the regulations for ethical review of chimeric antigen receptor (CAR) T cell therapy in China and the USA, aiming to provide recommendations for improving the ethical review system for this therapy. Method Using the search term “CAR-T cell therapy”, search for the relevant regulations, systems, and literature on governmental and medical association websites in China and the USA, as well as databases such as the CNKI, Wanfang, Weipu, SinoMed, PubMed, and Embase, and systematically summarized the findings. Results Key areas of focus in the ethical review of CAR-T cell therapy include the qualifications of research institutions, researchers, and third-party laboratories, informed consent, risk assessment and management, and vulnerable populations. Compared to the USA, China needs to enhance its ethics review system by establishing specific laws and regulations, developing comprehensive technical standards or guidelines covering the entire lifecycle of CAR-T cell therapy products, and refining ethical norms for these therapies. It is also crucial to support the development of cellular immunotherapy research at the national level to accelerate clinical investigation of these products. Conclusions Current regulations regarding the ethical review of CAR-T cell therapy in China are evolving rapidly. However, further refinement of ethical norms is needed to minimize risks and maximize benefits.

Recent years witnessed the surge of chimeric antigen receptor (CAR) T cell therapy in China to meet the great market demand. As of May 2024, there are 11 CAR-T cell products available globally, with five approved by the National Medical Products Administration（NMPA） of China. China has emerged as a global leader in CAR-T cell therapy research and development, particularly in terms of the number of patent applications and clinical trials. With the ongoing accumulation of experience and deeper exploration, the authorities in China have established a three-tier regulatory system of laws, regulations and guidelines that cover the entire life cycle of CAR-T cell products, from research and development to registration, production, and post-marketing surveillance. Nevertheless, there remain gaps when compared to the regulatory systems in countries and regions such as the United States, the European Union, and Japan. This paper examines the development of the CAR-T cell therapy industry in China, and introduces the regulatory practices of the United States, the European Union, and Japan, in order to provide recommendations for the regulatory system improvement for CAR-T cell products in China.

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

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

The development of digital health is of great significance in enhancing population health and promoting the high-quality development of healthcare sector. Many countries have prioritized digital health by incorporating it into their national strategic plans. Summarizing international experience of digital health development can provide valuable insights for China's digital health policy formulation and the advancement of Healthy China initiative. The study applies the ROCCIPI framework to analyze the policies and practices of the EU, the US, the UK and Japan in promoting digital health across seven dimensions, and systematically sums up their characteristics, key achievements and experiences. Based on the challenges in China’s digital health development, the paper proposes corresponding recommendations including improving the top-level strategy, consolidating digital infrastructure, establishing a digital health standard system, ensuring data security and privacy, and strengthening the pilot application of cutting-edge technologies such as medical artificial intelligence and blockchain.

Objective To investigate the current status of self-media management among healthcare professionals in tertiary hospitals in Shanghai, identify existing challenges, and propose optimization strategies to support future standardized management efforts. Methods A questionnaire survey and expert interviews were conducted in 20 tertiary hospitals in Shanghai to assess current status of the self-media account operations among healthcare professionals. The findings were summarized to identify problems in self-media management. Results Among the 539 respondents from tertiary hospitals participated in the survey, 130 (24.1%) reported having registered and operated self-media accounts. The most commonly used platforms included WeChat (73.1%), Douyin (51.5%), and Xiaohongshu (36.2%). Ninety-eight accounts (75.4%) had 10,000 to 50,000 followers, and one account had over 3 million followers. Survey and interview data showed that posted content primarily consisted of health education, lifestyle advice, and personal clinical insights. The major challenges faced were lack of time and energy, inadequate regulatory guidelines from self-media platforms, and constraints from medical institutions. Although basic systems and guidelines had been established for account regulation, deficiencies remained in platform supervision, content control, privacy protection, and other areas. Health related self-media accounts were associated with four potential risks: ideological concerns, public opinion sensitivity, inadequate content professionalism, and reputational damage to institutions. Conclusions Although the proportion of healthcare professionals operating self-media accounts in tertiary hospitals in Shanghai is relatively low, notable risks persist in the areas of ideology, public perception, content credibility, and institutional image. It is recommended to enhance management standardization by providing regulatory guidance, integrating expert resources, innovating management models, and optimizing internal processes.

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

Malignant tumors remain one of the leading causes of human mortality, imposing significant disease burden. Cancer rehabilitation plays a crucial role in improving patient prognosis. This paper systematically reviews the concept and historical development of cancer rehabilitation, compares the characteristics of five existing cancer rehabilitation management models, and identifies the fragmented nature of current rehabilitation systems. Based on existing challenges in China’s cancer rehabilitation practices, we propose recommendations including improving policies and regulations, establishing a stratified rehabilitation network system, and implementing comprehensive multidisciplinary rehabilitation. These suggestions aim to provide insights for constructing an integrated, multidisciplinary, multi-provider, patient-centered cancer rehabilitation system.

In recent years, the issue of population decline caused by low fertility rates has become increasingly prominent. As one of the main approaches to dealing with infertility, assisted reproductive technology holds practical significance for promoting high-quality population development. At present, assisted reproductive technology in China has entered a stage substantive coverage under medical insurance. This paper compares the policies of 21 provinces that have incorporated assisted reproductive technology in the medical insurance payment scope, analyzing the current status and deficiencies of China’s medical insurance policies for assisted reproductive technology from three dimensions: payment scope, price level, and benefit level. In order to optimize and improve assisted reproductive medical security policies, this study suggests strengthening the top-level design for assisted reproductive technology and a sound access mechanism. Meanwhile, the classification of medical insurance payment categories should be refined and the reimbursement benefits should be optimized to fully improve the medical insurance payment policy of assisted reproductive technology.

The increasing demand for healthcare services, coupled with the constraints of limited medical resources, presents an ongoing challenge for modern healthcare systems. Addressing these challenges is crucial for the transformation and sustainability of healthcare delivery. In response, Singapore has actively explored innovative out-of-hospital care models, most notably through the progressive piloting and expansion of the Mobile Inpatient Care at Home program. This article examines the background, operational framework, pilot implementation, and progress of Singapore’s home-based hospitalization initiative. It synthesizes key success factors, explores future directions for care redesign and development opportunities, and elucidates the roles and benefits of out-of-hospital care across the pre-hospital, in-hospital, and post-hospital continuum. Additionally, the article highlights critical elements and strategic considerations essential for healthcare system transformation, offering insights that may inform the global development of patient-centered and sustainable healthcare models.

Objective To analyze the trend of approvals and recalls of medical devices in China, and study the connection between the approval characteristics of medical devices and their recalls. Method Data were obtained from the official website of the National Medical Products Administration (NMPA) to analyze the approvals and recalls of medical devices in China from 2019 to 2024 in terms of the location of product manufacturing, product management category, product classification, recall level, and reasons for recall. Results The number of medical devices on the market in China is increasing. The innovativeness is improving, and the number of product recalls is decreasing year by year. During the study period, a total of 2,488 medical devices were recalled, 75.1% of the recalled medical devices were imported ones and 50.4% were Class III medical devices. Among recalls of domestic medical device, 61.6% were initiated based on regulatory monitoring. The incidence of Class III medical device approvals and recalls in China over the past 5 years is 1.8%. Class III high-risk devices are significantly more likely to be subject to Class I recalls compared with Class I and II devices (P<0.001). Currently, device design (58.1%), materials and manufacturing (28.4%) and software (6.1%) are the main reasons for Class I recalls. Conclusions In view of the current situation and characteristics of medical device approvals and recalls in China, the main responsibility of enterprises should be strengthened, and domestic enterprises should be encouraged to enhance adverse event reporting and recall proactively. The monitoring of high-risk devices should be increased, and the risk prevention system constructed according to historical recall data could optimize the design and supervision of medical devices.

Objective To construct an evaluation index system for the synergistic capability of close-knit urban medical groups, with the aim of providing a reference for promoting their development in China. Method Based on the Rainbow Model, an evaluation index system was initially constructed using literature review, revised and improved through expert consultation, and the weights of each indicator were determined using the analytic hierarchy process. Result An evaluation index system for the synergistic capability of close-knit urban medical groups was constructed, comprising six first-level indicators, 18 second-level indicators, and 53 third-level indicators, including system synergy (0.254), organizational synergy (0.216), professional synergy (0.180), service synergy (0.146), functional synergy (0.118) and normative synergy (0.086). Conclusion This evaluation index system is scientifically sound, and can serve as an effective evaluation tool for assessing the synergistic capability of close-knit urban medical groups in China.

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

Objective 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.

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

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

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

Objective Guided by policy objectives, this study aims to explore the impact of centralized volume-based insulin procurement on outpatient use in township health centers, providing a basis for evaluating the policy’s implementation effectiveness. Methods Electronic data on outpatient prescriptions were collected from six township health centers in a city in Shandong Province from May 2021 to May 2023. Descriptive statistics and an interrupted time series model were used to analyze the change of three indicators—defined daily doses (DDDs) of insulin, number of diabetes outpatient visits and average outpatient cost per visit—before and after the implementation of insulin centralized procurement policy on May 31, 2022. Results The interrupted time series model showed the centralized volume-based insulin procurement had a significant immediate impact on all three indicators, The DDDs of insulin increased notably (β₂ = 5 507.532, P<0.05), number of diabetes outpatient visits rose markedly (β₂ = 359.795, P<0.05), while the average outpatient cost per visit decreased sharply (β₂ = −20.634, P = 0.002). Following policy implementation, the upward trend in the average outpatient cost per visit nearly disappeared (β₁ + β₃ = 0.267, P<0.05). Conclusions Driven by the centralized volume-based insulin procurement policy, the volume effect of selected insulin has been evident, reducing economic burdens for grassroots patients and improving insulin accessibility. This has released the potential medication demand among diabetes patients, encouraging more patients to seek care at the grassroots level and facilitating the effective implementation of the tiered healthcare policy.

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.

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

Objective This study aims to investigate the preferences of women with infertility for different attributes of assisted reproductive technology (ART) programs, and to promote rational allocation of health resources. Methods A best-worst scaling (BWS) questionnaire was developed using a balanced incomplete block design (BIBD), and a face-to-face paper-based survey was conducted among women with infertility to investigate their preferences for assisted reproductive technology programs. Results were analyzed using a count method and a mixed logit model. Results A total of 150 questionnaires were collected, with 129 deemed valid for analysis. The results of the count method and mixed logit model analyses of preferences were highly consistent, showing that all attributes having a statistically significant effect on patients’ choices (P<0.05). The most valued attribute was the healthy live birth rate (P<0.05; Preference Share 36.7%), while the least valued was the timing of health consultations (Std.BW Score −0.61). The top six attributes in terms of relative importance were: healthy live birth rate, pregnancy rate, maternal complications, miscarriage rate, adverse reactions or side effects, and neonatal complications. Cluster analysis revealed preference heterogeneity among patients, although statistical differences were only observed in the number of years spend preparing for pregnancy (P<0.05). Conclusion Women with infertility prioritize the effectiveness and safety of ART treatments and their preferences vary across individuals.

Objective To compare the clinical effectiveness and cost of portable ultrasonic scalpel with conventional ultrasonic scalpel in urological tumor surgeries, providing evidence for the clinical applications and management decisions. Methods Data were collected from December 2022 to May 2023 for patients undergoing laparoscopic urological tumor surgeries using either portable ultrasonic scalpel or conventional ultrasonic scalpel at Shanghai Ruijin Hospital, Beijing Anzhen Hospital, and Ningbo First Hospital. Patients were divided into two groups: portable ultrasonic scalpel group (n=39) and conventional ultrasonic scalpel group (n=43). Surgical outcomes and costs were compared between the two groups. Results All patients in both groups completed their surgeries. Baseline characteristics of the two groups were comparable, with no significant differences (P>0.05). The portable ultrasonic scalpel group showed shorter surgical time, lower intraoperative blood loss, fewer than six hemostatic clips used, and shorter hospital stay compared to the conventional ultrasonic scalpel group, but the differences were not statistically significant (P>0.05). The consumables cost (including or excluding the ultrasonic scalpel head) in the portable group was significantly lower than that in the conventional group (P<0.05), while other cost differences were not statistically significant (P>0.05). Subgroup analysis by tumor location showed that the portable ultrasonic scalpel group had lower intraoperative blood loss, shorter hospital stays, and lower consumables costs (P>0.05). Conclusion The portable ultrasonic scalpel demonstrates favorable clinical outcomes and the potential to reduce hospital-related costs in urological tumor surgeries, though further large-scale clinical studies are needed to confirm its value.

Objective To analyze the allocation and changes in the operational efficiency of traditional Chinese medicine (TCM) health resources in the Yangtze River Delta region. Methods Descriptive statistical method was used to analyze the allocation status of traditional Chinese medicine (TCM) health resources in the Yangtze River Delta region from 2012 to 2021. A three-stage data envelopment analysis (DEA) model was used to statically analyze the operational efficiency of TCM health resources, while the dynamical analysis was achieved by a Malmquist index model. Results The Yangtze River Delta region is relatively rich in TCM health resources. Using the three-stage DEA, the comprehensive efficiency, pure technical efficiency, and scale efficiency of Jiangsu and Zhejiang were generally underestimated, while those of Shanghai were overestimated. For Anhui province, these efficiencies were overestimated from 2012 to 2016 and underestimated from 2017 to 2021. Dynamic analysis using the Malmquist index model revealed that from 2012 to 2021, the total factor productivity index of TCM health resources in the Yangtze River Delta region fluctuated around 1.000, with an average value of 0.984, indicating a downward trend in operational efficiency. Conclusions The allocation of TCM health resources in the Yangtze River Delta region is unbalanced, with differentiated utilization and insufficient efficiency. It is suggested that the government and health authorities adopt measures tailored to local conditions, rationally plan regional health resources, strengthen technological innovation, improve medical technology, and enhance the allocation and operational efficiency of TCM health resources.

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.

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

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

In the context of the continuous promotion of the Healthy China strategy, comprehensive prevention and control of myopia and multiple management are of great significance to improve the problem of myopia in children and adolescents. This paper explores the connotation, theoretical framework, structure, problems, mechanism and path of comprehensive prevention and control of myopia in children and adolescents in China. The study found that, under the influence of the changes in the participation of multiple governance entities in the comprehensive prevention and control of myopia, the governance structure has shifted from the single-center of centralized governance to the multi-center of collaborative governance, and the multi-governance has changed from unbalanced governance to balanced governance. In the multi-governance, there are still problems such as unbalanced governance structure, outdated governance system and lagging governance content. Through the construction of multiple governance mechanisms such as demand-driven concept identification mechanism, government-led overall coordination mechanism, multi-body coordination mechanism of pluralistic co-governance, and goal-oriented power and responsibility allocation mechanism, the comprehensive prevention and control of myopia in children and adolescents in China can be improved. In addition, the paper proposes a series of treatment approaches, such as sorting out the relationship between comprehensive myopia prevention and control, promoting the modernization of comprehensive myopia prevention and control capabilities, and building a comprehensive myopia prevention and control system, in order to enrich the comprehensive myopia prevention and control theory of children and adolescents in China and promote the orderly development of comprehensive prevention and control work.

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

Objective This 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 establish an indicator system for evaluating the biosafety risk prevention and response capabilities of different types of staff in BSL-2 laboratories. Methods Based on domestic laws, regulations, standards, and relevant literature, an indicator dataset was established. Twenty pathogen detection experts across the country were selected to evaluate the indicators and weights through a combination of the Delphi method and the Analytic Hierarchy Process (AHP). Results After two rounds of expert consultations, an evaluation system was established, including 4 primary indicators, 18 secondary indicators and 73 tertiary indicators for management personnel, laboratory personnel and auxiliary personnel. Four primary indicators include hazard identification capability, risk control capability, management capability and execution, and emergency capability. The enthusiasm coefficients were 95.24% and 100.00% in 2 rounds of experts consultations, with an anthortiy coefficient of 0.945, and the expert opinions of two rounds of consultations were consistent. Conclusions The evaluation indicator system established in this study can comprehensively, accurately, and scientifically evaluate the biosafety work capabilities of different types of laboratory staff. Necessary adjustments and improvements can be made based on the assessment results to enhance the biosafety capabilities of BSL-2 laboratory personnel and strengthen the overall biosafety level of the laboratory.

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.