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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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 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 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 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 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 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 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 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.

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.

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.

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.

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 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 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.

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 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 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 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.

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.

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.

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 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.

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 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.

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.

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

Objective To 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 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.

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.