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.

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

Objective To 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.

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

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

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

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

Objective To explore and evaluate the integrated health management model for patients with chronic diseases based on community outpatient clinical pathways, and to provide a basis for building a long-term, systematic, and continuous medical-preventive integration system for chronic disease health services. Methods Starting from October 2024, Xuhui District in Shanghai piloted an integrated health management model for patients with chronic diseases based on community outpatient clinical pathways. Data on the follow-up management of chronic disease outpatient services before the pilot (January to September 2024) and after the pilot (October 2024 to May 2025) were collected. Changes in service efficiency, management quality, and doctor-patient satisfaction before and after the pilot were analyzed and compared. Results The average monthly number of outpatient face-to-face visits increased from 766 to 2,299 after the pilot, and the average total time spent on comprehensive follow-up services per visit decreased by 20%. Following the pilot implementation, the proportion of outpatient face-to-face visits to total visits (48.79%) and the detection rate of blood pressure abnormalities through hypertension screening (6.08%) were both higher than those before the pilot (17.26% and 5.13%, respectively). Regarding satisfaction, the rate among contracted patients increased from 83.5% to 94.4%, showing statistically significant differences (χ² = 8,779.13, 10.44, 29.80; all P<0.01). The satisfaction rate of family doctors increased from 90.2% to 96.1%, but the difference failed to show statistically significant (P = 0.434). Conclusion The integrated health management model for patients with chronic diseases based on community outpatient clinical pathways has demonstrated preliminary effectiveness in improving service efficiency, enhancing management quality, strengthening patient medical compliance, and optimizing doctor-patient satisfaction.

Objective This study aims to evaluate the clinical value of the locally deployed DeepSeek R1 model, developed by DeepSeek Inc., in multi-task oncology scenarios. Specifically, this research attempts to systematically assess its real-world performance in assisted diagnosis, treatment pathway recommendation, clinical trial matching, and medical record quality control, and to verify its feasibility and potential for implementation in smart hospital development. Methods Real-world data were collected from the Oncology Department of the Chinese PLA General Hospital of Xinjiang Military Command between May and August 2024. A locally deployed framework incorporating retrieval-augmented generation technology was constructed, followed by multi-scenario performance evaluations. In the assisted diagnosis task, 30 patients with gastric cancer were enrolled to compare the diagnostic performance between the DeepSeek R1 model and junior physicians. In the treatment recommendation task, another 30 patients with gastric cancer were included to evaluate the model’s capacity, relative to ChatGPT-4, in generating suggestions for comorbidity management, nutritional intervention, and dynamic treatment plan adjustment. For the clinical trial matching and doctor-patient communication tasks, 10 patients with non-small cell lung cancer were assessed to measure the model’s accuracy in enrollment recommendation and its effectiveness in enhancing patient communication. In the medical record quality control task, 50 retrospective medical records were reviewed to evaluate the model’s sensitivity in detecting logical inconsistencies. Results In the diagnostic task, the DeepSeek R1 group demonstrated a significantly higher diagnostic accuracy (96.7% vs. 76.7%, P = 0.008), lower misdiagnosis rate (6.7% vs. 20.0%, P = 0.039), and shorter diagnostic time compared to the junior physician group. In treatment recommendation, the DeepSeek R1 group outperformed the ChatGPT-4 group in identifying comorbidities and generating personalized treatment suggestions (100.0% vs. 13.3%, P<0.001), assessing nutritional risk and providing intervention plans (86.7% vs. 6.7%, P<0.001), and dynamically adjusting treatment strategies (93.3% vs. 0, P<0.001). The model achieved a clinical trial matching accuracy of 90%. In the communication and quality control tasks, the shared decision-making questionnaire score was significantly higher in the DeepSeek R1 group than in the conventional communication group (38.7 ± 2.8 vs. 21.3 ± 3.5, P<0.001), and the model demonstrated 91.7% sensitivity in identifying tumor staging inconsistencies. Conclusions Through localized deployment and multimodal data integration, the DeepSeek R1 model demonstrates substantial potential in supporting various oncology-related decision-making tasks. Therefore, it provides a cost-effective technological pathway for advancing smart hospital development.

Objective This study aims to evaluate the progress and effectiveness of China’s graded diagnosis and treatment system, investigate existing problems, and explore countermeasures for system improvement. Methods Data from statistical yearbooks, government reports, and relevant literature were comprehensively collected and analyzed. The effectiveness of the system was assessed from four aspects: resource allocation, medical service provision, healthcare-seeking behavior, and vertical collaboration. Results As of 2023, regarding resource allocatation, China had 3.40 practicing (assistant) physicians and 4.00 registered nurses per 1 000 population, while the number of general practitioners reached 3.99 per 10 000 population. Despite these improvements in health workforce capacity, visits to primary healthcare institutions accounted for less than 65% of the total diagnosis and treatment volume and exhibited a declining trend. Correspondingly, fewer than 70% of patients in most regions chose primary healthcare institutions for two-week illness episodes. Nevertheless, the overall medical treatment rate within counties reached 94%, and the contract rate of family doctors exceeded 30%. In terms of vertical integration, more than 18 000 medical consortia had been established nationwide by the end of 2023, and a total of 30.321 7 million two-way referrals were recorded, including 15.559 7 million upward and 14.722 0 million downward referrals. Conclusions Since the implementation of the graded diagnosis and treatment policy, the overall availability of medical resources in China has increased, accompanied by improved downward allocation and a more balanced distribution of high-quality resources. However, challenges remain, such as the relatively low diagnosis and treatment volume and first-visit rate at primary healthcare institutions, as well as the need to enhance vertical collaboration. Future efforts should focus on strengthening the vertical integration of medical institutions and improving the supporting policy system.

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

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

In modern society, time poverty coexists with mental health crises, creating an urgent need for a mental health promotion model that is rooted in daily life, culturally inclusive, and practically operable. Through theoretical integration and deduction, this paper organically synthesizes Western empirical sciences, such as positive psychology and mindfulness-based cognitive therapy, with the “inward-seeking” wisdom of self-cultivation found in traditional Chinese culture, proposing the “Seven Dimensions of Time” theory. The theory posits that consciously enhancing the quality of seven dimensions—sleep time, exercise time, focus time, time in nature, connection time, reflection time, and introspection time—can effectively nourish psychological resources and facilitate the progression along the mental health continuum from “problem remediation” to “flourishing”. The “Seven Dimensions of Time” model emphasizes the individual’s proactive role in constructing daily life, offering a novel, time-anchored, and practice-oriented roadmap for mental health intervention that deeply integrates Eastern and Western cultures.

Against the backdrop of escalating medical complexity and soaring patient volumes, traditional medical record management systems face significant challenges, including the intensified burden of clinical documentation, inefficiencies in quality control, and the underutilization of data value. By synthesizing global practices, this paper systematically analyzes the application value and inherent challenges of artificial intelligence (AI) across critical phases of medical record management. Core scenarios had been examined including AI-assisted documentation, intelligent quality control, the automated management of medical record face sheets, the construction of quality indicator systems, and unlocking the potential of medical record data. The integration of AI remarkably improves the quality and efficiency of medical record management, assists in establishing intelligent risk prevention systems, and advances data governance and real-world evidence (RWE) research. However, the widespread adoption of AI is still constrained by multidimensional hurdles, such as technical limitations, privacy concerns, and regulatory compliance risks. To facilitate a sustainable AI transition, this paper proposes a tiered governance framework. At the macro-level, an ecosystem integrating policies, regulations, and collaborative innovation must be established. At the meso-level, hospitals should drive institutional innovation through digital value transformation and technical integration. At the micro-level, operational workflows must be standardized, with an emphasis on physicians’ ultimate accountability as final signatories and the enhancement of competency-based training.

Upholding and strengthening Party overall leadership constitutes the fundamental guarantee for the high-quality development of public hospitals and serves as a principal requirement for comprehensively deepening healthcare reform. In the process of advancing these objectives, this consensus addresses three key components: deepening the reform of operational mechanisms, implementing the president responsibility system under the leadership of the Party committee, and integrating Party building with clinical and professional work. By providing a systematic analysis of implementation pathways, the consensus seeks to ensure the effective execution of healthcare reform at the primary level. This document provides a standardized reference for healthcare policymakers, hospital executives, and policy researchers to facilitate the transition from strategic directives to institutional practice.

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

The global market for international medical services is experiencing rapid expansion. As a hub of high-quality medical resources in China, developing international medical services is essential for Shanghai to become an excellent global city and a premier medical center. Furthermore, it serves as a pivotal measure to promote high-level openness and high-quality development within its health service industry. This study reviews the policy evolution and current status of international medical services in Shanghai, analyzes its strategic advantages, and identifies critical challenges regarding marketing, branding, and management mechanisms. Systematic development strategies are proposed, including strengthening regional branding, deepening international cooperation, optimizing payment systems, and attracting global talents. These strategies aim to enhance the global competitiveness and influence of international medical services in Shanghai.

Objective The paper aims to analyze the current status and trends of non-local medical treatment in Shanghai, to explore the supply and demand characteristics of these patients, and to provide a basis for decision-making in improving the management of non-local medical care. Methods Based on the big data platform of the Shanghai Health Information Network, inpatient medical record face sheets from 2019 to 2023 were collected. The characteristics of patients residing outside of Shanghai, including inpatient service utilization, institutional distribution, and disease structure, were analyzed. Results From 2019 to 2023, the number of hospital admissions by patients from outside of Shanghai increased from 1.105 6 million to 1.345 4 million, accounting for 18.53% to 23.85% of the total hospital admissions in the city, with over 84% being admitted to tertiary hospitals. Patients from the Yangtze River Delta region accounted for more than 60%. Non-local patients mainly received cancer radiotherapy, chemotherapy, immunotherapy, and targeted therapy, accounting for over 40%. The average cost per hospitalization for cardiovascular diseases was relatively high. In terms of annual trends, the number of admissions to obstetrics and gynecology departments decreased by 21.74%, while pediatric admissions increased by 74.46%. Admissions to ophthalmology and otorhinolaryngology departments saw a modest increase. In contrast, admissions to the departments of oncology increased significantly, by 166.69%. Conclusions Disease severity and geographical accessibility are key drivers of non-local medical-seeking behavior. It is recommended to focus on establishing a rational and orderly diagnosis and treatment pattern for key diseases, and to establish a monitoring system for expenses related to non-local medical care.

Objective To analyze changes in gender, age distribution, and disease spectrum among Hong Kong and Macao residents hospitalized in Shenzhen, and to understand their inpatient demand in Shenzhen in order to provide evidence for building the “Healthy Greater Bay Area”. Methods A retrospective analysis was conducted on data from the medical record face sheets of Hong Kong and Macao residents hospitalized in Shenzhen between January 1, 2016, and December 31, 2024. Data on age, gender, and disease profiles were extracted and compiled using Stata MP17.0. Results From 2016 to 2024, a total of 25,779 hospital admissions of Hong Kong and Macao residents were recorded in Shenzhen. The majority of patients were female. The age distribution shifted from predominantly 30-44 years to predominantly 60 years and above. The number of inpatient admissions increased from 1,348 in 2016 to 11,676 in 2024. The top five disease categories among Hong Kong and Macao residents hospitalized in Shenzhen were: diseases of the genitourinary system (14.82%), neoplasms (10.70%), pregnancy, childbirth and the puerperium (9.70%), diseases of the digestive system (8.98%), and diseases of the eye and adnexa (8.59%). The rank of the top 10 diseases varied across years, genders, and age groups. Among Hong Kong and Macao residents admitted to Shenzhen, over 65% chose comprehensive or tertiary hospitals. Conclusions The inpatient demand of Hong Kong and Macao residents in Shenzhen is increasing, with a diversified disease spectrum. Patients showed a preference for tertiary comprehensive hospitals. It is recommended that Shenzhen continue to advance the construction of a “Healthy Greater Bay Area” by rationally allocating specialty resources and improving international medical service capabilities.

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

Objective The study aims to analyze the development status and trends of patents related to wearable devices in the global health management field, and to provide a reference for researchers in the field of wearable medical equipment. Methods Patents were retrieved from the IncoPat Global Technology Analysis and Operations Platform for the period from January 1, 2000, to December 17, 2024. Statistical analysis and visualization were conducted on dimensions such as patent application trends, geographical distribution, applicants, legal status, technology categories, technical efficacy, and keywords related to wearable devices in the global field of health management. Results A total of 4 270 patent documents were included, involving 4 270 patents. From 2000 to 2024, the number of patent applications for wearable devices in the global health management field exhibited a phased growth trend. Notably, China’s application trend in this field aligned with the global trend, showing rapid development in recent years to become the country with the most patent applications, followed by the United States, India, South Korea, and Japan. Technically, patents were primarily distributed in IPC classes A61B (Diagnosis; Surgery; Identification) and G16H (Healthcare Informatics, i.e., Information and Communication Technology for processing medical or health data). Major applicants included Samsung Electronics Co., Ltd., i4C Innovations Inc., Industrial Technology Research Institute, International Business Machines Corporation (IBM), and AliphCom. Regarding legal status, from 2000 to 2024, there were 2 208 patents in the authorized and published states, and 627 patents in the withdrawn and rejected states. Keyword cluster analysis indicated that “machine learning” was the most frequent term, followed by “health management”, “health monitoring”, “vital signs” and “smart wearables”. Conclusions The number of patent applications for wearable devices in the global health management field presents an overall phased growth trend, and China ranks first in the number of patent applications in this field. Currently, the R&D focus of wearable device technology is shifting towards intelligence and precision.

Objective This study attempts to analyze the utilization of inpatient services by residents from Tianjin and Hebei seeking care at tertiary public hospitals in Beijing before and after the implementation of the direct settlement policy for cross-regional medical care, to explore the influencing factors of cross-regional hospitalization costs, and to provide scientific evidence for the subsequent implementation and optimization of this policy. Methods Data were extracted from the medical record face sheets of tertiary public hospitals in Beijing between 2016 and 2022. The number of inpatients from Beijing, Tianjin, and Hebei was calculated, and data on their demographics, disease characteristics, medical insurance types, and average cost per hospitalization were collected. A fixed-effects log-linear regression model was used to analyze factors influencing medical costs. Results Among cross-regional patients in Beijing’s tertiary public hospitals, the proportion of patients from Tianjin and Hebei increased from 26.13% in 2016 to 28.71% in 2022. Patients aged 40-69 accounted for 70.04%, and those covered by Employee Basic Medical Insurance accounted for 36.61%. 26.09% underwent treatments or procedures such as radiotherapy, chemotherapy, and postoperative rehabilitation, and over 20% were hospitalized in surgical departments. During the observation period, the average cost per hospitalization for patients from Tianjin and Hebei was 28 489.6yuan, which was approximately 20.67% higher than that for local Beijing patients (β = 0.188, P<0.01). Conclusions The cross-regional healthcare policy has facilitated the sustained growth in the number of patients from Tianjin and Hebei seeking medical care in Beijing. Distinct characteristics were observed in their demographic and disease profiles: predominantly working-age individuals (40-69 years old), with a relatively high proportion of Employee Basic Medical Insurance participants. Their diagnosis and treatment behaviors were significantly concentrated in high-resource consumption areas such as surgeries, radiotherapy, chemotherapy, and postoperative rehabilitation. Correspondingly, the average cost per hospitalization for patients from Tianjin and Hebei was significantly higher than that for local Beijing patients. Therefore, it is recommended to improve policies by promoting regional healthcare coordination, optimizing medical services for the elderly, and strengthening differentiated payment policies of medical insurance funds, to enhance the equity and sustainability of the cross-regional healthcare system.

Objective The paper aims to analyze the current status of adult vaccination services in Shanghai, propose policy recommendations for existing problems, and to provide solutions for optimizing the adult vaccination service system. Method Data were collected from the Shanghai Comprehensive Vaccine Management and Vaccination Information System and questionnaire surveys to analyze the availability and uptake of adult vaccines, the provision of vaccination services, and clinic director’ attitudes toward the proposed changes in adult vaccination service models. Results There are 13 categories comprising 22 types of vaccines available for adults in Shanghai (excluding COVID-19 and yellow fever vaccines), which were primarily non-National Immunization Program (NIP) vaccines. From 2019 to 2023, the total number of doses administered to adults reached 12.048 3 million, showing a consistent year-on-year upward trend with an average annual growth rate of 27.33%. The vaccination rate for all types of vaccines among adults of all age groups remained below 50%. As of the end of March 2024, there were 432 vaccination clinics providing services for people aged 18 years and above, among which community health service centers accounted for the largest proportion (61.11%). On average, each vaccination clinic had 14.30 staff members, and 70.7% of the clinics had at least one licensed physician. The vaccination clinics were primarily set up to serve both adults and children, with 70.84% of them serving both populations. The survey showed that 85.31% of clinic directors considered it feasible for general practitioners (GPs) to recommend suitable vaccines to residents and prescribe vaccination recommendations; 89.81% supported expanding the scope of contracted family doctor services to include vaccine recommendations. However, 60.19% opposed the involvement of retail pharmacists within the jurisdiction in the vaccine management system. Conclusions The vaccination rate for adults needs to be further improved. The allocation of vaccination service resources was imbalanced among different districts. Attitudes toward the proposed adult vaccination service models varied among staff members. It is recommended to prioritize adult vaccination, strengthen vaccine recommendations, and optimize vaccination service models.

Data collaboration provides a key entry point for deepening the integration between basic medical insurance and commercial health insurance. However, addressing structural issues such as conflicting value objectives, overlapping responsibilities, and the absence of consultation and incentive mechanisms requires robust theoretical guidance. By analyzing driving mechanisms targeting demand gaps, product innovation, and regulatory resilience, this article proposes a policy framework focused on the dynamic balance of value objectives. This framework adopts incentive compatibility within collaborative structures as a starting point and establishes secure and efficient data circulation as a benchmark. Policy recommendations include refining rules for public value guidance and auditing, and integrating offline coordination with online data platforms. Furthermore, the article advocates for performance-linked mechanisms, clinical outcome data sharing, and comprehensive risk monitoring to facilitate the secure circulation of trusted data.

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

Objective This study aims to evaluate the impact of the pay-for-performance policy under the Diagnosis-Related Groups (DRG) system for dominant Traditional Chinese Medicine (TCM) diseases on patients’ medical expenses, hospital length of stay, hospital service volume, and efficiency. The empirical evidence obtained to support the scientific validity and feasibility of this payment method could offer a reference in deepening the reform of the medical insurance payment system. Methods This study selected a designated key development unit of a national TCM specialty as the research setting. The Difference-in-Differences (DID) model was used to analyze the differences in various indicators between insured patients (observation group) and non-insured patients (control group) before and after the implementation of the payment reform policy. Results A total of 713 cases were included, consisting of 296 cases before the policy implementation and 417 cases after. There were 475 cases covered by local medical insurance and 238 cases classified as others (including intra-provincial non-local, trans-provincial non-local, and self-pay). Following policy implementation, the average quarterly case numbers in both the observation group and the control group [(56.6 ± 16.77) cases and (26.80 ± 10.18) cases, respectively] were higher than those before implementation [(32.00 ± 5.02) cases and (17.33 ± 6.12) cases]. Conversely, the average total hospitalization costs [(9 641.73 ± 3 469.69) yuan and (13 827.50 ± 12 889.03) yuan] were lower than those before implementation [(15 952.75 ± 10 907.07) yuan and (17 967.68 ±16 787.22) yuan]. Additionally, the average length of hospital stay for both groups was lower, and the proportion of medical service income was higher than before the policy implementation. Before and after implementation, except for medical technology and nursing fees, the observation group showed a significantly greater reduction in other cost categories compared to the control group (β<0, P<0.05). However, there was no statistically significant difference in the change of hospital service volume between the two groups (P>0.05). Tests for parallel trends, placebo effects, and heterogeneity analysis confirmed that the results of the DID regression model were reliable. Conclusions The pay-for-performance policy for TCM significantly reduced the average total cost per case of dominant TCM diseases. Specifically, the costs of treatment, drugs, and consumables decreased most significantly. Consequently, the cost structure was optimized and hospital stay duration decreased to reach an enhanced hospital efficiency.

Objective The research aims to analyze the application of policy instruments in the current equalization policy of basic public health services in China and the equity dimensions they contain, aiming to provide reference for the formulation and optimization of related policies. Methods Based on quantitative analysis of policy texts, Nvivo 15 was used to code and process the basic public health service equalization policy documents. According to the connotations of the indicators, the coded items were incorporated into a three-dimensional framework of “Policy Instruments-Social Equity-Policy Targets”. The high-frequency words and weighted percentage in the policy texts were statistically analyzed to examine the frequency and characteristics of policy instrument usage, followed by a multidimensional cross-analysis. Results A total of 123 policy documents were included. In the word frequency statistics, words with a weighted percentage greater than 1% included "work", "management", "service", "healthcare", "health", and "system". Multi-dimensional cross-analysis showed that demand-side policy tools accounted for 16%, while environmental policy instruments accounted for 51.62%. Regarding the equity concepts embodied in the policies, equity of opportunity was the most common, reaching 61.43%, whereas perceived equity was relatively low at only 4.61%. The main targets of the policy instruments were the government and medical institutions, accounting for 45.47% and 26.2%, respectively, while medical personnel and social capital accounted for only 17.74% and 10.59%. Conclusions There are imbalances in the application of existing basic public health service policy instruments, which lean towards environmental policy instruments. The concept of equity within these policies mainly focuses on equity of opportunity on the supply side, with less consideration for residents’ perceptions. The government needs to dynamically balance the frequency of policy instrument usage, coordinate adjustments to the equity concepts, and strengthen the public’s perceived equity.

Objective This study aims to analyze the progress of China’s national volume-based drug procurement (NVBP), renewal, summarize the policy linkage between NVBP and renewal upon agreement expiry, and to provide suggestions for improving renewal policies. Methods Selection results and renewal procurement plans from NVBP Rounds 1-6 were compiled. Descriptive statistics were employed to examine NVBP winning prices, renewal winning prices, and the number of successful bidders. Results As of December 2024, agreements for 234 medicines had expired, of which 232 had completed the renewal process. Core renewal procurement consortia, led by Henan, Shanghai, Guangdong, and Jiangsu, emerged. Overall, renewal prices for the first 6 rounds of medicines continued to decline, with an average reduction of approximately 15%. However, 17.7% of medicines saw price rebounds during the renewal. The magnitude of price changes varied across consortia due to different methodologies. Price dispersion for the same product after renewal fluctuated: differentials widened in Round 1 but narrowed in Round 3 (P<0.05). Regionally, during the NVBP phase, winning prices in western China shifted from 1.0% higher than the national average initially to 0.4% below post-renewal. Conclusions Renewal procurement generally led to further price reductions following NVBP, although prices for some products rebounded. Different renewal mechanisms influenced price outcomes, and price disparities across products and regions remain notable. Future efforts should focus on evaluating the effects of different renewal methods, promoting transparency in renewal work, strengthening price fluctuation monitoring, improving inter-regional price coordination, and aligning renewal policies with the governance of medicines with the same generic name, dosage form, strength, and made by the same manufacturer.

Objective This study aims to examine family intergenerational support patterns by considering both their dimensions and directions, and to explore how these patterns relate to the seniors’ care preferences, with a view to promoting the allocation of elderly care resources and the development of family support policies. Methods Data from the China Longitudinal Aging Social Survey (CLASS) 2020 were used, including 7 840 samples. Latent Class Analysis (LCA) was employed to identify and classify family intergenerational support patterns. A multinomial logistic regression model was adopted to analyze the association between intergenerational support patterns and care preferences. Results The dominant family intergenerational support pattern in China was the “support type” (60.78%), followed by the “tight-knit type” (23.19%), while the “detached type” was least common (16.03%). Univariate analysis showed that intergenerational support patterns were significantly associated with care preferences (χ² = 84.51, P<0.001). Multinomial logistic regression results indicated that the “support type” was positively correlated with the preference for home-based care. The “tight-knit type” was positively associated with both community-based care (OR = 2.073, P<0.001) and institutional care (OR = 1.489, P = 0.002). The “detached type” had a positive but not statistically significant correlation with institutional care (OR=1.045, P = 0.823). Heterogeneity analysis revealed distinct patterns between urban and rural seniors, with males and the young-old participants showing stronger associations between the “tight-knit type” and care preferences compared to females and the oldest-old. Conclusions Intergenerational support patterns are correlated with the seniors’ care preferences. Insights from these patterns can further optimize the “support type” family model, imporve elderly care service supply strategies, and better meet the diverse needs of the aging population.

Objective The study attempts to explore the effectiveness, major problems, and optimization suggestions of China’s Volume-Based Procurement (VBP) policy for pharmaceuticals, and to provide reference for refining the VBP system and standardizing the full-process management of drugs. Method Using the Grounded Theory method, textual analysis was conducted on the interview transcripts of 19 interviewees through a three-stage coding process, including open coding, axial coding, and selective coding. Results The analysis of 266 representative raw statements yielded 48 initial categories. Following the three-level coding process, three core categories concerning VBP’s effectiveness were identified from the perspective of affected stakeholders: “Patients”, “Enterprises”, and “Medical Insurance”. Interviewees generally believed that VBP has created a “triple-win” situation for medical institutions, medical insurance, and patients. Regarding problems and suggestions, three core categories were distilled respectively: “Scope of Implementation”, “Core Objectives”, and “Operational Mechanisms”. Interviewees generally believed that the variety scope of VBP drugs needs to be further expanded, the supervision of the procurement process needs to be strengthened, coordination between national and local VBP programs is insufficient, and public demand for enhanced quality of VBP drugs is urgent. Conclusions Although the VBP policy has achieved certain outcomes in safeguarding patient core interests, standardizing clinical drug use, guiding industrial transformation, and improving the efficiency of the medical insurance system, operational challenges persist, including incomplete procurement coverage, inaccurate demand reporting, poor supply, and insufficient utilization for some drugs. It is recommended to continuously improve the VBP system, strengthen refined full-process management, ensure synergy between medical care, medical insurance, and pharmaceuticals, as well as vertical coordination, and reinforce price management and drug quality assurance, to provide the public with more cost-effective and reliable medicines.

Objective This study attempts to analyze the constraints on the policy implementation of China’s healthcare security agreement management, and to provide reference suggestions for enhancing the policy effect of healthcare security agreement management. Method Based on the Meter-Horn policy implementation model, the constraints on policy implementation of healthcare security agreement management were analyzed from six dimensions: policy standards and objectives, policy resources, inter-organizational communication and enforcement activities, characteristics of implementing agencies, system environment, and disposition of implementers. Result Constraints on the implementation of the healthcare security agreement management policies include: policy violations by the policy target group, the limited capacity of resource absorption and integration at the primary level, the underdeveloped communication and implementation procedures, the lack of internal motivation within implementing agencies, the insufficient strength of policy regulation, and the deviation in implementers’ compliance intentions. Conclusion To enhance the effectiveness of policy implementation in healthcare security agreement management, it is recommended to refine policy implementation standards, optimize the allocation of policy resources at the primary level, improve communication and implementation mechanisms, clarify the organizational structure of policy execution, establish a normalized supervision mechanism, and create a favorable policy environment to promote precise alignment and advance the high-quality development of the healthcare security system.

Objective The paper aims to analyze the research hotspots and trends of tiered diagnosis and treatment in China, and to provide references for improving the theoretical and practical research on China’s tiered diagnosis and treatment system. Methods Journal articles related to tiered diagnosis and treatment included in the China National Knowledge Infrastructure (CNKI) database from 2012 to 2024 were searched. Data were exported in RefWorks format, and the included studies were analyzed using CiteSpace 6.1 R3 for bibliometric and visual analysis. Results A total of 6 198 valid articles were included. The annual publication output on tiered diagnosis and treatment in China initially increased and then decreased, peaking in 2018 with 1 143 articles and declining year by year after 2019. A core group of high-yield authors and strong collaborative research networks have not yet been formed. Keywords such as tiered diagnosis and treatment, medical consortia, two-way referral, and influencing factors appeared with high frequency and centrality. Research themes focused on tiered diagnosis and treatment, medical consortia, family doctors, and influencing factors. Emerging research frontiers included specialty alliances, medical-prevention synergy, artificial intelligence, knowledge graphs, and medical communities. Conclusions Future research should prioritize identifying emerging high-impact topics within the tiered diagnosis and treatment system. It is essential to strengthen interdisciplinary collaboration and team-based research, and to promote synergistic studies integrating tiered diagnosis and treatment with medical insurance and high-quality medical development.

Objective The study attempts to analyze the hospitalization patterns and characteristics of non-local patients with cancer in Shanghai, and to provide evidence for optimizing cross-regional medical care policies and guiding the strategic transformation of hospitals. Methods Dig data from the Shanghai Health Information Network were utilized to analyze the inpatient medical records (2019-2023) from all municipal medical institutions. Again, data of patients with cancer were extracted to systematically analyze the medical visit characteristics of non-local patients. Results From 2019 to 2023, hospital admissions for non-local patients with cancer increased from 444 900 to 548 900 person-times, with total costs rising from 10.535 billion yuan to 15.688 billion yuan. Over 60% of the non-local patients were from the Yangtze River Delta region, with patients from Jiangsu province accounting for more than 30%. The most common cancer types among non-local patients were digestive system malignancies (26.62%), respiratory system malignancies (20.93%), benign tumors (9.63%), and breast malignancies (7.88%). The primary treatment modalities were therapeutic surgeries and chemotherapy, with significant increases observed in targeted therapy and immunotherapy. Conclusions Cancer continues to be a major disease category driving cross-regional medical care. The balanced distribution of high-quality medical resources has reduced the need for cross-regional care. Leading hospitals in medical destination hubs urgently need to adjust their strategic positioning and transform their service development. Implementing Diagnosis Related Group (DRG) and Diagnosis-Intervention Packet (DIP) payment management for cross-regional medical services, covering both intra-provincial and inter-provincial care, is a crucial supporting measure for future reforms.

Drawing upon the practical experience of the United Kingdom and Ireland in refining their healthcare delivery systems, this paper analyzes specific interventions across four key domains: operational management, resource allocation, talent cultivation, and technological innovation. The United Kingdom and Ireland have continuously enhanced their healthcare systems by establishing professionalized hospital management teams, prioritizing budget management and resources allocation, and integrating Diagnosis-Related Group (DRG) with clinical pathways. Key drivers of efficiency include the advancement of medical information interoperability, the optimization of service workflows, and the fostering of high-caliber general practitioners, alongside the development of robust technological innovation support systems. Currently, China faces challenges such as fragmented resource distribution, suboptimal talent structures, and developmental gaps in training systems. Moreover, bottlenecks in digital infrastructure and data sharing, coupled with the low efficiency of translating medical research into clinical practice, remain significant barriers. Future strategies must prioritize professional workforce development, strengthen digital health infrastructure, and consolidate high-quality resources. By optimizing workflows and standardizing clinical training, China can build a more efficient healthcare delivery system, thereby substantively advancing the high-quality development of the national health sector.

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

Through a comprehensive analysis of development strategies, methodological guidelines, and assessment manuals from representative global health technology assessment (HTA) agencies, this study explores the application of frontier digital technologies, represented by artificial intelligence (AI), in the HTA field to provide a reference for China’s digital HTA transition. Leading global HTA agencies have placed the digital transformation of HTA on their agendas, emphasizing the broad prospects of AI-empowered HTA in their recent strategic plans. These agencies have initiated the exploration of AI technologies, such as natural language processing, neural networks, and machine learning algorithms, to collect and analyze data in evidence synthesis and outcome evaluation. China should recognize the strategic significance of HTA digital transformation for modernizing the national health governance system and capacity, establish and improve corresponding organizational and institutional support mechanisms, and comprehensively advance the application and development of frontier digital technologies, represented by AI, in HTA.

Objective The study aims to systematically analyze published invention patent applications related to medical large language models (LLMs) in China, and to explore their application status and developmental characteristics. Methods Patentometrics and patent content analysis were employed to construct a multi-level classification framework for application domains. Quantitative analysis and visualization were conducted on disclosure trends, patent assignees, geographical distribution, keyword frequency, and application domains. Results As of April 15, 2025, a total of 660 invention patent applications related to medical LLMs had been published in China. Related patents began to emerge in the second quarter of 2023 and peaked in the first quarter of 2025. Technology enterprises were the primary patent assignees, with patenting activities concentrated in Beijing, Shanghai, and Guangdong. Application scenarios were mainly clustered in two domains: medical service management and medical education and research. Key areas included clinical decision support, medical image processing, AI-aided consultation, and research assistance. Conversely, areas such as the healthcare industry, public health, and primary care remained relatively weak, indicating an imbalanced distribution of use cases. Conclusions The number of patent applications for medical LLMs in China exhibits a sharp increase, with technological innovation highly aligned with healthcare service needs. However, challenges stay in industrialization, adaptation for primary care, and system integration. It is urgent to strengthen data interoperability, expand application use cases, improve regulatory frameworks, and cultivate interdisciplinary talent to promote the sustainable development of medical LLMs.

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

Objective The study aims to explore the differences in health technology assessment (HTA) and reimbursement policies for chimeric antigen receptor T-cell (CAR-T) therapy products across the EU5 countries (UK, France, Germany, Italy, and Spain), and to assess their implications for China. Methods Official documents from HTA agencies, reimbursement decision-making bodies, and payers in the EU5 countries were retrieved. Combined with data from the European Medicines Agency (EMA) and the UK Medicines and Healthcare Products Regulatory Agency (MHRA), HTA reports, reimbursement decisions, and pricing mechanisms for CAR-T therapy products approved in major European markets as of April 2025 were analyzed. Results As of April 2025, six CAR-T therapy products had been launched in these five countries. Differences existed in HTA timelines, conclusions, and reimbursement decisions. The UK had the shortest initial HTA cycle (average 9.2 months). Through the coverage with evidence development (CED) mechanism, the Cancer Drugs Fund (CDF) provided temporary reimbursement for products not meeting routine access criteria; however, the secondary assessment process, based on real-world evidence, had a longer cycle. France adopted an early patient access policy, resulting in a relatively short HTA cycle (average 10.7 months). Its HTA results directly determined the reimbursement rate and pricing strategy, also utilizing the CED mechanism. Secondary evaluations were more frequent in France, with shorter intervals between initial and follow-up evaluations. Italy, Spain, and Germany featured fragmented payment systems and discontinuous HTA and reimbursement decision processes. All three adopted the pay-for-performance (P4P) model but differed in reimbursement trigger points, outcome indicators, and payment mechanisms. Germany implemented a survival-based “refund-for-failure” model, while Italy and Spain adopted a staged payment model based on clinical results. Conclusions Both CED and P4P can effectively address the high value and high uncertainty of CAR-T cell therapy products. CED enables provisional reimbursement while conducting concurrent post-marketing studies, whereas P4P links routine access to efficacy milestones for risk-sharing; both rely heavily on real-world evidence. It is recommended to integrate CED and P4P into the medical insurance access framework to reduce decision-making uncertainty through dynamic evidence updates.

Objective This research attempts to develop a Healthy Shanghai Index (HSI) evaluation system, systematically assess the implementation effectiveness of the Healthy Shanghai Action, and provide a scientific basis for urban health governance. Methods A literature review and policy analysis were conducted to establish the evaluation system framework and an initial pool of indicators. The Delphi method was then applied to design questionnaires and consult experts, with indicators screened based on their importance, feasibility, and the rationality of calculation methods. Indicator weights were determined using the Analytic Hierarchy Process (AHP) and the equal-weighting method. Indicator data from 2019 to 2024 were collected to calculate annual HSI scores. Results The HSI evaluation system comprised seven first-level indicators (health outcomes, healthy living, health services, health environment, health security, health industry and technological innovation, and health governance), 26 second-level indicators, and 65 third-level indicators. From 2019 to 2024, the composite HSI score increased from 58.93 to 83.68, representing a 42.00% growth. Scores across all dimensions exhibited an upward trend, with particularly pronounced growth in the health industry and technological innovation dimension (209.84%) and the health governance dimension (143.49%). Conclusions The HSI evaluation system is scientifically sound and applicable. It can effectively track progress and identify gaps in the development of the Healthy Shanghai Action and serves as a quantitative tool for assessing health governance performance in megacities. The index provides a reference for further advancing the Healthy Shanghai Action and for healthy city development nationwide.