In order to understand the latest progress of health decision support system (HDSS) construction, grasp the law of HDSS development and adopt the international advanced experience, this paper took Australia for example, presented a comparative analysis on the construction practices, including the contents, features and system functions of national construction guidelines for HDSS in different periods, and showed the integral development level of Australia HDSS was still in the exploratory stage, and its construction goal, function orientation and construction mechanism got improved gradually with the deep development of public health information. Additionally, to assure the accuracy and safety of HDSS function, Australia has been laying stress on the standard specification construction and system function authentication.
Objective To discuss the epidemiological characteristics of young and middle-aged people infected with COVID-19 in Gansu province under the new epidemic policy. Methods A total of 1800 people were collected from two tertiary hospitals in Gansu province from November 8, 2022 to January 28, 2023. The vaccination status, nucleic acid antigen detection, the specific time of infection, main symptoms and severity of the disease were investigated. Results Among 1800 participants, 1685 (93.6%) were vaccinated and 1565 (86.9%) were infected with COVID-19. Among the 1565 infected persons, 523 (33.4%) completed both nucleic acid and antigen testing, 382 (24.4%) completed nucleic acid testing, 490 (31.3%) completed antigen testing, 170 (10.9%) received IgG testing. 1490 (95.2%) were slight ill, 75 (4.8%) were critical ill, and 96 (6.1%) were hospitalized, and no one died. In 2022, 92 cases (5.9%) were infected in the first half of November, 141 cases (9.1%) in the second half of November, 630 cases (40.3%) in the first half of December, and 553 cases (35.4%) in the second half of December. 109 cases (7.0%) were infected in the first half of January, 38 cases (2.2%) in the second half of January, and 2 cases (0.1%) in the first half of February of 2023. and no cases in the second half of February. Among the 1565 infected persons, 825 (52.7%) had respiratory symptoms, 293 (18.7%) had gastrointestinal symptoms, 257 (16.4%) had autonomic disorders, 140 (8.9%) had other symptoms such as decreased smell and taste, and 48 (3.3%) had no symptoms after infection. Conclusions The vaccination rate of young and middle-aged people in Lanzhou city of Gansu Province is high. Since the new policy, the infection rate of the novel coronavirus among young and middle-aged people is high, the number of antigen tests is more than nucleic acid tests, most of the infected patients are slight, with fewer critical patients, and the hospitalization rate is low. The peak of infection occurred in early December 2022, and the infection rate was basically zero by February 2023. The main symptoms of COVID-19 infection are mainly respiratory tract, followed by digestive tract and autonomic nervous system disorders, and few patients are completely asymptomatic.
ObjectivesTo explore the poor population’s cognition and satisfaction on medical assistance policies in Sichuan province, so as to provide evidence for improving health poverty alleviation policies.Methods A telephone survey was conducted between October and December 2017 among 1 280 poor individuals in Sichuan Province, with multi-stage stratified random sampling. The contents of the survey included general demographics of the poor population, and knowledge and satisfaction of health poverty alleviation policies.ResultsThe awareness rate of medical assistance policy was 91.80%, and the satisfaction rate was 91.88%. Poor individuals from non-poor counties, who had been out of poverty, and who reported that they had not signed up for family doctors, had low awareness of poverty alleviation policies. Poor individuals from non-poor counties, who usually went to the municipal hospital, who reported that they have not signed up for family doctors, and who do not know about health policies for poverty alleviation had a lower satisfaction rate.ConclusionsThe overall awareness rate and satisfaction rate of medical assistance policies in Sichuan province are relatively high, however, there are still some shortage. In the future, more attention should be paid to strengthen the promotion of health poverty alleviation policies for non-poor areas and those who had been lifted out of poverty, speeding up the contract service of family doctors and exploring ways to further alleviate the burden of medical expense of patients with serious diseases.
ObjectiveTo investigate the variations in patient hospitalization expenses before the enforcement of the centralized procurement policy, after the implementation of the drug centralized procurement policy, and after the introduction of the consumables centralized procurement policy. The efficacy of the centralized procurement policy will also be examined. MethodsThis retrospective study utilizes data obtained from the medical records homepage of the Health Information Statistics Center under the Health Commission of Gansu Province. It included 32 938 inpatients who underwent PCI surgery for coronary heart disease in Gansu province between January 1, 2018, and December 31, 2022. A double-breakpoint interrupted time series model was employed to analyze the fluctuation trends in hospitalization costs among patients across various stages of the centralized procurement policy's implementation. ResultsThroughout the three phases of implementing the centralized procurement policy, the average total hospitalization costs were RMB 46 149.49 yuan, RMB 46 629.12 yuan, and RMB 28 771.76 yuan, respectively. After the centralized procurement policy with a focus on drug volume was initiated, there was an immediate reduction in average total hospitalization costs, drug costs, consumable costs, and medical service fees by 4.64%, 5.62%, 18.12%, and 8.85%, respectively. However, there was a subsequent increase of 25.28% in average medical service fees. Following this phase, average out-of-pocket costs, treatment costs, and other expenses exhibited a consistent upward trajectory, increasing by an average of 2.23%, 1.51%, and 1.21% per month. Upon the introduction of the centralized procurement policy for consumables, there was an immediate surge of 23.75% in average medical service fees, while average total hospitalization costs, out-of-pocket costs, consumable costs, treatment costs, and rehabilitation costs experienced a gradual decline. ConclusionThe enforcement of centralized procurement policies for drugs and consumables has effectively managed to reduce hospitalization costs for patients undergoing PCI surgery due to coronary heart disease, thereby easing the financial burden on patients. However, changes in consumable costs and average medical service fees were relatively modest. Going forward, it is essential to refine the centralized procurement policy concerning consumables, improve the compensation mechanism for medical service pricing, and enhance the overall value proposition of medical services.
With the establishment and development of regional healthcare big data platforms, regional healthcare big data is playing an increasingly important role in health policy program evaluations. Regional healthcare big data is usually structured hierarchically. Traditional statistical models have limitations in analyzing hierarchical data, and multilevel models are powerful statistical analysis tools for processing hierarchical data. This method has frequently been used by healthcare researchers overseas, however, it lacks application in China. This paper aimed to introduce the multilevel model and several common application scenarios in medicine policy evaluations. We expected to provide a methodological framework for medicine policy evaluation using regional healthcare big data or hierarchical data.
Health insurance system has been proved to be an effective way to promote the quality of health service in many countries. However, how to control health expenditure under health insurance system remains a problem to be resolved. Some developed countries like UK, Canada and Sweden linked their health technology assessment results with decision making and health insurance management, and made prominent achievements in both expenditure control and quality improvement. China is carrying out its health system reform and running a new health insurance project. Using the experiences of other countries is undoubtedly of great importance in developing and managing our health insurance system.
ObjectivesTo analyze the characteristics six types of cross-regional cancer patients and their medical behavior in Beijing.MethodsWe described the characteristics of cross-regional patients, analyzed the differences between cross-regional and local patients, and identified the key factors by analyzing the influencing factors of patient's cross-regional behavior to factors by using binary logistic regression model.ResultsCompared with local patients, cross-regional cancer patients had the following characteristics: consisting primarily of young and middle-aged workforce, simpler disease status and those more inclined to choose special hospital and surgical treatment.ConclusionsPromoting the construction of regional oncology medical center can meet the needs of cross-regional patients and relieve the pressure of medical treatment in large cities caused by cross-regional medical treatment behavior.
Objective To evaluate the pathways for improving the operational efficiency of medical teams, thereby providing micro-level empirical evidence for the refined management and high-quality development of public hospitals. MethodsBased on panel data from nine surgical teams in the Department of Thoracic Surgery at Sichuan Cancer Hospital from 2021 to 2024, this study employed the data envelopment analysis (DEA) with the BCC model to assess static efficiency, including technical efficiency (TE), scale efficiency (SE), and overall efficiency (OE). The Malmquist index was used to analyze the dynamic total factor productivity (TFP) and its decomposition into efficiency change (EC) and technology change (TC). Input indicators were the number of physicians and the number of open beds. Output indicators included the proportion of surgical patients, the proportion of grade Ⅳ surgeries, and the average length of stay (reciprocally transformed for positive orientation). Results The mean OE of all medical teams showed a continuous upward trend, while the mean SE exhibited a “V-shaped” pattern, initially decreasing and then increasing. The most significant growth was observed in mean TE, which was the primary driver of the OE improvement. All medical teams achieved positive TFP growth, with TC values greater than 1.000 across all teams, indicating that technological innovation was the core engine of efficiency enhancement. However, EC showed a divergent trend among the teams. Conclusion Public hospital performance appraisal policies effectively guide technological upgrading of medical teams through indicators such as “proportion of discharged patients undergoing surgery” and “proportion of grade Ⅳ surgeries”. However, issues of hospital resource mismatch and SE differentiation persist. It is necessary to establish specialized operation groups for dynamic resource monitoring and construct a “technological upgrading, scale adaptation, and management innovation” triangular balanced system to achieve a sustainable mechanism for maximizing healthcare resource input-output.
Objective To understand the basis and status of setting up the dispensing fee at home and abroad, and to ascertain the scope of dispensing service, so as to offer references to the setting up and implement of dispensing fee in China. Methods According to the evidence-based principle, the descriptive method was adopted to demonstrate the basis of setting up the dispensing fee. The different definition, payment mode and standard were compared at home and abroad. Results Separation of prescribing and dispensing was the basis of setting up the dispensing fee. In western countries, the charge of dispensing fee was almost at the same level, though its definition and scope were different among countries. It was more reasonable to determine the level of dispensing fee according to the visiting frequency, compared with the price, the number and the type of drugs in the prescription. Conclusion China’s calculation of dispensing fee should be based on the prescription fee, the cost of drug administration and store. Dispensing fee should be implemented in the pilot hospitals firstly. Institutions providing primary health care services (rural health clinics, community health service centers etc) which follow a policy of “separating revenue from expenditures” may not adopt the dispensing fee temporarily. In urban hospitals, it is advisable to promote the separation of prescribing and dispensing gradually and bring pharmacists to provide prescription auditing, dispensing and advisory services. For retail pharmacies, pharmacists should be gradually fully staffed as one of the necessary conditions for operating. Performance evaluation of pharmacist’s services and pharmacy administration also should be developed.
The construction of high-level talent teams is the core of building up high-level universities and hospitals, and it is an important reference index for the ranking of universities and academic disciplines. The first-class medical talent teams is an essential requirement for comprehensive hospitals to be ranked as "Double First-Class". Based on the practice of construction of high-level medical talents in West China Hospital of Sichuan University, this paper introduces the optimal appoaches in this regard.