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Building a strong public health system has become an urgent task in the new era. Based on more than eight years of systematic research， we believe that five aspects need to be prioritized for a strong system. First， we should change the perspective on public health， using the word “gonggong jiankang” to replace “gonggong weisheng” and the word “gonggong jiankang tixi” to replace “gonggong weisheng tixi”， to lead the public health system development. Second， we should develop a suitable public health system and continuously improve the health capacity for governance. Third， we should make it clear that the goal of building a strong system is not far-fetched， and we need to consolidate the existing institutional advantages of China’s public health system： when encountering major problems， we can maintain a unified goal and mobilize the whole society to cooperate effectively to accomplish the goal. However， we need to make up for shortcomings one by one， especially to solve the key problem of lacking a strong coordination mechanism in daily work. Fourth， we should pursue excellence and consolidate the“suitable” mechanism proven in the process of coping with the COVID-19， so that efficient mechanisms to deal with major issues can be used in routine work， and efforts should be made to consolidate the advantages of prevention and control of infectious diseases and emergency response，so as to achieve the balanced development of regions categories and units.Finally， it is necessary to strengthen the coordination of government and research institutions， in the aspects of technological innovation， talent team building and accurate consulting services， and work together to pursue a suitable and strong system to realize the modernization of the health system and capacity for governance.
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The outbreak of COVID-19 has exposed many shortcomings in disease control and prevention system (DCPS) of China.Resolving the problems and strengthening the DCPS became the top priority on China′s public policy agenda.This paper reveals the problems of the DCPS system regarding policy-making, regulations, operation mechanism and staff, and proposes several strategies from three aspects of legal construction, management system, and operation mechanism, including:"Prevention first" should be incorporated into the national legal system, all the departments should be engaged in "Healthy China 2030" initiative, laws and regulations should be amended, new disease prevention and control management institutions should be set up, a high-quality professional team should be retained, the regional health information exchange channels should be strengthened, the coordinated mechanism for disease prevention and control should be normalized, the long-term investment mechanism should be established, and the equipment renewal and reserve system should be improved.
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The outbreak of COVID-19 has exposed many shortcomings in disease control and prevention system (DCPS) of China. Resolving the problems and strengthening the DCPS became the top priority in China’s public policy agenda. This paper revealed the problems of the system regarding policy-making, regulations, operation mechanism and staff, and proposed several strategies from three aspects of legal construction, management system, and operation mechanism, including: 'Prevention first' should be incorporated into the national legal system, all the departments should be engaged in 'Healthy China 2030' initiative, laws and regulations should be amended, new disease prevention and control management institutions should be set up, a high-quality professional team should be retained, the regional health information exchange channels should be strengthened, the coordinated mechanism for disease prevention and control should be normalized, the long-term investment mechanism should be established, and the equipment renewal and reserve system should be improved.
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On the basis of systematic evaluation of 32 provincial capital cities and municipalities in their capacity for preventing and controlling emerging infectious diseases, focus analysis is made on Wuhan in relation to its advantages and disadvantages as follows:There has been a legal basis for epidemic prevention according to law, but it has not translated into effective action.There has been an organizational basis for responding to epidemic, but coordination mechanism has not been effectively established.The management mechanism has been complete, but the division of responsibilities among different departments has not been clear.The monitoring network has been set up, but its role of "predictive warning" has not been played.Insufficiency of public health service delivery was observed owing to lack of financial investment.In cities of China, advantages and disadvantages have been both existent in their capacity to prevent and control of emerging infectious disease.We should be vigilant in this regard. It is imperative to "fill defects, stop leaks and strengthen weakness".There is a Chinese saying:"It is not too late to mend a fold after the sheep have been stolen".
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OBJECTIVE@#To assess the relationship between yogurt intake and mortality risk from prospective cohort studies.@*METHODS@#The PubMed, EMBASE, and Web of Science databases were searched for all records related to yogurt intake and mortality risk [all-cause or cardiovascular disease (CVD) or cancer mortality] before October 1, 2018. The Newcastle-Ottawa Quality Scale was used to estimate the quality of all eligible articles. The results of the highest and lowest categories of yogurt intake in each study were collected and the effect size was pooled using a random effects model. The dose-response analysis was calculated using the generalized least squares trend estimation model.@*RESULTS@#Eight eligible cohort studies were included in this meta-analysis. There were 235,676 participants in the 8 studies, and the number of deaths was 14,831. Compared with the lowest category, the highest category of yogurt intake was not significantly related with all-cause mortality [hazard ratio (HR)=0.93; 95% confidence interval (CI): 0.85, 1.01], CVD mortality (HR=0.92; 95% CI: 0.81, 1.03) and cancer mortality (HR=0.97; 95% CI: 0.83, 1.12). These studies were homogenous, since the homogeneity test showed that I was 28.7%, 15.1% and 11.8%, respectively. However, yogurt intake ⩾200 g/d was significantly associated with a lower all-cause mortality (HR=0.88; 95% CI: 0.80, 0.96) and CVD mortality (HR=0.87; 95% CI: 0.77, 0.99) in the subgroup analysis. The dose-response analysis showed that yogurt intake of 200 g/d was inversely associated with all-cause mortality (P=0.041, HR=0.95, 95% CI: 0.92, 1.00) and CVD mortality (P=0.009, HR=0.92, 95% CI: 0.86, 0.98), and all of which were linear relationship (P>0.05).@*CONCLUSIONS@#This review provided the evidence regarding yogurt intake can reduce all-cause and CVD mortality. Although some positive findings were identified, more high-quality cohort studies and randomized controlled trials are warranted on a possible protective effect of yoghurt on health.
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Objective To analyze the status of information release and the ability to identify public needs for hypertension prevention and control information in Shanxi and Hebei areas. Methods A systematic data collection method was used to obtain various information about hypertension prevention and control published in Shanxi and Hebei provinces. Based on the Delphi method, sensitive and evaluation indicators for the tertiary prevention of hypertension were determined. To evaluate the degree to which public needs were met in the two areas, the authority, timeliness, continuity, systematicness, and credibility of identifying public needs were calculated. Results The release of information on hypertension prevention and control in Shanxi and Hebei lagged behind that in World Health Organization (WHO) for 2 and 27 years, respectively, and this was mainly carried out by research institutes, with no response from professional associations and government agencies. Information on primary and secondary prevention was first released in 1980 in Shanxi province, while primary prevention information was first released in 2005 in Hebei province. Regarding hypertension prevention and treatment, Shanxi province could meet 6.11% of the public need, and Hebei province could meet 3.57% of it. The five dimensions of authority, timeliness, continuity, systematicness, and credibility of identifying the public need were 11.34%, 25.29%, 0, 50.31%, and 0 in Shanxi province, and 6.86%, 14.54%, 0, 50.00%, and 0 in Hebei province, respectively. Conclusions The ability to identify the public need for information on hypertension prevention and control in Shanxi and Hebei provinces is relatively low. Relevant departments should take measures to enhance the two‐way communication of information and improve the public's knowledge and participation.
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Objective Measure the variation trend and the problems of bed allocation and its equity at primary medical institutions and provide theoretical basis for optimizing the policy of health resources allocation for the government.Methods Analysis of the distribution and equity of the inpatient beds at primary medical institutions in terms of geographical area by means of the survey of regular overall statistics forms and the methods of Gini coefficient and Theil index.Results From 2009 to 2012,the number increase of beds at such institutions geographically was 7.72%,while that in eastern,central and western regions of China were respectively 5.35%, 3.97% and 27.88%.The number increase at community healthcare centers was 46.58%,while that in eastern,central and western regions of the country were respectively 18.09%,29.57%和 81.53%.The number increase at township hospitals was 2.33%,while that in eastern,central and western regions were respectively - 3.83%,- 0.43% and 22%.The Gini coefficient of bed allocation at such institutions was beyond 0.6,while that in eastern, central and western regions were respectively under 0.3,0.3-0.4 and 0.6 above.The Gini coefficient of bed allocation at community healthcare centers fell from above 0.4 to under 0.4.The Gini coefficient in the western regions increased from 0.3-0.4 to over 0.4.The variation trend of township hospitals was similar with the overall conditions at such institutions.The intra-regional Theil indexes and their contribution rates of bed allocation at such institutions were higher than those of inter-regional. Conclusions The overall variation trend of bed allocation at such institutions was on the rise,yet its variation trend of equity remains unchanged.The bed allocation and its equity at such institutions were higher than those at township hospitals.The growth rate in western regions was the highest,but the absolute number was the lowest.Moreover,the equity of bed allocation in such regions was not only the lowest,but also was found rising.The influence of bed allocation in intra-region terms was large,while its equity was not only lower but falling as well.
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Objective: To examine the influencing factors of the efficiency of county-level centers for disease control and prevention ( CDCs) in China. Methods:458 county-level CDCs were selected based on a systematic sam-pling method. Multilevel modeling was used to analyze the region-level and institution-level influencing factors affect-ing the efficiency of CDCs. Results: It was found that the region ( province) is associated with the efficiency of a CDC. The region-level factor of population density exhibited a significant influence, while the institution-level factors such as the proportion of health technicians, service income and CDC laboratories per capita also had an influence on overall efficiency. Conclusions: Both the region-level and institution-level determinants influence efficiency. Multi-level modeling can help researchers gain a comprehensive understanding of the influencing factors that affect the CDC efficiency.
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Objective:To analyze the effects of essential medicine system on revenue structures at primary med-ical institutions. Methods:Data on revenue status and structures from 58 township health centers in Shanxi Province was collected to analyze changes and trends. Results:Along with growing government investments in primary medical institutions, the essential medicine system has fundamentally realized full coverage. The percentage of essential medi-cine revenue to pharmaceutical revenue rose from 20 . 45% in 2009 to 97 . 03% in 2013 , though the percentage of pharmaceutical revenue to total revenue dropped by 18 . 43%. The percentage of fiscal subsidy revenue in total reve-nue rose from 25 . 77% in 2009 to 54 . 16% in 2013 , though the percentage of business revenue to total revenue dropped in general. Conclusions:The essential medicine system requires the government’s financial support. Essen-tial medicine lists and primary financial aid policies should be further improved;doctor reimbursement and incentive mechanisms should be improved as well and unreasonable doctor service pricing and reimbursement mechanisms should be reformed.
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OBJECTIVE:To provide reference for the further implementation of national essential medicine system of township hospitals. METHODS:5% township hospitals in a province were collected as sample by using random cluster sampling method, and statistics,comparison and evaluation was made by issuing questionnaires to get health resources distribution status,health ser-vice status and income and expenditure status before(in 2009 and 2010)and after(from 2011 to 2013)the implementation of na-tional essential medicine system of township hospitals. RESULTS:Totally 46 township hospitals were surveyed and totally 46 ques-tionnaires of township hospitals were recycled. Average number of beds in township hospitals increased from 15.1 beds in 2009 to 19.4 beds in 2013. Average annual outpatients increased from 11 200 in 2009 to 16 100 in 2013,and average number of hospital discharge increased from 644 in 2009 to 924 in 2013. The proportion of government financing to total income increased from 25.9% in 2009 to 47.1% in 2013,proportion of drug income to the total income decreased from 54.9% to 29.7%,drug profit rate decreased from 25.5% to 3.7%,and proportion of township hospital under deficit decreased from 17.4% to 4.3%. Average time that residents see a doctor in township health center increased from 0.47 in 2009 to 0.74 in 2013,and cost of average hospitaliza-tion and outpatient drugs decreased from 805 to 718 and 28.1 to 24.1,respectively. CONCLUSIONS:The implementation of nation-al essential medicine system has no negative effect on outpatient service,but first inhibits then promotes the inpatient services. Na-tional essential medicine system has effectively cut down the financial burden of drugs,but it has no effect on total health burden. It is difficult to realize the excessive rapid rise of health ex-pense by the single implementation of essential medicine sys-tem,and it needs comprehensive reform,collaboration and in-teraction of medicine and health to effectively relieve the prob-lem of“expensive ill”.
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Given limited health sources, how to make DRGs [Diagnosis Related Groups] more feasible is a big question in developing countries. This study contributes to the debate on how to bridge the pay-for-service and DRGs during the transitional period of payment reform. From 2008 to 2012, 20740 patients with cirrhosis or duodenal ulcer disease were chosen as sample. Using multiple linear regression analysis, the interrelationships between the total medical expenses of the inpatients, and age, gender of the inpatients, length of stay [LOS], region and economic level of the hospitals were examined. The main findings were 1] length of stay [LOS] and the economic level of treatment location had a statistically significant impact on patients with cirrhosis or duodenal ulcer disease. Meanwhile gender is not a significant factor for both of them. 2] Under the premise of limited resources, developing countries should first narrow down to screen for common and frequently occurring diseases, then study the key factors which affect the treatment cost of the diseases. Based on picking out common diseases and their key factors, Simplification of the DRGs setting process will greatly increase the efficiency of implementing DRGs in the developing world
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This article aims to introduce, compare and analyze the design and development of Critical Illness Insurance systems in different parts of China under different social and economic conditions, to explain their characteristics and similarities. It may provide references to other countries, especially developing countries, to solve the problem of high medical costs. According to the methods in Comparative Economics, 3 areas [Taicang in Jiangsu, Zhanjiang in Guangdong, Xunyi in Shanxi] which are in high, medium and low socio-economic condition respectively were chosen in China. Their critical illness insurance systems were analyzed in the study. Each system shares several common points, including coordinating urban and rural medical insurance fund, financing from the basic medical insurance surplus, and exploring payment reform and so on. But in the way of management, Taicang and Zhanjiang cooperate with commercial insurance agencies, but Xunyi chooses autonomous management by government. In Xunyi, multi-channel financing is relatively more dispersed, while funds of Taicang and Zhanjiang are mainly from the basic medical insurance surplus. The specific method of payment is different among these three areas. Because of the differences in economic development, population structure, and sources of funds, each area took their own mode on health policy orientation, financing, payment, coverage, and fund management to design their Critical Illness Insurance systems. This might provide references to other areas in China and other developing countries in the world
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Performance appraisal is an important means for keeping hospitals on correct tracks for their medical services and their public interest nature,in addition to its importance in enhancing internal performance management within public hospitals.Since 2006,Shanghai Shenkang Hospital Development conducted performance appraisal for directors of 23 public hospitals in Shanghai.This paper highlights the importance of performance appraisal for these directors,and its significance in keeping the correct director of hospital operation.
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Objective Studies of the positioning,framework and weight of the performance of directors of third-grade public hospitals will pave the way for launching a study of the performance of these directors,and for the performance appraisal of the directors of third grade public hospitals.Methods The following methods are called into play:Meta-analysis of literature to summarize the research outcomes of the appraisal thinking and modeling for managers of public hospitals;the balance score card to design the theoretical base of public hospital performance framework;the Delphi Method to identify the functionality expected of public hospitals,and the thinking and framework for performance appraisal;in addition to experts consultancy to demonstrate via questionnaires.Results Positioning of directors performance appraisal of third-grade public hospitals comprises both desirable social effect outcomes and desirable operating status.This performance appraisal consists of such five dimensions as social satisfaction,effective management,asset operation,development sustainability,and employee recognition,totaling 12 performance objectives.Conclusion Scientific and reasonable design of the framework and weight of the perfofinance appraisal for managers of public hospitals is conducive to assuring the public interest nature for public hospitals.
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In light of the scientific procedure of policy making and based on the logical deduction of direct and indirect factors related to the chaotic drug market, the authors found the root of the chaos, viz. The mechanism of reimbursement ofr medical institutions that formed a vicious circle. Inview of the root, a policy model was developed and verified, viz. The optimal utilization of medical resources. The prerequisite condition to the implementation and success of the policy is the exertion of concerted efforts by various departments concerned underthe centralized leadership of the government. And it has been proven by experience that to tackle the chaos of the drug market it is necessary to start with medical institutions and the logical order of the steps to be taken to carry out the policy is as follows: control of the total drug expenses, gradual control of the gross profit from drugs, extrication of medical institutions from their dependence on drugs, improvement of the management of the frug market,perfection of the "rules of game" of the market, and development of key techniques for each procedure. Evaluation of the results of the implementation of the policy indicates that the policy is scientific, rational and easy to operate and the steps are feasible.
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In light of the scientific procedure of policy making and based on the logical deduction of direct and indirect factors related to the chaotic drug market, the authors found the root of the chaos, viz. The mechanism of reimbursement for medical institutions that formed a vicious circle. In view of the root, a policy model was developed and verified, viz. The optimal utilization of medical resources. The prerequisite condition to the implementation and success of the policy is the exertion of concerted efforts by various departments concerned under the centralized leadership of the government. And it has been proven by experience that to tackle the chaos of the drug market it is necessary to start with medical institutions and the logical order of the steps to be taken to carry out the policy is as follows: control of the total drug expenses, gradual control of the gross profit from drugs, extrication of medical institutions from their dependence on drugs, improvement of the management of the drug market, perfection of the “rules of game” of the market, and development of key techniques for each procedure. Evaluation of the results of the implementation of the policy indicates that the policy is scientific, rational and easy to operate and the steps are feasible.
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The paper describes the short and medium term (within 2 to 5 years) priorities that any region in China right now faces in working out and implementing its regional health planning, viz. the coordinated development strategy of medicine and health, medical security and social economy. The authors hold that to achieve the coordinated growth of the health cause and society, it is imperative to overcome in the short run logically related obstacles in four aspects: ineffective solution to the apparent problems followed with interest by both the social and health sectors and lack of effective operating conditions accompanying medical insurance reform, both resulting in the lack of a driving force in the reform within hospitals; difficulty in achieving breakthroughts in the development of the health cause; and the probability of a regional health planning becoming a mere formality because of the above factors. In addition, the fact that reform of medical and health institutions in their setup and ownership of property rights lags behind macroscopic social economic reform obscures the explanation of and solution to the above problems. Based on the research results, the paper sets forth the priorities in short and medium term planning.
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The paper argues that if the policy of separating pharmacy from medicine is to be implemented in China in the current situation, medical institutions will appear to be the direct interest losers while the broad masses of drug consumers (or payers) will be the eventual interest losers. In other words, consumers (or payers) will have to cover the costs entailed in separating pharmacy from medicine whereas the channels for drug circulation(wholesalers and retailers) and the drug producers will benefit from the policy. The government will be faced not only with the pressure of either raising the level of charges for medical services or increasing compensations for medical institutions, but also the dilemma of whether to stunt the development of medical institutions or to allow the abnormal growth of medical expenses. Besides, it will be confronted with moral accusations of supporting the channels for drug circulation at the expense of the interests of medical institutions and consumers and increased government input. These problems have already emerged in an embryonic form in the cunent implementation of the policy of "progressive separation of pharmacy and medicine" by the drug administration agencies. The ideal state for adopting the policy of separating pharmacy from medicine would be the overall reduction of drug prices by 26% to 30%, the turnover of the drug gross profit valued at 46.9 to 54.7 billion yuan into the scope for readjusting the level of charges for medical services, and a yearly readjustment in future of the level of charges for medical services according to the price index.
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Proceeding from the problems confronting hospitals, the paper first offers an analysis of the relationship between the coordination of the "three reforms" and the reform of the management system of public hospitals and then provides some views on the steps for the coordination of the "three reforms" including the reform of the management system of public hospitals, the breakthrough point of the issue in particular. The author holds that the breakthrough point of the coordination lies in reforming the mode of payment and the compensation mechanism of hospitals. The current method of payment by service items ought to be changed into the mode of total quantity control and payment by the amount of service so as to form a policy and operational environment wherein hospitals will seek substantial development on their own initiative. Under such an environment, hospitals can achieve maximum benefits only by minimizing the costs and the primary goals of the coordination of the "three reforms" can thus expect to be attained. On the basis of this, relevant models for the reform of the management system of public hospitals can be promoted. system; Public; Reform