Objective:To forecast the reduce of medical direct expenses of China from 2016 to 2020,under the circumstances that some outpatients and inpatients of tertiary hospitals and secondary hospitals could be distributed to primary medical institutions.Methods:According to the number of outpatients,number of inpatients,medical expenses of outpatients per visit,and medical expenses of inpatients per visit in the first grade,second grade and third grade public hospitals from 2006 to 2015,the corresponding visit numbers and costs from 2016 to 2020 were forecasted based on liner regression model.The percentages of transferable patients out of all patients in different levels of institutions could be equal to 10％,20％ and 30％.The direct medical expense could be saved after the distribution were calculated.Results:If the trend of health service utilization from 2016 to 2020 were equal to the sample,the third grade hospitals would keep the fast increasing of outpatient expenses and patients.8％,16％ and 24％ of the total expenses would be saved if 10％,20％ and 30％ patients in third and second were led to the second and first grade medical institutions.Conclusion:It needed to slowdown the increasing trend of medical expenses,lead patients visit hospitals reasonably,strengthen the construction capacity of second grade medical and health institutions,meanwhile,the medical and health service system construction should adjust the distribution ratio.

Objective:To obtain the health production efficiency performance and its changing trend of China's health system in recent years by adopting international comparison,and to provide policy recommendations to improve health production efficiency.Methods:It described the relative efficiency of health system in China by reporting the international ranking of health inputs and outputs indicators.It employed total health expenditure per capita as input indicator and health outcomes as output indicators to construct frontier health production function,China's health production function and marginal health production function based on data envelopment analysis and production function method.Results:In the past decade,compared to efficient countries with similar health development level,the efficiency performance of China's health system was between 65％ and 73％.With the increasing trend of health investment,China's marginal health output had been declined and tended to be gentle.Conclusion:The current health production efficiency in China was relatively high.However,how to improve the efficiency and marginal health output was the focus of future health system reform under the background of rapid growth of total health expenditure.

With the background of establishing a community of common health for mankind,to secure global public health safety and enhancing health status are the common concerns to all nations in the world.To develop primary health care system is the most important strategy.China has achieved remarkable progress in health system development over the past seven decades,especially in strengthening primary health care system,which have been highly appraised by international society.This paper presents synthesis of China's experiences in developing and supporting rural health security system,tiered health care delivery system and essential public health package,followed by discusses on policy implications for other settings.

Objective:To evaluate the current situation of organizational capacity and maturity of primary medical institutions(PMIs)in Beijing,and to provide a reference for improving organizational capacity and promoting sustainable development of PMIs.Methods:This study designs a self-assessment questionnaire based on the organizational capability index system established in the previous stage,and selects all PMIs in D district(urban)and S district(suburban)of Beijing as the research objects.Ten middle managers who are familiar with the operation of their organizations are selected from each organization as questionnaire respondents.A total of 295 valid questionnaires are collected and the organizational capability score and maturity of each PMIs are evaluated on the basis of verifying the reliability and validity of the questionnaires.Results:The score of organizational capability of the 33 PMIs included in this study is 4.10±0.40,and it indicates that the organizational capability of D district is higher than that of S district in all dimensions.In general,core capability in the first level indicators is the highest and development capability is the lowest.In the second level indicators,the score of prevention and control of infectious diseases capacity is the highest and the score of resource management capability is the lowest.Most of the PMIs are in the phase of basic stability and steady development.Conclusions:There are differences in the organizational capacity among PMIs in Beijing,and PMIs in developed areas are more likely to have higher organizational capacity.The PMIs in Beijing have moved out of the initial stage of development,but they should still focus on improving their resource management capability and learning capability.In addition,the PMIs should also pay attention to the cultivation of development capacity.

Objective:To analyze the impact created by the reallocation of a tertiary hospital on the neurosurgery inpatients volume in the functional core area of Beijing as the capital city, for reference to improve the healthcare resource reallocation policy.Methods:The data were obtained from the data sheet of discharged patients and the monthly report of medical statistics in Beijing. The study analyzed the average monthly neurosurgery inpatients volume, surgical beds and bed utilization rate of secondary or higher level hospitals from the core area, a tertiary hospital(hospital A), and as well as three tertiary hospitals(hospitals B, C and D)within 5 kilometers of Hospital A original location before and after the reallocation of Hospitls A. Periods of November 2017 to August 2018 and November 2018 to August 2019 respectively serve as the time frame before and after the relocation of Hospital A.Results:After the reallocation, the average monthly total inpatients volume, inpatients volume from other places, and local inpatients volume of neurosurgery at secondary or higher level hospitals in the core area decreased from 2 238, 1 610 and 628 to 1 526, 996 and 530 respectively. The inpatients volume changes were all statistically different( P<0.001). The number of neurosurgery inpatients in Hospital A and Hospital B increased from 983 and 659 to 1 316 and 934 respectively, as well as the number of neurosurgery inpatients in Hospital C and Hospital D did not change much. After the relocation of Hospital A, the number of surgical beds in secondary or higher level hospitals in the core area was reduced from 5 213 to 4 782, while that of Hospital A increased from 557 to 750, while the other three tertiary hospitals remained unchanged. The changes of bed utilization rate of the 4 hosptials were all less than 7.00%. Conclusions:After the reallocation Hospital A, the neurosurgery inpatient volume in the core area decreased, which was mainly contributed by the decrease of patients from other places, suggesting a positive outcome by the reallocation of healthcare resources in Beijing. On the other hand, it is necessary to study the influence of alternative medical resources on the reallocation effect.

This study conservatively estimates that the Chinese government invests about 267millions USD per year on health facilities aid,almost reaching the amount of Germany,and ranked fifth globally.Health facilities built by China mostly are general hospitals and health care centers located in Arica with unified model and standards,and are the "Turn Key" projects.These facilities have helped to alleviate the scarcity of medical and health resources and accessibility of residents to health services to some extent,as well as promoting the employment and the living standards of local people.However,due to the lack of guidance and coordination of the overall strategic planning and harmonization of health aid efforts,and the knowledge of partner countries' health systems,emphasis on demand driven and feasibility of infrastructure construction while ignoring the needs assessment and feasibility of functional fulfillment,it's hard to achieve the targeted assistance in China's health facilities aid projects.It was found that it's necessary to make three changes in the future:from "infrastructure assistance" to "functional assistance";from "'project assistance" to "program assistance";from a single government official assistance to a combination of official assistance and investment.

Objective:To evaluate the impact and analyze the mechanism of separating drug sales from medical services reform on the total medical expenditure containment of outpatient services in Beijing. Methods:The monitoring data and historical data from 89 third-level,78 second-level public hospitals,and 206 primary health institutions and community health service agencies,which participated in the reform,were analysed to estimate the impacts on outpa-tient service utilization and service price. The analysis was based on the data of the first and second quarters of 2016 outpatient and emergency department fee changes,and analysis of service utilization and service price factors on the im-pact of changes in outpatient and emergency services mechanism. Results:The total outpatients'expenditure in Beijing in the second quarter of 2017 was 17.38 billion yuan,representing a slight decrease of 1.14% than the expenditure in 2016. The growth rate reduced by 2.46%. Expenditure in third-level and second-level hospitals decreased by 2.82% and 3.02%,respectively,with reductions in growth rates of 4.06% and 3.74% respectively. Expenditure in primary institutions increased by 17.09%. The increase rate in the second quarter of 2017 was 26.28%,representing a remark-able increase compared to the rate in 2016(15.84%). The contribution from the medical institution service prices and service utilization to the change of outpatient and emergency medical expenditure containment was 6.98% and -7. 65%,respectively. For third-level hospitals,the contribution was 10.37% and -12.00%,respectively;second-level hospitals were 0.72% and -3.35%,respectively;and the primary health institutions was 6.08% and 9.57%. Con-clusions:Beijing's comprehensive reform of separating drug sales from medical services reform has effectively controlled the rising medical expenditure of outpatient services,mainly by adjusting outpatients service utilization between differ-ent level healthcare institutions.

Objectives:To describe and summarize international evidences on policies and programs for training health personnel in rural areas,to identify best practice to increase health manpower in rural areas, and to provide references for China's policy of targeted admission program. Methods:This is a literature review based research. 48 literatures in Chinese and English were selected about the training of health professionals in rural areas at home and a-broad. Thematic framework approach was applied to review and analyze the related strategies and practices,and les-sons learned. Results: Common measures to train health personnel in rural areas included: enrollment of students with a rural background,tutoring system in medical training,internship in rural health institutions, financial incen-tives,and compulsory rural services after graduation. Lessons learnt:(1) adequate financial resources are a prereq-uisite for smooth program implementation;(2) Good project management and evaluation are critical aspects of effec-tive project implementation;(3) choosing the right combination of various practices to implement such projects can improve effectiveness. Conclusions:The policy of targeted admission program is suitable for China's current situation. Meanwhile,international experiences can provide valuable lessons to improve China's program design and implemen-tation and these include:increasing capital investment,strengthening management and evaluation,and strengthening sector cooperation to further improve targeted admission program.

Objective:Utilizing a seven-year panel data set of a targeted admission medical student cohort,this study aims to examine their career development and provide insights for retaining healthcare talent in township health centers and village clinics in the central and western rural areas of China.Method:Starting from 2015,cohorts of targeted and general clinical graduates from four medical colleges in central and western China were selected and tracked for their career progression.Results:The targeted graduates'standardized residency training and medical licensing examination pass rates were similar to those of general clinical graduates.They advanced more quickly in professional titles and positions,with 82.5%becoming attending physicians and 16.2%obtaining positions in the seventh year after graduation.However,their monthly income was significantly lower than that of general clinical graduates,and this income discrepancy expanded annually.As of December 2022,among the 493 targeted graduates who completed their contracts,38.5%stayed in grassroots positions.Of those who left,60%moved to county-level or higher public hospitals,7.9%pursued further studies,and 27.7%were unemployed.Conclusion:Targeted graduates are well-trained and advance rapidly in their careers,but their lower income significantly impacts their willingness to remain at the grassroots level.After completing their service period,about one-third of the targeted graduates choose to stay in grassroots positions.

Objective:To understand the impact of hierarchical medical system on the medical staff at all levels of medical institutions in the pilot areas,and their cognitive status and influencing factors for hierarchical medical sys-tem,for the purpose of providing scientific reference for improving the hierarchical medical system. Methods:435 of medical staffs were selected with the help of by stratified random sampling from different levels of medical institutions from 15 pilot areas and a questionnaire survey methodology was used in this study to gather views of the medical staffs. Results:It has been revealed that after the system is implemented,there were differences in the total monthly salary,performance pay ratio,workload and the relationship between doctors and patients at different levels of medi-cal institutions. The medical staff at all levels of medical institutions had a high degree of awareness of hierarchical medical system,and the cognition rate was 81.4%. Among them,tertiary hospitals,township hospitals,community health service centers,secondary hospitals;different department categories,job titles,performance pay ratio and sal-ary changes in the medical staff have different cognition of the grading. Conclusions:To further develop the key role of medical staff in the hierarchical medical system, strengthen the attention of secondary hospitals to enhance the service capacity of primary healthcare units at the same time,reform the pay system,mobilize the enthusiasm of med-ical institutions and medical staff,and promote the development of hierarchical treatment system.