Objective: This paper aims to evaluate the poverty impact incurred by out-of-pocket payment (OOP) on rural residents in the selected remote minority-inhabited areas in western China both in 2011 and 2014. Methods: Under China's national poverty line, poverty headcount ratio and poverty gap were estimated from two rounds of household survey in 2011 and 2014, respectively. The Pan's Parade was also pictured. Results: In 2011, the poverty headcount ratios before and after the OOP were 31.07% and 51.70%;and the poverty impact was 20.63%. The impact of average poverty gap and mean positive poverty gap was 284.24 Yuan and 183.73 Yuan, respectively. In 2014, the poverty headcount ratios before and after the OOP were 29.40% and 44.66%;and the poverty impact was 15.26%. The impact of average poverty gap and mean positive poverty gap was 242.68 Yuan and 240.41 Yuan, respectively. Conclusion: Poverty headcount ratio and average poverty gap were reduced in the area of interest within the current study, but the mean positive poverty gap was increased. New rural cooperative medical scheme needs to be further adjusted for improving the insured individual's benefits. Low-income group should be paid more attention to eliminate impoverishment incurred by OOP.

Objective To establish an influencing factors system for the implementation effect of the vertical integration of services between the hospitals and community health service institutions.Methods Primary data related to influencing indicators were collected by literature review,questionnaire method and in-depth interview,and then the analytic hierarchy process (AHP) and Delphi method were used for the construction of final influencing factors indicator system.Results An influencing factors indicator system which coincides with the status of the vertical integration between hospitals and community health service institutions in Nanjing,Wuhan and Zhenjiang was established,including 4 firstlevel indicators,10 second-level indicators and 36 third-level indicators.Conclusion This study can provide a basis for hospitals and community health centers to improve the integration service system,and fill the gap of research on the influencing factors of the vertical integration of the domestic health care system,which are meaningful for the vertical integration of health care system in other districts and patterns.

Objective: In order to better understand the influencing factors of vertical rural health services integration and put forward policy suggestions for its sustainable development.Methods: 288 residents were investigated through questionnaire survey in three sample areas of Jiangsu province in August 2015.Results: In this study, 4 common factors have been found, namely organizational management, incentive mechanism, policy and supporting measures, as well as information sharing and business communication.The overall scores given by health managers, doctors and nurses, and public healthcare professionals were 0.03, 0.04 and-0.02 respectively.Conclusions: Therefore, in order to succeed, it is very necessary to introduce targeted supporting policies, establish a mutual communication mechanism, and make an effective incentive mechanism.

ObjectiveTo understand the urban preference for outpatient pre-registration in large hospitals,and probe into the influencing factors,for recommendations to improve outpatient preregistration at the hospitals.Methods With Nanjing City as an example,the authors used tailoreddesigned questionnaire and qualitative interviews to investigate the preference of 1200 households of local residents regarding outpatient clinical pre-registration service at the tertiary hospitals.Results Age,education and economic factors are found to be the most important influential ones for urban preference in their outpatient pre-registration at large hospitals.Other factors include traditional approaches to outpatient clinic,inconvenience for outpatient pre-registration,and concerns for appointment breaking.Conclusion in order to increase their preference for outpatient pre-registration at large hospitals,hospitals should work to explore and improve approaches for outpatient pre-registration,and better their service quality,which will involve greater participation of both the hospital staff and residents.

Objective To provide reference for focusing and improving policy efficiency in China by establishing the conceptual model and index system of effectiveness of Township and Village Health Services Integration Policy(TVI).Methods The conceptual model and index system of TVI effectiveness were established by literature review and Delphi method.Comprehensive Index Method and Weighted TOPSIS Method were used in index consistency check.Results The conceptual model and index system of TVI effectiveness contain four conceptual modules,8 policy goals and 27 evaluation indexes.The positive coefficient of experts is 0.95 and authoritative grades of experts are more than 0.90.Conclusion Based on SPO Model,the conceptual model and index system of TVI effectiveness in China have been established,which consists three aspects:construction of organization system,health services and satisfaction.

Objective:To analyze the perception and evaluation of rural patients with hypertension and diabetes on the health management services , thereby identifying the problems and proposing countermeasures .Methods:570 rural patients with hypertension and diabetes were investigated by the stratified random sampling method .Descriptive statistic method and logistic regression analysis were applied to analyze the rural patients'perception and evaluation on the health management services .Results: The majority of rural patients with chronic diseases such as hypertension and diabetes were alerted of the health management service .The satisfaction rate on the disease control effect was 82.28%, and that among patients below the age of 60 years old was lower than that of the others ( P <0.05 ) . 77 .24%of patients deemed that some services such as on-site visit , physical examination and prevention of complica-tions were deficient (the selection rates among patients were 11.90%, 10.41% and 9.29% respectively).The health management services problems mainly included deficiency of on-site visits, incomplete medical equipments and service items ( the selection rates among patients were 16.36%, 9.29%and 8.92%respectively ) .Conclusions:In order to improve the quality and positive effect of health management for patients with hypertension and diabetes , the collaborative mechanism between township institutions should be developed , the government should increase invest-ment in rural public health , strengthen the rural heath personnel brainstorming , and on-site visits and debates on health should be reasonably arranged according to the needs of rural patients , and the quality and effectiveness of the management of hypertension and diabetes together with other chronic diseases should be improved .

During the process of China’s healthcare reform, the concept of “costly access to health care” has been discussed for quite a long time. However, big data indicates that a small number of patients (5%) account for disproportionate costs ( approximately 50%) . “Costly access to health care” may not be a ubiquitous perceived prob-lem for all residents. In this paper, the concept“high-need patient” will be introduced and the characteristics of the population will be analyzed. According to the healthcare reform experience from the international perspective, this paper proposed healthcare strategy for Chinese high-need patients and policy recommendations for China’s healthcare reform.

Objective To analyze the importance and necessity of patient public education, and to explore its contents and approaches. Methods From September to October 2017, 2224 medical workers and patients from 9 tertiary public hospitals among southern, central and northern Jiangsu province were surveyed with the self-designed questionnaire. Demographic data of respondents and their views related to patient public education topics were surveyed. Descriptive analysis and chi-square test were used to analyze the data. Results Some patients were irrational in their cognition of patients′ obligations, risk of disease, expectation of curative effect, and responsibility for medical malpractice. 19. 9％ of them held that"patients were vulnerable groups who should not carry much obligations". Some of them were found with obvious negative emotions and unhealthy psychological characteristics. 54. 4％ of the medical workers held that"psychological conflicts among the various roles of patients lead to various behavioral contradictions", which obviously affected their medical work. Conclusions Patient public education can be an important approach to avoid irrationality of patients when they see doctors. Patient public education is an education activity against irrational cognition, psychology and behavior of the patients at large. It requires an orchestrated effort by the governments, schools, hospitals among other stakeholders.

Objective:To analyze the influencing factors of patient loyalty in internet diagnosis and treatment, for references for improving the service quality and promoting the sustainable development of internet diagnosis and treatment.Methods:In November 2023, a simple random sampling method was used to select patients who had received internet diagnosis and treatment as the survey objects and conduct a questionnaire survey on performance expectations, effort expectations, social influence, promotion conditions, price values, patient trust and patient loyalty. By establishing an unified theory of acceptance and use of technology model of influencing factors of patient loyalty in internet diagnosis and treatment, the hypotheses were put forward. The structural equation model (SEM) test and mediation effect test were used to verify the hypothesis path and variable mediation effect, and explore the influencing factors of internet patient loyalty.Results:A total of 1 800 patients were included in this study, including 1 188 patients(66.0%) who received internet diagnosis and treatment≥3 times/month. According to the SEA test, performance expectations ( β=0.296, P<0.001), social influence ( β=0.146, P=0.014), promotion conditions ( β=0.366, P<0.001), price values ( β=0.452, P=0.017), and patient trust ( β=0.459, P<0.001) had a direct positive impact on patient loyalty; Social influence ( β=0.147, P<0.001) and promotion conditions ( β=0.084, P<0.001) had a direct positive impact on patient trust. According to the mediation effect test, patient trust partially mediated the relationship between social influence and patient loyalty ( β=0.071, P=0.018), as well as the relationship between promoting conditions and patient loyalty ( β=0.748, P=0.041). Conclusions:Performance expectations, social influence, promotion conditions, price values, and patient trust had a positive impact on patient loyalty, among which social influence and promotion conditions could enhance patient loyalty by strengthening patient trust. It was suggested that relevant institutions should focus on the service quality of internet diagnosis and treatment, further improve performance expectations, expand social impact, improve promotion conditions and regulate price values, so as to enhance the patient loyalty, promote the wide application and rapid development of internet diagnosis and treatment.

Objective:To investigate the current situation and analyze the influencing factors of job satisfaction of infectious disease physicians in Jiangsu Province.Methods:From April to May 2021, a stratified random sampling method was used to select 10 municipal level infectious disease hospitals in Jiangsu province. An electronic questionnaire survey was conducted on the infectious disease physicians of these hospitals using an online questionnaire platform. The questionnaire mainly included the job satisfaction scale developed by Greenhaus and Wormley, and a self-designed job satisfaction influencing factor scale based on resource conservation theory. At the same time, semi-structured interviews were made with relevant insiders on such issues as salary and benefits, and career development among others. Descriptive analysis was conducted on the questionnaire data, while single factor analysis and multiple linear regression analysis were used to identify the factors that affect their job satisfaction, and the results of the interviews were studied with Colaizzi 7-step analysis.Results:A total of 457 valid questionnaires were recovered. The job satisfaction score of infectious disease physicians was (3.38±0.76). The results of univariate analysis showed significant differences in job satisfaction scores among infectious disease physicians of different ages, educational backgrounds, professional titles, and positions. The results of multiple linear regression analysis showed that salary and benefits ( B=0.141, P<0.001), work environment ( B=0.128, P<0.001), leadership support ( B=0.112, P=0.014), development security ( B=0.117, P<0.001), self-efficacy ( B=0.084, P=0.045) and social support ( B=0.285, P<0.001) were both influencing factors of their job satisfaction. The interview results identified such problems as low salary, insufficient salary security, large gap in social security levels between in-staff and off-staff physicians, and insufficient career development potential. Conclusions:The job satisfaction of infectious disease physicians in Jiangsu Province was found at an average level. It is recommended that the government increase the investment in personnel expenses for infectious disease physicians, optimize the salary and benefits structure, pay attention to the career development needs of middle-aged and young physicians, and care about the social relationship needs of infectious disease physicians to improve their job satisfaction.