Methods:To describe the connotation and construction mechanism of integrated medical service system.Methods:Based on the data of hierarchy diagnosis situation in China Statistical Yearbook from 2005 to 2015,the traditional medical service system and integrated medical service system were compared from the objective,method and core,while the construction mechanism of integrated medical service system was analyzed from the lead,control,supervision and adjustment.Results:Under the background of Health China,integrate medical system based on the purpose of health community,the method of division and cooperation and the core of cost management was different from the traditional medical service system which based on the aim of medical service,the method of competition and split and the core of ‘business of water'.Hierarchy diagnosis was the appearance/mehod of regional integrated diagnosis and the result from medial resource optimized allocation under the integrated medical service system.Constructing the integrated medical service system was the basic demand of medicine and health system reform.Conclusion:Constructing the integrated medical service system should be led by the performance appraisal of medical institutions,controlled by the cost accounting and adjusted by medical service prices,so that to make the benefits for the demander,the provider and the third party of medical service system to construct and share the health community.

Objective:To analyze the impacts of volume-based procurement(VBP) of artificial joints on the hospital costs for discharged patients who underwent total hip arthroplasty.Methods:The discharge data of 515 total hip replacement patients at a tertiary public hospital in Baise city was collected, comprising 353 cases pre-VBP (January 2021 to March 2022) and 162 cases post-VBP (April to October 2022). Data was analyzed using interrupted time series method. Between October to December 2022 and July to August 2023, one-to-one unstructured qualitative interviews were conducted with the director, doctors, and nurses of the orthopedic department, as well as staffs of the medical equipment department and the health insurance office. The aim was to gather insights about the implementation details of the VBP policy for artificial joint implants, VBP policy's impact on hospitalization costs and its underlying causes.Results:After the implementation of the VBP for artificial joint implants, the hospitalization expenses of surgical patients immediately dropped by 22 566 yuan ( P<0.001), but the change in the slope of the long-term trend was not statistically significant ( P=0.430). From the perspective of cost structure, the cost of disposable surgical materials decreased immediately by 26 889 yuan ( P<0.001), with a long-term trend slope change of -515 yuan per month ( P<0.001). Meanwhile, there were varying degrees of immediate increases in surgical treatment costs, non-surgical item treatment costs, and non-surgical disposable medical material costs ( P<0.05). Specifically, the long-term trend slope for surgical treatment costs and non-surgical disposable medical material costs decreased by -637 yuan per month and -372 yuan per month, respectively ( P<0.001). However, the long-term trend slope of non-surgical item treatment costs did not show statistical significance ( P=0.196). The out-of-pocket expenses immediately decreased by 7 195 yuan ( P<0.001), but the change in the slope of the long-term trend was not statistically significant ( P=0.550). The interview results showed that there were not much overall changes found in the use and surgeries of artificial joints after centralized procurement, but there were delivery delays, and the changes in some cost indicators of hospitalization expenses were also related to the reform of diagnosis related groups payment methods. Conclusions:The implementation of VBP effectively reduced the hospitalization cost for total hip arthroplasty patients, primarily by decreasing artificial joint cost. In addition, it optimized the cost structure, alleviated the financial burden on patients and saved medical insurance expenditures. Future initiatives should focus on improving the medical insurance payment reform to form a policy synergy, creating a cohesive policy framework that enhances the effectiveness of VBP policy, thereby facilitating the high-quality development of public hospitals and medical services.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective To evaluate the equity of health human resources allocation in traditional Chinese(TCM)hospitals from 2012 to 2021,and forecast the number of various health technicians,so as to provide theoretical basis for the reasonable allocation of health human resources of TCM health service.Methods The data of health personnel in TCM hospitals were collected,and Theil index and clustering degree were used to analyze the equity of health human resource allocation.The grey GM(1,1)model was used to predict the demand of health personnel in TCM hospitals.Results From 2012 to 2021,the health human resources of TCM hospitals in China showed an overall growth trend.According to the analysis of Theil index in each region,the contribution rate of Theil index showed that the difference between regions was the main factor causing the difference in personnel allocation.The concentration degree of TCM hospitals in terms of geographical allocation was eastern region,central region and western region,respectively.Conclusion The expansion of high-quality medical resources and the rational allocation of TCM resources should be promoted.Clear target responsibility,promote fine management,improve the fairness of medical personnel allocation;Based on traditional advantages,broaden training ideas,and effectively build a multi-dimensional training system for TCM talents.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.