Overall enhancement of the public health system ranks a key task and goal for the ongoing health reform.This paper described the public health development in Shenzhen amid the ongoing health reform.Shenzhen has achieved the following objectives as required in the reform:better public service by public health institutions,availability of major and primary public health services as required by the state and city,overall elevation of public health service capabilities,and significant drop of disease morbidity and mortality.Challenges ahead include room of improvement in public health service network,incentive mechanism of public health service providers,and that of public health service delivery capability.

While generative artificial intelligence(AI), exemplified by ChatGPT, demonstrated impressive capabilities in understanding the semantics and context of natural language, and generating coherent and meaningful responses, its performance in the medical field, which required high-level expertise and complex reasoning, remained uncertain. This article aimed to explore the potential applications and challenges of generative AI technology, with ChatGPT as a representative example, in enhancing the capabilities of primary healthcare services. Generative AI, represented by ChatGPT, had potential applications in enhancing primary healthcare services, including clinical assistance in diagnosis, electronic medical record documentation, remote management of chronic patients, and patient education. However, limitations such as the inability to guarantee accuracy, lack of doctor-patient interaction, language barriers, and concerns related to data security, patient privacy, and ethical considerations constrained its practical implementation. Therefore, the application of ChatGPT in improving the capabilities of primary healthcare services required extensive discussion and analysis throughout society. A comprehensive evaluation of potential risks and the establishment of corresponding policies and regulations were necessary to ensure the prudent and responsible introduction and application of ChatGPT, ultimately achieving the goal of empowering primary healthcare services.

Objective To study the needs, demands and utilization levels of health services for residents in Shenzhen, and to provide a basis for the rational allocation of health resources and formulation of relevant policies. Methods Using stratified random sampling, 6 072 residents from 2 365 households in 7 districts of Shenzhen were selected. The residents’ health status, health service demand and utilization were investigated by a questionnaire survey. The questionnaire survey response rate was 98.5%, and there was no significant difference between the sample and the population in age distribution (χ²=5.60，P=0.47). Results The average score of self-health assessment was 84.9. The prevalence rate of chronic diseases was 21.1%. The two-week disease prevalence rate was 21.5%, and the doctor visit rate of the two-week disease was 19.5%. The hospitalization rate was 7.2% in the past year. The average outpatient cost was 500 yuan, and the average cost of hospitalization was 10 567 yuan. The average length of hospital stay was 7.3 days. A total of 652 (55%) patients had their first outpatient visit at the community health service centers, and 82.2% of the families were within 1 kilometer from the nearest medical institutions. Conclusion Compared with that of the national population, the overall health service needs of Shenzhen residents were relatively low, but there is a problem that the hospitalization demand has not been effectively released. The prevention and treatment of chronic diseases such as diabetes and hypertension should not be ignored, and the construction of the public health system needs to be strengthened. The "health gatekeeper" system has initially taken shape, but the residents' sense of acquisition needs to be further improved.

The United States is the country with the most pilot practices in value-based healthcare payment reform, and value-based purchasing (VBP) is one of its pilot projects. The authors introduced the basic situation and implementation effects of the pilot projects of VBP payment reform in the United States from the hospital and physician levels respectively, and analyzed the causes for their unsatisfactory implementation effects. Then, the authors proposed its enlightenments for China from such aspects as the construction of value-based medical payment index system, implementation of value-based medical payment reform, and management costs, to provide reference for the construction of high-quality value-based medical service system in China.

The pilot project for alternative payment models was originated from the implementation of the 2010 Affordable Care Act in the United States, which aimed to establish a new payment mode to replace the traditional payment based on service fees, thereby achieving the goals of ensuring healthcare quality, reducing healthcare costs, and improving healthcare equity. The pilot projects of alternative payment models included two types: accountable care organizations and bundled payments for care improvement. The authors introduced their profile and implementation effects, analyzed the causes of the current implementation effects, and then proposed enlightenments for the value-based medical payment reform in China, with the aim of providing reference for the construction of a high-quality value based medical service system in China.