Although the Shanghai's basic health insurance always takes the leading position nationwide in the aspects of coverage, funding level, security level, etc, it still cannot avoid the contradictory problems brought by the rapidly rising demand for health care, poor results of funds management, etc. Commercial health insurance has its u-nique advantages in terms of funds and personnel management. Therefore, they can play their complementary role to the basic medical insurance in order to improve the basic health insurance system. Based on the perspective of com-mercial health insurances, this paper explores the basic health insurance system in Shanghai from the aspects of man-agement patterns, governing body, insurance objects, funding modalities and insurance programs.

Objective To evaluate the knee joint function at 3-7 years after anterior cruciate ligament (ACL) reconstruction with ligament advanced reinforcement system (LARS) artificial ligament and assess the morphologic changes of LARS artificial ligament in human tissues.Methods Fifty-seven patients (58 knees) undergone ACL reconstruction with LARS artificial ligament were recruited to this multi-factor retrospective study and divided into acute injury group and chronic injury group according to time between injury and operation.LARS artificial ligament harvested from the three patients (4 knees)who had an additional surgery were observed histologically.Results Knee joint function and range of movement were significantly improved after surgery (P ＜ O.O1),however subjective and objective estimation on knee joint function presented no statistical differences between the two groups (P ＞0.05).X-ray films and MRI revealed different degree of bone tunnel progressive augmentation in average 1.5 years,indistinctive correlation of knee joint stability with bone tunnel augmentation (P ＞ 0.5) as well as no statistical difference concerning incidence of tibial and femoral bone tunnel augmentation (P ＞ 0.05).Histological observation revealed well-arranged fiber tissue growth into LARS artificial ligament as well as fibrous joint among single-beam polyester fibers as well as a bundle of polyester fibers at postoperative 2 years.Conclusions (1) LARS artificial ligament gains a satisfactory knee joint stability and function in ACL reconstruction.(2) There exists bone tunnel augmentation that tends to stability at postoperative 1.5 years,but knee joint stability is not correlated to the extent of bone tunnel augmentation after surgery.(3) Postoperative data evaluation of acute injury and chronic injury is the same.(4) Human normal fibrous tissues grow into LARS artificial ligament regularly.

Objective To observe the pathologic changes of ganglion cell and nerve plexus in internal anus sphincter of rats with congenital anorectal malformations (ARM).Methods Healthy and pregnant Wistar-Imammichi rats were induced to ARM by ethylene thiourea (ETU). There were 67 rats with ARM at all. The pelvis was continuously cut from the exactly midsagittal plane. The HE staining was performed, and the numbers of the ganglion cell and nerve plexus in the internal anus sphincter were observed under the microscope.Results The average numbers of the ganglion cell and nerve pluxes in the ARM embryos were (1.206±0.012) and (0.308±0.051). Those of the normal control embryos were (3.710±0.043) and (1.227±0.072) respectively. There was a significant difference between two groups ( P<0.05～0.01). While, those of the embryos without ARM which dealt with ETU were (3.012±0.032) and (1.187±0.004) respectively, didn't differ from the normal control embryos.Conclusion The decrease of the ganglion cell and the nerve plexus in internal anus sphincter is an important pathologic change of ARM.

There is a unification of the social pooling accounts and personal saving accounts of Urban Employees' Basic Medical Insurance ( UEBMI) in Shanghai. In recent years, the revenue and expenditure of UEBMI funds increased, and the fund balance sprouted year by year, and mostly concentrated in personal health insurance saving accounts. On the whole, the vast majority of insured personal saving accounts have balances, but the balance is not high, i. e. less than 1000 yuan accounted for 52. 3%. Judging from the age group, the personal health insur-ance saving account funds is mainly concentrated in the 30-year-old and over working population. Because of its par-ticularity, the personal health insurance saving accounts can only be invested in current deposit (bank live), time deposit and national debt, bonds and other hedge. Compared with the price index devaluation, the personal health insurance saving accounts somehow failed to give full play to the personal attributes. It is suggested to explore the use function of personal health insurance saving accounts by establishing family saving accounts-family coexistence, pur-chasing of supplementary medical insurance and so on. Simultaneously, the channels of maintaining and increasing the value of personal health insurance saving accounts could be broadened.

According to the target-model of the health care system and characteristics of the health financing system,it is proposed in the paper that the charges of medical services should be the main revenue of public hospital compensation.Efforts should be made to adjust health care service prices and strengthen pharmaceutical management simultaneously so as to rebuild the structure of medical service charge.Medical insurance should make the majority in the compensation to cover most the medical expenses,with government subsidies supporting development.Both government financial investment and medical insurance should join their efforts for planning-guidance and performance-guidance.The authors also suggested to improve a graded and normative diagnoses and treatment system,regulate medical behaviors of public hospitals and their cost standards,justifying the total compensation and standard verification of such hospitals.

Objective: To study the relationship between Framingham risk score for coronary artery disease (CAD) and cognitive function in healthy community elders.
Methods: A total of 276 healthy community elders were evaluated by Framingham score to predict the risk for suffering from CAD in 10 years. The subjects were divided into 3 groups. High risk group (the risk > 20%), n=46, Mid risk group (the risk at 10%-20%), n=76 and Low risk group (the risk < 10%), n=154. The cognitive function was measured by mini-mental state examination (MMSE) and China adult intelligence scale (CISA). The differences of cognitive function levels to 3 CAD risk groups were studied.
Results: With the increased CAD incidence from Low risk, Mid risk to High risk groups, the MMSE score reduced accordingly (26.9 ± 1.45) vs (24.3 ± 1.53) vs (22.2 ± 1.43), P=0.014. Pearson analysis presented that MMSE score was negatively related to Framingham risk score (r=-0.213, P<0.001). There were several elements of cognitive function related to Framingham risk score including MMSE score, question answering, grid filling, oral arithmetic and word distinguishing (r=-0.247), (r=-0.167), (r=-0.132), (r=-0.152) and (r-0.256), all P<0.05.
Conclusion: CAD risk level was negatively related to cognitive function, the higher Framingham risk score resulted in the lower cognitive function in healthy community elder subjects.

Premium healthcare is the key area of healthcare industry and private medical institutions. Howev-er, with the expansion of VIP services in public hospitals and policy barriers to private medical institutions, the de-velopment of premium healthcare in China is still in its early stage. The premium healthcare industry has in fact be-gun to take shape in some developed countries, accumulating rich experience in the aspects of developing bases, op-erating modes and security systems. Therefore, this paper introduces the experiences of premium healthcare develop-ment in several countries:the United Kingdom, the United States, Germany, Singapore, Australia, and India: the building of safety net hospitals;the setting of hierarchical pricing and differential financial assistance;the use of pub-lic-private partnership based on commercial health insurance to determine prioritization. Based on the actual situation in China, this paper provides some implications to develop premium healthcare, including the implementation of dif-ferential payment policies built on the provision of basic healthcare services, the promotion of commercial health in-surance and public-private partnerships, and the determination of preferential areas.

Premium healthcare is one of the major components of private healthcare, a key part of the health service industry, and one of the significant areas of the Thirteenth Five-Year Plan of health. However, there is no clear definition of premium healthcare that is widely accepted based on a Chinese literature review, and to define the concept of premium healthcare is the basis and premise for research. This paper adopted the methods of systematic re-view, field investigation and key person interviews to clarify the definition of premium healthcare and the results sug-gested that areas of health management, medical care for the elderly, mobile medical care, and so on should be the priorities of premium healthcare development.