Objective:To analyze the characteristics of health financing at the provincial level according to the total health expenditure since China health system reform began in 2009 and provide evidence for improving health fi-nancing policy. Methods:20 provinces were chosen and vertical and horizontal Comparative approach was used to an-alyze the data. Results:Total health expenditure increased for all regions, of which the biggest rate was Anhui prov-ince, about 82. 97%, while the largest increasing for government health care expenditure was Ningxia province, a-bout 108 . 71%. In 2012 , the provinces with social health expenditure share of total above 40% were allocated in the east region, and the number of provinces with out-of pocket payment share of total above 40% reduces to 5. Conclu-sion:Total health expenditure grew in all regions, but there were differences in the degree that this spending matched the economic level;The financing structure was optimized, but the characteristic of regional financing was different. Some provinces were under huge pressure to reduce out-of pocket payments. Suggestions: Under the premise of im-proving the funding level, financing structure adjustment must be focused, and public funding should play a bigger role and out-of pocket payments should be reduced.

Objective:It aims to investigate the impact of tobacco use on Catastrophic Health Expenditure(CHE),providing a ba-sis for government investment in tobacco control and the formulation of effective anti-smoking policies.Methods:Based on the 2018 National Health Service Survey data from Shandong Province,the incidence rate,average overshoot gap,and relative overshoot gap of CHE under different thresholds for different household were calculated to analyze the distribution of tobacco-related diseases for smoking households.Results:In 2018,the overall incidence rate of CHE for current smoking households in Shandong Province was 13.56%(at a 40%threshold),with average overshoot gap and relative overshoot gap of 4.61%and 34.02%,respectively.As income levels decreased,the overall incidence rate of CHE increased.Rural current smoking households had higher overall incidence rates of CHE,average overshoot gap,and relative overshoot gap than urban households.Smoking households that experienced CHE were pri-marily afflicted with chronic diseases.Conclusion:The CHE risk is significantly higher in smoking households,particularly in rural and low-income households.It is recommend implementing a diverse range of promotional methods to strengthen anti-smoking health education,with a specific focus on intensifying awareness of the dangers of tobacco use in rural areas.Additionally,it is suggested to further increase tobacco taxes so as to reduce the motivation for smoking among low-income populations.

The reform on the outpatient coordination of Employee Medical Insurance is very important in the field of medical secu-rity.It sorts out the design of outpatient treatment in areas where general outpatient coordination has been carried out before the na-tional reform of outpatient security launched in 2021,summarizes the institutional design and main characteristics of"two lines and one ratio",and provides a decision-making basis for further promoting the reform of total outpatient security in various regions.

Objective:To investigate the overall clinical performance of nursing students and analyze its influencing factors to provide evidence for the improvement.Methods:A questionnaire survey was carried out among 288 nursing students from Qilu Hospital of Shandong University in March to May 2020. The survey included a general data questionnaire, Holistic Clinical Assessment Tool, Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, Medical Student Safety Attitudes and Professionalism Survey of nursing students. The factors associated with overall clinical performance of nursing students were analyzed by t test, analysis of variance, Pearson correlation analysis and multiple linear regression. Results:The total score of Holistic Clinical Assessment Tool was 114.95 ± 22.91. The total score of Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale was 156.70 ± 26.98. The total score of Medical Student Safety Attitudes and Professionalism Survey was 123.65 ± 31.00. The influencing factors included social practice experience and clinical learning environment, which accounted for 28.0% of the total variation of overall clinical performance of nursing students.Conclusions:Educators and managers of nursing students' schools and internship hospitals should actively explore the educational reform practice to promote the improvement of clinical ability, so as to promote the improvement of the overall clinical ability of nursing students.

Objective:Based on"the System of Health Account 2011",it aimed to analyze the differences and causes of the medical economic burden between domestic and foreign population,and provide reference for the medical economic risk protection policies in China.Methods:Data of recurrent health expenditure of China and OECD member states were collected and descriptive statistical analysis was used to explore the relationship between the population's economic burden of medical treatment and medical security system and health service system.Results:In 2020,the average proportion of personal health expenditure in household con-sumption expenditure in OECD member countries was 3%,and the proportion in China was 5.24%.In China,public financing ac-counted for 54.81%of recurrent health expenses,which was lower than the average of OECD member states.Personal health expendi-ture of OECD member states was mainly spent on medical supplies and outpatient services,and China's personal health expenditure was mainly spent on outpatient services and inpatient services.Conclusion:Difference of medical security system is the important factor of the uneven medical burden.An appropriate health service delivery system is the basis to reduce the medical economic bur-den,a perfect hierarchical medical service system can guide the demand for medical service,and the collaborative chain of"pre-vention-diagnosis-control-care-rehabilitation"is fundamental to alleviate the medical economic burden.

Objective:Based on the accounting results of total health expenditure in different regions since the 18th National Congress of the Communist Party of China,to analyze the regional disparity and evolution trend of health financing level and financing structure in 2012-2022,so as to provide references for subsequent adjustment and improvement.Methods:Range,standard deviation and coefficient of variation were used to analyze the degree of absolute and relative differences of total regional health expenditure in China and the changing characteristics of regional total health expenditure differences since the New Era(2012-2022).Results:Since 2012,the total health expenditure in various regions has been increasing continuously,and the average annual growth rate of total health expenditure is higher than that of the economy in this region.The relative difference of the proportion of total health expenditure to GDP in 31 provinces has converged in the fluctuation,but the absolute difference is still very large;the relative gap and absolute gap of per capita total health expenditure are expanding;the absolute difference in the proportion of out-of-pocket payments to total health expenditure has narrowed,while the relative difference has gradually narrowed.Conclusion:There are obvious differences in the growth rate of total health expenditure in different regions,so it is suggested that"appropriate growth"and"accurate control of health expenditure"should be carried out in parallel;the regional disparity of health investment in China has not improved,especially the regional disparity of per capita investment level continues to increase,so narrowing the regional disparity is a long-term task.The gap of regional financing structure has converged,but the gap is still large.

Sound financing mechanism is an important support for the development of health system.In response to the problems exposed in the health system during the COVID-19 pandemic,OECD countries have proposed intervention directions and investment strategies to strengthen the resilience of the health system.The investment allocation in strengthening core public health capabilities,proactive material reserves,and coordinated supply from OECD countries were analyzed,in order to explore the characteristics and effectiveness,which could provide a reference for strengthening the resilience of China's health system.

Objective:Clarifying the comorbidity patterns of chronic disease and its distribution of catastrophic health expenditure in the elderly,in order to provide scientific data support for the development of chronic disease management strategies in various regions.Methods:Data were selected from China Health and Retirement Survey.Latent class model and Geoda were used to analyze the mode of chronic disease comorbidities in the elderly and the spatial distribution of catastrophic health expenditures.Results:The comorbidity pattems of chronic diseases in the elderly included circulatory and metabolic diseases,digestive disease,skeletal diseases,respiratory diseases,tumors,digestive and psychiatric diseases,and multisystem diseases.The incidence of catastrophic health expenditure with chronic disease comorbidities was 30.12％,and Moran's I value was 0.854(P＜0.05),indicating spatial autocorrelation.Qinghai,Inner Mongolia and Tianjin etc.were high-high areas,while Liaoning,Jilin and Zhejiang etc.were low-low areas.Conclusion:The occurrence of catastrophic health expenditures was characterized by sociodemographic differences and regional and comorbidity pattems of inequality.It is suggested that we should pay more attention to the management of chronic diseases,dynamically adjust the old-age chronic disease insurance policy and explore medical security system with a comorbidity model.

Based on discussing the U.S.strategies for reducing potentially preventable hospitalizations(PPHs)among elderly residents in long-term care facilities,the experiences are explored to provides insights for policy development in China.The U.S.has effectively lowered PPH rates and healthcare costs through a comprehensive long-term care service system,clinical interventions,and incentives.Analyzing the effectiveness and challenges of these measures suggests that China should conduct the reform by clarifying the roles of care institutions,strengthening incentive mechanisms,improving caregiver training,establishing evaluation systems,and enhancing data-driven decision support.It aims to develop a long-term care system tailored to China,reduce PPH rates,and improve the quality and efficiency of nursing services.

Objective:Based on"the System of Health Account 2011",it aimed to analyze the differences and causes of the medical economic burden between domestic and foreign population,and provide reference for the medical economic risk protection policies in China.Methods:Data of recurrent health expenditure of China and OECD member states were collected and descriptive statistical analysis was used to explore the relationship between the population's economic burden of medical treatment and medical security system and health service system.Results:In 2020,the average proportion of personal health expenditure in household con-sumption expenditure in OECD member countries was 3%,and the proportion in China was 5.24%.In China,public financing ac-counted for 54.81%of recurrent health expenses,which was lower than the average of OECD member states.Personal health expendi-ture of OECD member states was mainly spent on medical supplies and outpatient services,and China's personal health expenditure was mainly spent on outpatient services and inpatient services.Conclusion:Difference of medical security system is the important factor of the uneven medical burden.An appropriate health service delivery system is the basis to reduce the medical economic bur-den,a perfect hierarchical medical service system can guide the demand for medical service,and the collaborative chain of"pre-vention-diagnosis-control-care-rehabilitation"is fundamental to alleviate the medical economic burden.