Objective:This study aims at exploring the impact of the health resources allocation on healthcare seeking behavior of inpatients with different income in China. Methods:Data at individual level were collected from China National Health Service Surveys conducted in 2008 and 2013 , interlinked with the data of health resources in county level. Multilevel zero-inflated negative binomial regression and multilevel multinomial logit model were respec-tively used to examine the impact of the health resources allocation on inpatient visits and the influence of the choice of healthcare providers by inpatients. Results: The results show that the increase of the number of beds in primary health centers ( PHCs) and physicians in county hospitals increased inpatient visits within counties. The investments in health resources in PHCs had greater impact on improving the likelihood of inpatient visits within counties for the low-income populations than that for the high-income populations. Conclusion: Investments in health resources in PHCs are vital to improve the healthcare seeking behaviors of the low-income populations in China.

Objective To explore a new training method of nursing skills under 24 hours shift system in the practical training base in the college. Methods The practical training base in the college was rebuilt into a simulated hospital. 120 three-year-course nursing students in grade 2007 were divided into the control class and the experimental class with 60 students in each class. The control class adopted routine teaching method, including teacher demonstration, single project training, concentrated training before clinical practice. The experimental class participated in the tutoring mode of nursing skills under 24 hours shift system in simulated hospital. The cases were pre-designed and students acted as patients by tums. One teacher led 4 students into nursing skill training by day shift, evening shift and mid-night shift. The teaching effect was compared between two classes. Results There was significant difference between the two groups in comprehensive technique test and graduation theoretical test score. Clinical nursing teachers thought the skill training in simulated hospital under 24 hours shift system can help students prepare for the nursing work in hospital ahead of time and improve their comprehensive capability. Conclusions Training mode of nursing skills in simulated hospital under 24 hours shift system is feasible for enhancing nursing skills.

Objective:To analyze the implementation and effectiveness of primary health care reform in Feixi county, Anhui province. Methods: This paper uses data analysis of interviews with key insiders, policy documents and archives, as well as institutional questionnaire survey and other methods to collect information, and then it com-bines qualitative and quantitative research to arrive at research findings through cross-analysis and interpretation. Re-sults:From 2010 to 2014, the reform enhanced the capacity of primary health care in four main aspects, including capacity building of primary health care personnel, network construction of primary health care system, improvement of working conditions, and system construction of institutional management. Accordingly, the human capacity of pri-mary health care personnel was improved, their enthusiasm for work increased, their income was raised, the working conditions were improved, the cooperation mechanism for vertical and horizontal health care services was established, and the consultation rate and primary health care utilization in Feixi county increased. Conclusion:Both the“bottom-up” exploration approach and “from point to area” implementation strategy adopted by Feixi county have not only been the core content of primary health care system’s comprehensive reform, but also effectively leveraged the other aspects of the reform. They have played an important role in deepening medical reform and establishing institutional mechanism of health care system.

Objective:The paper aims to explore the structure and effectiveness of three health service systems in Anhui province and provide policy recommendations to promote the integration of health care systems. Methods:By using typical sampling method, this paper conducts case study analysis of health service system in Ma’anshan, Feidong and Feixi county of Anhui province. The data mainly come from questionnaires for the institutions, doctors and patients, as well as from interviews with key informants. By integrating quantitative and qualitative data analysis, this paper uses social network analysis method to analyze the system structure and its degree of integration. Results:The degree of integration of health service structure in Ma’anshan is the highest, followed by Feixi, and Feidong is the lowest. The system effectiveness is same as the degree of integration. All three health service systems have advantages and disadvantages regarding to system integration. Conclusion:The effectiveness of health service system integration and its implementation is the product of combined effects of internal and external environment of each health service system. The reforms in Ma’anshan and Feixi health service systems have not only integrated health care structures, but also had a positive impact on the effectiveness of the health service systems.

Objective:To analyze reverse effects induced in the implementation process of“primary health care strengthening” policies, and the innovative initiatives and countermeasures raised in primary health care system’s comprehensive reform of Feixi county. Method:Based on the principles of Critical Discourse Analysis ( CDA) , this paper designs its analytical framework for policy analysis. Results:Many reverse effects appeared in the implementa-tion process of “primary health care strengthening” policies. However, through improvements in terms of manpower upgrading, network building, working conditions and management mechanisms, Feixi county has successfully strengthened the capacity building for primary health care institutions. Conclusions:The expected and unexpected re-sults should be evaluated systematically when the policies are being implemented, and local governments need to pro-ceed according to local conditions in order to prevent unintended reverse effects from happening.

The fragmentation of health care system within a county and serious capacity constraints of health-care services in township health centers are generally the most significant problems facing underdeveloped counties in western China. Under constraints of limited public financial resources, how to increase service capability of township health centers and improve service quality, continuity and convenience of health care system has become one of the most severe challenges in implementing China’s county health care system reform. This paper takes Huangzhong coun-ty, Qinghai province as a case study. It investigates how the locals use health care alliance to vertically integrate county health care resources during reform implementation, analyzes various aspects of reform measures and the corre-sponding structural characteristics such as the integration of administrative management, integration of human re-sources, dual diagnosis referral, interoperability of information systems, sharing of resources and test results, etc. , and provides similar China’s counties with a case study to be used for reference.

Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.

Recently , the country actively explores the pattern of an integrated healthcare which enables the as-sociation among hospitals of different levels , aimed to achieve maximum utilization of medical resources and lead a reasonable distribution of the patients .By reviewing the practices related to the integration of healthcare in Beijing , Shanghai , Zhenjiang and Wuhan city , this paper sums up in five typical mechanisms , i.e.organization and manage-ment mechanism , human resource management mechanism , interest distribution mechanism , service continuity and resources sharing mechanism .The effects of these practices were analyzed and the faced challenges were discussed . The following points were made clear during analysis and discussion:the sustainability of the collaboration mode and organization structure , human resource supports and incentive methods , health insurance guidance for hospitals and patients , two-way referral system and supporting measures , and building of information system .Then we put forward some suggestions , hoping to offer some references to the establishment of integrated healthcare in other regions .

OBJECTIVETo establish a animal model of biliary leakage in pigs with laparoscopy.

METHODSEight healthy Bama minipigs were subject to laparoscopic surgery under general anesthesia.The cystic duct was resected at 0.5-1.0 cm from the root and the stump was left open with the gallbladder removed. Blood routine and hepatic functions of the pigs were tested before and 24 h after the surgery, and endoscopic retrograde cholangiography (ERC) was performed 24 h after the surgery. At 48 h after the surgery, the pigs were sacrificed for observation of the stump of the cystic duct.

RESULTSThe gallbladder, cystic duct, cystic artery, and the anatomical relations between the gallbladder and liver and between the cystic duct and common bile duct were fully exposed under laparoscopy. White blood cells, neutrophils and direct bilirubin increased significantly after the operation (P<0.05). The cystic ducts were resected at 0.5-1 cm away from the roots of the cystic ducts in 7 pigs and at 2 cm in 1 pig.

CONCLUSIONLaparoscopy is safe and feasible for establishing the porcine model of biliary leakage.

Animals ; Biliary Fistula ; Cystic Duct ; surgery ; Disease Models, Animal ; Female ; Laparoscopy ; Male ; Swine ; Swine, Miniature

Objective:To analyze the reform actions on raising the appropriateness of inpatient care use, as well as the current situation, so as to provide suggestions on improving the appropriateness.Methods:Policies and literatures on the appropriateness of inpatient care use released from 2009 to 2021 were collected from such official websites as the State Council and China National Health Commission as well as literature databases from home and abroad, for a text analysis. Based on the data of China Health Statistics Yearbook(2010-2021) and The Sixth National Health Service Survey Report (2018), descriptive methods were adopted to analyze the situation of inpatient care use in China. Results:Since the new healthcare reform, the Chinese government had standardized the hospitalization standards and procedures to minimize inappropriate use of inpatient care, increased financial subsidies for public hospitals to minimize their inappropriate patient attraction merely for economic interests, and reformed the medical insurance payment methods so as to regulate physicians′ behavior. Under the influence of the above policies, the average length of stay decreased from 10.5 days in 2009 to 9.1 days in 2019, with an average annual growth rate of -1.42%. The average waiting time in hospitals decreased from 3.6 days in 2008 to 1.5 days in 2018.From 2012 to 2019, the admission rate increased from 13.2% to 19.0%.Conclusions:Since the new healthcare reform, the average length of stay in China has decreased year by year, but the admission rate has increased year by year. Therefore, it is necessary to further reduce the inappropriate utilization of inpatient care use by speeding up the construction of the close-type medical alliances, improving the reform of payment methods, refining the performance appraisal standards for medical staff and strengthening supervision mechanism.