Health policy and systems research in China has rapidly developed over the past two decades, which helps evidence-based policy making and health systems strengthening.This article aims at reviewing and analyzing, and to come up with a summary of the major progress and future development trend in health policy and systems research are reviewed and analyzed.This article discusses also the current challenges and opportunities of health policy and systems research prevailing in China.

In order to meet the health needs of people, China’s health service system needs continuous reforms and adjustments. Health needs, equity and efficiency, quality of service, and the development history and current situation of the health service system are the four main dimensions to be considered during the building process of the system. This paper argues that building a people-centered health service system is the direction, and it describes its connotation from five different aspects, including human care, interrelated interests, primary health care-oriented, continuous integration, and conditions for support. This paper proposes the strategies and paths to build a people-cen-tered health service system, including to promoting the quality of primary health care, integrating health service sys-tems, and strengthening government’s responsibility.

Based on the related theories of physician behavior analysis, summarize and discuss the incentives mechanism of supplier payment on physician behavior and its inner mechanism, provide theoretical supports and political suggestions for further analysis on payment reform.

To discuss the influences of government health input on the efficiency of hospital operation. Methods:Taking 16 county-level hospitals in Ningxia as samples, using DEA and DEA-malmqutist indicator method to calculate the technical efficiency scores from 2000 to 2012, then analyze the compositions of technique efficiency(TE) , using Tobit regression to analyze the relationship between government budget health expenditure and medical institution efficiency. Results: The Ningxia governmental health budget expenditure is growing almost 3 times from 2000 to 2012 and the average TE is 0.82-0.94. In the 16 county-level hospitals, the TFP of 6 hospitals (37.5%) was less than 1, and the minimum was 0.82; while the TFP of 10 hospitals (62.5%) were more than 1, the max was 1.699. For the 6 hospitals of which TFP was less than 1, the reason for negative growth of TFP was contributed to the slow technique change, the pure efficiency or small scale. The regression result of TOBIT showed that the government health expenditure increases 1 000 units, the efficiency of medical institutions will increase 0.0031. Conclusion: The relationship between the governmental expenditure and medical institutions is positive, but the technical efficiency of medical institutions expenditure was the result of multiple factors.

Objective:To explore means of process quality assessment for antibacterial drug utilization among a-cute appendicitis patients under the New Rural Cooperative Medical Scheme ( NCMS) through the use of the explicit method in order to provide evidence for the rationality of drug utilization in NRCMS. Methods: Data was collected from the NCMS information system of one county in Shandong Province from 2007 to 2011 and included 1 ,721 cases of acute appendicitis in county and town-level hospitals. The explicit method was employed, which adopted the ad-herence rate to represent drug process quality by comparing the actual antibacterial drug utilized with those recom-mended by quality standards. Descriptive statistics were used to analyze quantitative data with Excell2007, Microsoft SQL 2005 and SPSS 17 . 0 . Results: The average overall adherence rate from 2007 to 2011 was 22 . 4% ( SD =22. 3%) at the individual level. The overall adherence rate of township health centers was very low, between 14. 6%and 19. 6%, with no significant difference among the five years. The utilization of cephalosporin drugs was relatively stable at town-level hospitals, that is, third-generation cephalosporins was used most frequently, while cephalosporin, recommended by quality standards, was the least utilized in all five years. At county-level hospitals, fourth-genera-tion drugs were gradually substituted with second and third-generation drugs. Utilization of the recommended drug metronidazole of the nitromidazoles drug group decreased over time at both the town and county-level hospitals, and the drug was gradually substituted by tinidazole and ornidazole, especially in county-level hospitals. Conclusions:From 2007 to 2011 , the rationality of drug utilization was low in the NCMS designated hospitals at both town and county-level hospitals, particularly in town-level hospitals. The underuse of recommended quality standard drugs was the main issue at hand, and this situation experienced no significant changes during the study period.

The health care system has always faced challenges from two competing fronts: rising costs and quality concerns. The common issue of debate confronted by various health care systems is whether or not rising medi-cal expenditure can lead to quality improvements. The key to addressing this issue is to figure out the correlation be-tween quality of care and medical expenditure. Based on Donabedian’s structure, process and outcome quality theory, this study reviews relevant international studies related to this topic in order to provide empirical evidence in a clearer way. Results show that the analysis of current studies have typically been based on the regional level, health provider level and patient level; the quality indicators used varied among studies while expenditure indicators had much in common;more studies were found to focus on the association between outcome quality and expenditure while less studies explored the link between structure or process quality and expenditure; additionally, the majority of relevant studies were located in the inpatient setting and studies from outpatient settings were found to be lacking. Overall, ac-cording to current knowledge, no inclusive conclusion could be obtained, but quality indicators, data and methods, and limitations revealed in these studies can be reviewed by future study to explore the correlation between quality and expenditure of medical care in a more objective way.

This paper aims at describing and comparing the changes of health resources allocation before and after new health system reform during 2006—2015 . Methods:Province-level data were used to analyze the inequities of licensed ( assistant) doctors and beds. 31 provinces were divided into 5 groups by GDP per capita and 3 groups by geographical regions. Absolute difference, relative ratio and concentration index were respectively used to compare and measure the absolute difference, relative difference and inequities in different groups before and after the new health system reform. Results:The findings of this study show the allocation of China's health resource before and after new health system reform to be as below:(1) the quantity of health resource is increasing, and the growth rate after the reform is higher than before. (2) the disparities of health resource in different economic development level areas are declining, and the decrease is faster after the reform. (3) the disparity of beds in different regions is decreasing, but the disparity of licensed (assistant) doctors in different regions is enlarging. (4) The inequities of health resource al-location in China are reduced, and the improvement is greater after the reform than before. However, the health re-source allocation is still highly inequitable to geographical areas. Discussion:(1) the policies of health resource allo-cation implementation after the reform needs improvement. ( 2 ) The amount of health resource still needs to be in-creased in certain areas, especially need to strengthen the training of high-qualified health personnel. (3) When al-locating health resources, government should focus on the impact of both population and geographical size factors.

Objective:To analyze the correlated factors on the non-public hospitals efficiency performance and compare different types of them in order to provide reference for improving efficiency.Methods:Based on the result of 160 non-public hospitals total efficiency,questionnaire surveys were taken for collecting the information of region,quality,form of ownership,whether invested by the government,whether under the medical insurance,the total amount of employers,bed and service amount as the independent variables,while the total efficiency as the dependent variable to conduct the Tobit multi regression analysis.Results:Access policy,investment policy,nature of ownership,the number of beds,the proportion of physicians,the per capita services,assets and equipment had significant impact.Conclusion:The development of non-public hospital was related to the policy environment,operation mode and internal management.

Objective:To evaluate the technical efficiency and scale efficiency of non-public hospitals in China to provide references for improving efficiency of non-public hospitals with the comparison with the differences among different non-public hospitals with different types.Methods:Input and output data of 160 non-public hospitals in 2014 were collected;C2R and BC2 models were adopted to evaluate the annual total efficiency,technique efficiency and scale efficiency.Results:There were 16 total efficient hospitals(10.00％),41 technical efficiency hospitals(25.63％) and 20 scale efficiency(12.50％),43 at IRS stage,99 at DRS stage.Conclusion:The overall efficiency of non-public hospitals was low relatively and most of them were lower than public hospitals at same level.Scale was an important factor affecting the efficiency of non-public hospitals.

In this paper, 172 non-public hospitals have been investigated covering east, central and western regions with structured and semi-structured questionnaire and group interviews. We found that the health insurance policies were the most concerned policies by non-public hospitals, accounting for 26.5% of the total. We also found that non-public hospitals from different areas, levels profit nature have different policy expectations, for example Eastern regional institutions wanted to make a breakthrough of the planning policies, the central region wanted to change the health personnel policy, while the western region is considered to be limited by land policy. Tertiary hospitals were more concerned about research projects and land policy, and secondary hospitals were more concerned about access policy. There were 44.8% of the surveyed institutions considered that regulatory policywasmore stringent public hospitals and public hospitals, and there were no difference between profit and non-profit hospitals. According to the survey results, this paper puts forward suggestion that we should implement more targeted policies, purchasing more services from non-public hospitals and enhanced supervision. Considering the survey results research team puts forward sensitive advice as: provide preferential policies in according with different kinds of institutions reinforce purchasing service and enhance non-public hospitals supervision.