Performance agreements management plays an important role in transforming government functions, improving public management efficiency and quality of public services. The international experience shows that: performance agreements management, as a new tool, is also applicable to public hospital governance yet calling for basic policy environment,incentive mechanism and technical support.This paper analyzed the performance agreements managements'applicability in the governance of public hospitals,the implementation conditions and environment,the mechanism and so on,in order to provide a theoretical reference for the introduction of performance agreements for the pilot cities of the public hospital reform.

This study reviewed the history and major issues of the reimbursement system reform on public hospitals in China,and analyzed the impact mechanism of specific reform approaches including price adjustment of health service and government special appropriation on the health care services provided by hospitals using qualitative analysis methods.This study has the following findings:if the public hospital is allowed to operate independently,the compensation by health service price adjustment will encourage hospitals to increase their service provision;the compensation method of government special appropriation will decrease the amount of service,and probably cut back the amount of drugs sold;with both reforms combined,hospitals will be encouraged to increase their medical service provision to make up for the revenue lost caused by canceling drug mark-ups.Finally,there were several policy suggestions.

The objective of this article is to review the health decision support system and improve scientific decision-making and service. Based on the population and health data resources, the article designed the health deci-sion support system, covering public health, primary health, medical services, drug administration, and medical in-surance, with five core functions and function model, such as information support, monitoring, analysis and evalua-tion, forecast, and comprehensive optimization. It has also designed a system framework comprising data layer, busi-ness layer, presentation layer, as well as decision support databases including data warehouse, model base, method base and knowledge base were designed. Meanwhile, Taking medical insurance as an example, aiming at decision-making needs, the auxiliary decision making function was designed and successfully implemented.

The division of specialists and general practitioners is the important of the establishment of a GP system. According to the theory of labor division, the study analyzes the evolution mechanism on the division of spe-cialists and general practitioners and discusses the main factors influencing the division in China. It is found that transaction costs of general practices are not much lower than that of specialist medical care, which encourages outpa-tients to visit specialists in hospitals. Additionally, transaction costs of referral are much higher than profits. There-fore, while there is no division of specialists and general practitioners, it has been difficult to address competition between them and the quality and the efficiency of general practice care in community health centers. Moreover, the income gap does not attract medical students to work in general practices, which has worsened the quality and effi-ciency of general practices. Finally, the transaction costs of general practices have continually increased. This vicious cycle has hindered the division of specialists and general practitioners in China.

Objective To study the changes and its clinical prognostic value of plasma endothelin 1 (ET-1) and P-selectin on early in-stent restenosis after percutanous intervention (PCI) in patients with acute coronary syndrome (ACS). Methods Venous blood samples were drawn from a total of 108 patients who underwent PCI before and right after the operation, as well as at 1 week, 2 weeks, 1 month, 3 months and 6 months post-procedure. Plasma was separated immediately by centrifugation at 4℃ and stored at -70℃ until detection. All patients received coronary angiography after six months and were catagorized into the restenosis and non-restenosis group according to the result. Plasma levels of ET-1 and P-selectin of the two groups were analyzed. Results Four cases received acute PCI died and another 4 cases lost follow-up. The remaining cases were divided into the restenosis (n=16) and non-restenosis (n=84) group according to their coronary angiography result. Plasma levels of ET-1 and P-selectin reached the peak concentration in the two groups right after PCI. In the non-restenosis group, plasma levels of ET-1 and P-selectin resumed to pre-opeation level at 24 hours and resumed to normal level at 2 weeks. In the restenosis group, plasma levels of ET-1 and P-selectin did not resume to normal level at 2 weeks but increased persistently, and showed their second peak value at 3-6 months after PCI. Conclusion The risk of restenosis increased accompanied by the persistent increase of plasma levels of ET-1 and P-selectin in early stages (1-2 weeks) after PCI in ACS patients. ET-1 and P-selectin may be regarded as makers for early recognition of restenosis.

[Objective] To compare the expression of matrix metalloproteinase 2(MMP-2)and matrix metalloproteinase 9(MMP-9)induced by alumina and ultra-high-molecular-weight polyethylene(UHMWPE)wear particles,and investigate the role of MMP-2 and MMP-9 in the mechanism of the periprosthetic osteolysis induced by wear debris during aseptic loosening.[Methods]Seventy-two Kunmin mice were divided into 3 groups(24 per group)in a murine air pouch model of inflammation.The air pouches were injected with 3ml of suspension containing 1?108 /ml alumina particles in group A,while UHMWPE particles in group B,and control pouches received 3ml of sterile PBS.All animals were sacrificed at 3、7、14 days after injection.Histological changes and cell counting were assessed by light microscope.RT-PCR and immunohistochemistry method were applied to detect the gene and protein expression of MMP-2 and MMP-9 in the pouches.[Results]Increased cell infiltration and MMP-2,MMP-9 mRNA and immunoreactivity expression were detected in group A and B,and compared to control group,cell number and gene and protein expression of MMP-2 and MMP-9 in group A and B was significantly higher(P

Objective To learn the business operations of the pilot county-level public hospitals chosen for the 2014 experiment,which were subsidized at different levels in the financial subsidy mechanism reform.Methods County-level public hospitals from 109 counties were sampled as pilots from two provinces of the eastern,central and western regions of China.Descriptive analysis and correlation analysis were made to study their business operations at various subsidy levels.Results Proportional differences in the governmental financial subsidy level make a difference in the revenue and expenditure of county-level public hospitals.The higher the subsidy proportion,the lower the annual average of the total workload of the hospital(P <0.01),the less the inpatient expenditure per hospitalization(P =0.01),and the lower the drug proportion as well(P <0.01 ).Conclusions Financial subsidy plays a key role in the financial balance and business operation of such hospitals.Hence the government is proposed to guarantee its financial subsidy responsibility,to build a long-term financial subsidy mechanism.

Objective: To investigate the impact of New Rural Cooperative Medical System (NCMS)on rural resident’s medical burden. Methods: It investigates the survey data from the China Health and Nutrition Survey and employing difference-in-difference method based on the fixed effect model. Results: NCMS increases rural resident’s actual reimbursement rate, release the high health medical expenditure, but has limit impact on medical expenditure. The low-income group has greater risk on high medical expenditure. Conclusion: It is needed to improve the level of NCMS policy implementation; strengthen the supervision of designated medical institutions and increase policy support for low-income rural residents.

This paper reviews practices and features of health service system planning in some countries, and analyze its implications for China’s system planning. It is an international common practice to perform health service system planning to improve resource allocation efficiency, to meet multilevel demands of medical services, and to control dramatic growth of medical expenditures. Governments and their affiliated departments are the main body to formulate and implement the plans, and different levels of governments have different responsibilities in planning. During the procedure of formulating and implementing plans, collaborative governance network can be utilized to en-courage multi-party stakeholders to participate. The government should play an active role in planning to ensure the equity and accessibility of health services. The authority of planning can be achieved mainly through the comprehen-sive measures in legislation, political regulation, economic incentives, etc. Improved tools and methods based on multidisciplinary theories can be used to improve plan’s scientificity and delicacy. China can learn from international experience in formulating and implementing health service system plans.

International experiences can provide evidences for general practitioners ( GPs) system building in China. The paper reviews the development of GP systems from several typical countries of different insurance sys-tems, including national health care systems, commercial medical insurance systems, and social medical insurance systems, etc. The factors that influence GPs systems are analyzed. It is found that the control force of health security system on health system, the control force of specialists on health system, the incentive mechanism of general prac-tice, and the development of general medicine influence the establishment of GPs systems. Finally, this paper pro-vide several policy implications:First, in order to meet the needs of public health, a GPs system with Chinese char-acteristics should be established;Second, the core values of general medicine should be promoted to provide public support for the establishment of a GPs system;Third, a sound incentive mechanism should be established for the de-velopment of a GPs system to improve the status of general practitioners;Fourth, the division of general practitioners and specialists should be promoted to improve the development of general medicine.