OBJECTIVE:To propose policy recommendations for China to solve medicines shortage fundamentally. METH-ODS:The causes of medicines shortage in China were analyzed. Chinese,American,Canadian and European literatures and the government website of typical countries about responses to medicines shortage since 2010 were searched and reviewed. RESULTS& CONCLUSIONS:Medicines shortage in China are due to regulation and policy changes and unfair competition. Both China and foreign countries face the problem of medicines shortage to some extent,either due to demand side or supply side. It is necessary to improve related laws and regulations to deal with medicines shortage,establish multi coordinative mechanism,shortage monitor-ing system and information and communication network platform with the patient-centered approach,leave reasonable profit for pharmaceutical production and distribution enterprises and crack down hoarding of raw materials. The experiences of typical coun-tries in defining clear responsibility for each stakeholder in the medicines supply chain,establishing comprehensive policies and co-ordinative mechanisms in response to medicines shortage are valuable for China to follow.

Objective:To investigate the wether vascular endothelial growth factor (VEGF) and endostatin could be used as new serum markers of endometriosis. Methods:Preoperative serum levels of VEGF and endostatin in 82 women with endometriosis(stage Ⅰ-Ⅱ 43 cases and stage Ⅲ-Ⅳ 39 cases) were assayed in duplicate using enzyme linked immunoadsordent assay. Serum levels were compared with levels of 60 healthy controls. Results: Serum VEGF and endostatin levels in endometriosis were significantly higher than that of controls. The levels of VEGF and endostatin of endonmetriosis stages Ⅰ-Ⅱ were significantly lower than those of stage Ⅲ-Ⅳ. The sensitivity, specificity, positive predictive value and negative predictive value of serum VEGF in detecting endometriosis were 0.92,0.78,0.82 and 0.90, respectively; those of enedostatin were 0.95, 0.84, 0.86 and 0.95, respectively. When both factors were used concomitantly, they were 0.98,0.75,0.76 and 0.98, respectively. Conclusion:These results indicates that the balance of angiogenic stimulators and inhibitors may regulate the development and progression of endometriosis and demonstrates that the circulating levels of both VEGF and endostatin maybe useful markers for endometriosis.

Objective To compare the effects between dilation and curettage (D&C) and hysteroscopic electroresection (HE) in the management of endometrial polyps. Methods Entered into the study there were 86 patients with endometrial polyps, 32 of them were treated by D&C (Group D&C) and 54 by HE (Group HE). The operation time, pre- and post- operative complications, and recurrence of 2 groups were compared. Results Of the Group D&C and Group HE, the operation time were (8.5?4.2) min and (9.0?3.1) min, without statistically significant differences (t=0.632, P=0.529), while the recurrence numbers and recurrence time of the 2 groups were 9 (36.0%) and 3 (7.5%) cases, (5.3?3.5) months and (11.2?4.8) months, respectively, with significant differences (?2=6.516, P= 0.011; t=6.058, P=0.000). Conclusions Compared with D&C, HE is characterized by lower recurrence rate and longer recurrence time.

OBJECTIVE:To provide policy recommendations for optimizing medicines distribution system reform in China.METHODS:Literature review and field investigation were used to mapping the medicines distribution system. Problems and influ-ential factors were analyzed and policy recommendations for optimizing the medicines distribution system reform were put forward. RESULTS & CONCLUSIONS:Medicines distribution system has been undergoing a rapid development and transformation under the overall health system reform. Most medicines distributors are still with small scale,low concentration,high cost,low profitabil-ity,lack of core competence, development of new form facing challenges. A large number of drug distributors still follow the tradi-tional business model,know little about modern drug supply chain management,and not understand their appropriate roles under the new social and economic development. Medical E-commerce face both opportunities and challenges in the process of develop-ing. Drug distribution industry needs vertical and horizontal integration, speeds up the socialization of the third party logistics and the healthy development of the medical electricity supplier, improves and perfects the drug distribution supervision system which is suitable for the healthy development of new form.

OBJECTIVE:To provide reference for further implementation and improvement ofTwo Tax Billmedicines distri-bution reform. METHODS:Literature review and field investigation were used to systematically sort out,summarize and analyze the effect ofTwo Tax Billmedicines distribution reform and potential problems. Corresponding policy suggestions were proposed. RESULTS & CONCLUSIONS:TheTwo Tax Billmedicines distribution reform boosted the integration and re-combination of medicines distribution system,and effectively rectify the medicines distribution system. However,this study found no evidence of its effect on reducing the high medicines prices. We suggest that,the implementation ofTwo Tax Billmedicines distribution re-form should firstly ensure the stable supply of medicines,especially the availability of essential medicines in rural remote areas, and those medicines with high risk of shortage. It is also suggested to strengthen the audit of tax receipts;establish long-term mecha-nism to promote on-time payment to suppliers by hospitals;break down local protection;set up efficient multi-ministerial coordina-tion mechanism.

OBJECTIVE:To provide policy recommendations for improvement of the pooled medicines procurement policy through legal analysis. METHODS:The pooled medicines procurement policies in China were reviewed and compared with related laws and regulations to analyze the problems and put forward recommendations. RESULTS:For the pooled medicines procurement policy,there were several conflicts between it and the Bidding Law,Government Procurement Law,Anti-monopoly Law and An-ti-unfair Competition Law. In terms of the pooled medicines procurement institution,there were conflicts between it and Bidding Law,Government Procurement Law. In terms of the price-volume linkage and the main body of tendering,there were conflicts be-tween it and the Bidding Law. In terms of the organization and participants,there were conflicts between it and the Anti-monopoly Law and Anti-unfair Competition Law. CONCLUSIONS:The pooled medicines procurement system should rationalize the main body of tendering,insist on volume secured procurement and price-volume linkage,establish reasonable incentive mechanism through supporting heath system reform policies,eatablish and perfect modern government principles in the field of medicines regulation. The pooled drug procurement policy should be moderately adjusted to follow the above laws in order to raise the procurement efficiency.

OBJECTIVE:To provide reference for setting reasonable medicines insurance payment price in China.METHODS:We retrieved and analyzed academic articles formally published at home and abroad,official websites and government documents,summarized.medicines insurance payment pricing mechanism as well as fair solutions to high-cost medicines,so as to put forward the suggestions to formulate reasonable medicines pricing policy in China.RESULTS&CONCLUSIONS:The international medicines payment prices are usually determined by internal reference pricing method,incremental cost-effectiveness evaluation method and external reference pricing method.The sustainable and fair accessibility of high-cost medicines are promoted by fair medicines pricing program,medicines patent pool,open source medicines discovery znitiative and so on.After the goal of universal health care has been achieved in china,reasonable medical insurance payment price should be explored and formulated.It is necessary to adopt,intemal reference pricing method to determine the payment standard of completitive eneric products,external reference pricing method or incremental cost-effectiveness evaluation method to determine the reference price for price negotiation of the innovative patented medicines;the concept of fair pricing for high-cost medicines.

DRG-based prospective payment system ( DRG-PPS ) is one type of mature inpatient care payment mechanisms in most countries and pilot projects would be introduced to China in 2017. This article provides an overview of the previous typical DRG-PPS reform initiatives on provincial, municipal and county level respectively. It also summa-rizes the characteristics of the reform programs, describes the diversities of policy implementation, and discusses the suc-cessful experience and implications of the initiatives. The paper puts forward some suggestions on the upcoming DRG-PPS pilot projects based on the progress and problems of the initiatives, to promote the DRG-PPS reform in China.

The aim of the present paper intends to explore the international experiences of healthcare profes-sional organizations and its enlightenment for China. The functions of health professional organizations in advanced countries include certification and accreditation, self-discipline, academic exchanges, political participation, service for industry, member rights protection and so on. The legal authorization, comprehensive supervision and competitive market mechanisms which make sure these functions perform well are worth learning for China.

This article is based on a questionnaire survey of healthcare professional organizations and interview leaders of them. The results of this investigation show that the number of staff is small, and lack of highly qualified human resources. The organizations rely on donation for income and some of them run at a deficit. The functions such as professional self-discipline are not well performed. The analysis reveals four reasons why functions are not well per-formed:the bureaucratic style of the professional organizations and unclear legal status;the limited authorization from legal and administrative bodies;the defects in the governance system and the lack of capacity. Four aspects of policy recommendations are were proposed: to clearly define the role of the professional organizations and authorization through legal and administrative procedures; to strengthen support of professional organizations through various poli-cies;to improve governance and build comprehensive regulation mechanisms;to enhance the capacity of these organi-zations and so on.