The hierarchical medical system is to match and balance the medical service demand and supply. This article probed into main problems encountered in introducing such a system, discussed the mechanism of action for the system which was based on diseases, and proposed the driver model for a disease-based hierarchical medical system.

Objective To detect the expression of p-STAT3 and survivin in primary gallbladder carcinoma (PGC) and explore its significance for the genesis and development of PGC.Methods The expression of p-STAT3 and survivin were determined with immunohistochemistry in samples from 45 PGC tissues and 20 chronic cholecystitis.The relationship between the expression of these proteins and various clinicopathological factors was evaluated.Results The expression rate of p-STAT3 and survivin in 45 PGC tissues was 55.6％ ( 25/45 ) and 64.4％ ( 25/45 ),respectively,which was significantly higher than those in 20chronic cholecystitis tissues 5.0％ ( 1/20),10％ ( 2/20 ) ( P ＜ 0.01 ).pSTAT3 expression was correlated with survivin ( r =0.830,P ＜0.01 ).p-STAT3 and survivin protein expression were significantly associated with histopathological grading,lymph node metastatis,nevin staging and 3-year survival rate.Conclusions p-STAT3 and survivin might play a vital role in the development of PGC.The expression of p-STAT3 or survivin was an independent prognostic factor in PGC.

OBJECTIVE:Studies have confirmed that basic fibroblast growth factor stimulating periodontal ligament cells can promote the proliferation of human periodontal ligament cells.so as to facilitate the reconstruction of lost periodontal tissues.By use of different concentrations of basic fibroblast growth factor,the in vitro cultured normal human periodontal ligament cells were stimulated to observe the decorin gene expression in the periodontal ligament cells.METHODS:The periodontal ligament cells were isolated and cultured using trypsin digestion method.The third generation of cells at logarithmic growth phase were preserved in DMEM containing 10% DMSO and 20% FBS frozen crvopreservation fluid,then moved into liquid nitrogen preservation at the second day Immunohistochemistry was used to identify anti-vimentin and cytokeratin staining The sixth generation of human periodontal ligament cells were divided into experimental group and control group.The experimental group was cultured in DMEM culture medium containing basic fibroblast growth factor at the concentration of 0.1,1,10 μg/L under standard conditions for 24 hours;control group was cultured with DMEM culture medium under standard conditions for 24 hours.The intracellular decorin gene expression was determined using RT-PCR.RESULTS:By microscopic observation,the cells in the control group had no significant changes,and cells proliferated in the experimental group,before stimulation the cells at the bottom of the bottle became denser than those in sparse regions.Adding basic fibroblast growth factor into periodontal ligament cells,could significantly decrease the mRNA expression of decorin,along with the increase of basic fibroblast growth factor concentration,the inhibition effect gradually weakened and became the strongest in the 0.1 μg/L but the weakest at 10 μg/L.CONCLUSION:The basic fibroblast growth factor stimulation can promote the proliferation of periodontal ligament cells and inhibit the synthesis of decorin in a dose-dependent manner,0 1 μg/L induces the strongest inhibitory effect.

The three-level prevention theory is called into play as guided by the contemporary medical model and combination of prevention and treatment,to classify the services into three levels.Services by maternal and child health care institutions are designed as Level-1,early discovery,early diagnosis and early treatment prevention as Level-2,while clinical prevention as Level-3.The paper also clarified misunderstandings and proposed the general healthcare concept for such institutions.

Objective To investigate the relationship between the neonatal period hyperbilirubinemia and dyskinetic cerebral palsy.Methods The data of 36 dyskinetic cerebral palsy children with early neonatal period significant jaundice were analyzed retrospectively. The information of children was obtained through a questionnaire that included the case, severing clinical characteristics and treatment.Results 12 cases (33.33%) were born with hemolytice disease of newborn; 8 cases (22.2%) were born with early onset infection; 5 cases (13.9%) were born with cephalohematome; others were unknown etiologies. 6 cases had serum total bilirubin (TSB) value more than 600 μmol/L (the highest value was 792 μmol/L); 12 cases had TSB value ranged from 513 μmol/L to 600 μmol/L; 14 cases had TSB value ranged from 425 μmol/L to 512 μmol/L; 2 cases had TSB value lower than 425 μmol/L (the lowest value was 396 μmol/L). 2 cases had no TSB data. The time of jaundice significantly turned severer was 156±12.56 hours after birth. The time of jaundice continued was 23±5.62 days after birth. 34 cases had been diagnosed and treated. But the first treatment time of all were later 150 hours after birth.Conclusion As the main risk factor of dyskinetic cerebral palsy, severe hyperbilirubinemia need be valued. How to ease bilirubin quickly in the early stage is much important.

Objective To understand the influence of the disease-based hierarchical medical system on inpatients flow covered by the new rural cooperative medical system ( NRCMS) , and that on the funding diversion and medical costs so incurred. Methods One county was selected from the eastern, central and western regions of China respectively, where the disease-based hierarchical medical system has been in place. Policy documents of the three counties were reviewed to analyze such changes as NRCMS inpatients flow, inpatients subsidy diversion, NRCMS fund surplus rate of the current year and medical costs per hospitalization before and after the system was in place. Results A comparison with 2014 found a 1. 26%drop of the out-of-county inpatients of county W of the western region, a 2. 00% increase of township hospitals inpatients of county D in the middle region, and the same ratio of out-of-county and in-county inpatients in county F of the eastern region in 2015. Compared with 2014, the fund surplus rate of county W increased 10. 46%, and the inpatient subsidy ratio of county D decreased 2. 51% for those in out-of-county medical institutions in 2015. Thanks for the quota payment of specific diseases under global budget in county W, the inpatient medical costs per hospitalization dropped at both county and township medical institutions. Conclusions The disease-based hierarchical medical system could optimize the NRCMS inpatients distribution among various medical institutions, conducive for establishment and operation of such a system.

Objective To learn the behaviorist changes of county and township hospitals in their care of the diseases categorized in the hierarchical system before and after the system was in place. Methods Descriptive statistics and correlation analysis were used to analyze the changes of the diseases categorized in the hierarchical system which were cared at both county and township levels. Results The inpatients coverage of such diseases in county W in the western region at county and township hospitals was 44. 97%and 59. 28% respectively. These data were higher than that in county F in the eastern region, which were 18. 32% and 15. 58% respectively. As discovered in the Spearmen rank correlation analysis, the inpatients growth of diseases under the hierarchical system of counties F and W in 2015 was positively correlated to the difference between the pricing for the disease in question and the average hospitalization fee for the same disease in 2014 (r=0. 462, P<0. 001;r=0. 304, P=0. 018 ). In county W where the quota payment of specific diseases was in place, the increase of the average cost per hospitalization in 2015 was positively correlated to the above mentioned difference in 2014 and 2015(r=0. 447, P<0. 001). Conclusions The coverage of such diseases should be expanded. Changes in the pricing for such diseases will influence inpatients flow, while quota payment per disease can curb the increase of costs per hospitalization.

To achieve the goal of universal healthcare coverage,and the objective of the ongoing healthcare reform to establish an essential healthcare system,the study proposed a financial framework for building the essential medical service package,covering medical services offered by primary medical institutions,treatment of major diseases,and essential medical services offered by secondary and tertiary hospitals.With data over the years of the total medical expense and medical service usage as the basis,and in the principles of affordability and cost-effectiveness,the total financing quota of essential medical services is expected to reach 1 940.846-2 1 62.41 7 billion,accounting for 30.66%-34.1 6% of the total healthcare expenditure.75% of the financing load should be carried by the government and society, focusing on financing medical services offered by primary institutions and lowering out-of-pocket burden of residents.

Objective To divide the medical services currently offered by various medical institutions into priority,extended and non-essential items.Methods The items were divided according to their actual usage at these hospitals,and such services were screened based on hospital positioning and clinical pathway of diseases.Results The selected priority services at the primary,secondary and tertiary hospitals were 255, 378 and 820 respectively.Their proportions in total medical services of these hospitals were 92.9%,95.9% and 97.4% respectively,and the proportion of their costs in total medical service costs were 57.9%,76.8% and 84.5% respectively.Conclusions The selected priority items had covered most of the services and costs,which deserve promotions at all the hospitals as it embodied the principle of benefiting the majority of the population.

Objective To determine the main contents and key points of the essential medical services by means of priority setting of diseases with high incidence and serious damage based on the demand of residential medical services.Methods The priority setting method is applied in this study,and the incidence,prevalence,hospitalization rates and the ratio of different types of inpatient are used as indicators to reflect medical demand and utilization.The integrated balance method is also used,and the priority diseases list is made based on the analysis from the view of disease onset,considering the service delivery,social equity and the health financing.Results Based on the data analysis made,this paper proposed that the priority diseases cover 29,66 and 103 types for primary hospitals,secondary hospitals and tertiary hospitals respectively.The main diseases so determined include hypertension,diabetes, maternal and child health,severe mental illness,infectious diseases,emergency treatment,etc.Conclusions The method and result of setting priority disease and main disease can be the basis of setting for main diseases in essential medical services.