The Anderson model was founded in 1968, based on the three initial components of predisposing characteristics,enabling resources and need as its original components.It has been modified and improved for five times since then by increasing measurement index,adjusting structure,expanding path relation,and transforming a-nalysis path,to become a complete theoretical model and the feasibility of empirical research finally.The Anderson Model was widely recognized by the international academia,and used in the field of healthcare services research in U-nited States and Europe as a theoretical model for analyzing the main influence factors of utilization behavior of health service,such as individual medical choice, medical costs, disease screening, drug use etc.This paper aimed to summarize the development and the usage of the model in foreign countries.It will be not only be helpful to the theo-retical and applied research in the field of healthcare in China, but also be helpful to improving the medical and health policy and designing the questionnaire in the National Health Service Survey.

Objective:To investigate the characteristics of seeking behavior and medical expense of outpatients in the New Rural Cooperative Scheme,and provide suggestions and theoretical basis for the implementation and pro-motion of hierarchical medical policy systems.Methods:In this study,13 counties in the eastern part of China were selected.By using data about diabetes mellitus distribution and medical expense of outpatient service reimbursement database in Beijing New Rural Cooperative Medical Scheme from 2009 to 2013,the diabetes mellitus were divided in-to two groups:with complications and without complications; the number of visits and proportion of the first-class, secondary-and tertiary-level medical institutions and the average annual growth rate of the five-year were calculated and the total expense,the average cost,the individual burden and the annual growth rate of the two types of diabetes mellitus were statistically analyzed.Results:The visits in the tertiary medical institutions of diabetes mellitus without complications decreased from 1895 to 661 and the proportion decreased from 3.05% to 0.6% from 2009 to 2013, while the visits in the tertiary medical institutions of diabetes mellitus with complications increased year by year and the proportion increased from 3.27%~4.24% since 2010.Outpatient medical expenses varied widely between pa-tients with and without complications and the higher the level,the greater the difference between the two.At the first-class,secondary-and tertiary-level institutions,the average expenses per time of diabetes mellitus with complications were 2.50,3.34 and 3.75 times higher than the diabetes mellitus without complications and the average out-of-pock-et expenses per time were 2.62,3.66 and 3.96 times higher than the latter respectively.Conclusions:From 2009 to 2013,the utilization of primary outpatient service in the region achieved some success while there were still some problems including unreasonable outpatient distribution, and more diabetic patients with complications went to the tertiary-level institutions than those without complications.Compared with outpatients without complications,patients with complications face up to a larger direct-economic burden of disease.The construction and the ability to prevent and control diabetes mellitus of basic medical institutions should be further strengthened,and the distribution of pa-tient needs to be reasonably led to enhance the service quality and ability of preventing,treating and controlling dia-betes and complications,and to guide patients with diabetes to seek medical treatment in primary healthcare institu-tions.

Objective:To analyze the situation of seeking medical treatment and assess the impact of interven-tion on rural chronic disease patients.A comprehensive intervention strategy was developed and implemented in rural area of Jiangsu province.Methods:According to the implementation plan,a random sampling method was adopted in Gaochun,Jingjiang and Huaiyin districts of Jingsu province to select a total of 4 261 people to be surveyed on the baseline,with 2116 people were in the intervened group and 2 145 in the controlled group,which was conducted for one year.The changes of flow tendency,times and expenses of seeking medical treatment before and after the inter-vention were analyzed.Results:After intervention,patients with chronic disease choosing primary health institutions for medical treatment has obviously improved, which was observed to be significant when compared with the con-trolled group.The average times of seeking medical treatment in primary health institutions is exceeding 10 times and which is significantly higher than before the intervention and the controlled group.After the intervention, patients, medical expenses reduced,which is significantly lower than that of the controlled group.Conclusions: Through one year of intervention,more and more patients with chronic diseases were choosing primary health institutions for medi-cal treatment.But the medical expenses have not yet achieved good control.So the support of national policy to fur-ther standardize the patients,behavior of seeking medical treatment is still needed.

This paper analyzes the main performance problems of public hospitals in China,s health service field,including the deep institutional mechanism contradictions and the inefficient use of resources relying on debt to expand.Based on the policy paper of public hospital reform,this paper puts forward the path of public hospitals,par-ticipation in supply-side structural reform of medical services with objectives including:to resolve the historical debts of public hospitals,to control the financial and fiscal risks;to strictly control the cost of public hospitals, to cutrail the unreasonable increase of expenses in public hospitals and provide affordable services;to innovate the management system and operation mechanism,to make compensation and supervision in place, and improve the governance sys-tem of public hospitals;to strengthen the links between public hospitals and primary,social capital so as to integrate the medical industry chain,and expand the supply of high-quality medical resources.

With the new medical reform, healthy China 2030 plan and the 13th Five-Year poverty reduction with the implementation of health assistance project,the poor counties will continue to benefit.But,in the long run, the sustainable development of the rural health system will eventually change to blood formation"hematopoiesis"rath-er than blood transfusion,which requires structural change from health planning to governance of the normal mecha -nism.With the central government fund focus on higher level of health delivery system and promote private health in -vestment in rural health,the health planning process of poverty county in 13th Five-Year is full of game,choice and adaptation.According to the study of 4 poorest counties in western area.The health planning in poor counties prefers the incremental planning of project investment, which is embodied in the incremental speculation and conservative management of resources planning.Poor counties need to balance the public interests and the sector interests, the vertical administrative control structure and introducing more private resource also lead to the poor counties,transfor-mation of health planning and promoting development.

Objective: To understand the cognition and needs of medical personnel for the Horizon Scanning System(HSS)for emerging health technology based on the survey conducted in two provinces(municipalities)in some general public hospitals in eastern and western China,to provide a reference for establishing a proper,new HSS for emerging health technology in China.Methods:A total of 10 general public hospitals in Shanghai and Gansu were selected by convenience sampling method.The self-designed anonymous questionnaire survey was conducted on medi-cal staff.Results:There were 837 respondents,59.95%of which considered it of great necessity to establish a HSS for emerging health technology in China and 91.53%of which would use this system.The most expected functions of the HSS were identifying innovations in the field of health technology,and providing reference for decision-making of the introduction/distribution/use of the technology.The most expected feature of the HSS was involving clinicians and technical experts,and maintaining independence and justice.Conclusions:Medical personnel had a great demand for the HSS.The HSS was expected to identify new technologies efficiently and timely,and provide relevant information for decision makers.

Objective:To model and evaluate the cost-effectiveness of next-generation sequencing(NGS)panel for the screening of breast and ovarian cancer using the decision-making model amongst UK Ashkenazi Jews(AJ) women in the German community,determining whether a multi-gene panel would be cost-effective in patients referred to high-risk of breast cancer when compared with no testing program.Methods:Based on the population epidemiology and cost data in the United Kingdom,a decision-analytic model was developed to compare lifetime costs and benefits associated with NGS panel.The cost-effectiveness analysis was analyzed from a payer,s perspective across a lifetime horizon.Multiple source data were used for estimating cancer incidence,total costs,life-years,quality-adjusted life-years(QALYs)and incremental cost-effectiveness ratio(ICER).Costs were reported at 2014 prices and discounted at 3.5%.Deterministic and probabilistic sensitivity analysis(PSA)based on Monte Carlo Simulations were per-formed to evaluate the robustness of model.Results:In the base-case analysis,compared with no screening strategy, multi-gene panel test lowered the cancer incidence by 1.1%(0.75% for breast cancer,0.47% for ovarian canc-er),and gained an additional 0.87 life years and 0.89 QALYs,resulting in a discounted ICER of? 6766/QALY. Considering 70%testing uptake,this led to 601 fewer breast cancer cases and 283 fewer ovarian cancer cases.One-way sensitivity analysis indicated that the model was robust to variations for most of model parameters.The penetrance rate of breast cancer susceptibility genes was an important factor affecting overall results of the model.PSA showed that the probability for NGS panel being cost-effective at the threshold of? 20000/QALY-￡ 30000/QALY was over than 90%,compared with no screening strategy.Conclusion: NGS panel testing of breast cancer was cost-effective compared with no screening strategy,especially for those AJ women with high mutation rates.

Objective:To understand the concerns and attitudes of large public hospital presidents in China to-wards the main hospital reform measures.Methods:A cross-sectional survey was conducted on 200 randomly selected third-class public hospital presidents to learn the managers,perspectives on public hospital reform.Results:The most concerned problem for public hospital presidents was increasing government investment,and the number of followers accounted for 83.7%;the least concerned problem for public hospital presidents was implementing clinical pathway, and the number of followers accounted for only 19.7%.The hospital presidents believed that the government invest-ment should account for 50.8%of the total hospital income,and 55.1% of the hospital presidents thought that the government should invest in public hospitals in the way of project investment.82.0%of the hospital presidents as-sumed that the lack of increase in income was the main factor affecting the active participation of medical staff in hos -pital reform,and only 14.5% hospital presidents were satisfied with their current income level.Conclusion: The presidents of tertiary public hospitals are most concerned with the reform measures related to the operation of hospital. The hospital presidents are were also concerned about the compensation system reform,and the reform on responsibil-ity and rights of hospital presidents.Therefore,public hospital reform should establish a scientific and rational medi-cal service price system and a long-term government investment mechanism, and establish a job performance based compensation system to mobilize the enthusiasm of medical personnel of medical industry,and clarify the power and responsibility of hospital presidents,and the implementation of public hospital management autonomy.

Based on the structural reform approaches of management system and mechanism implemented by the British NHS, this paper systematically introduced governance models and characteristics of NHS Foundation Trusts(FTs)from the four dimensions:perfecting the laws,establishing accountability framework,improving finan-cial management,and operational governance business model.As a public benefit corporation, on the basis of the principle of public-private partnerships(Public-Private-Partnership, PPP), NHS foundation trusts currently intro-duces a number of entrepreneurial practices under the premise of public welfare attribute, and provide goods and services according to entrustment contract and core NHS principles-free medical care,demand-oriented,affordability and so on.With these reform measures being implemented,the legal status and independent decision-making power of NHS Trust Fund Medical Consortium will be remarkably improved,so as the Foundation Trusts will be much more"on their own"and take complete responsibility for ensuring that they are successful.At the same time, with the norms of the provider,s behavior and medical services,and the improvement of competition and regulation mechanism has also greatly promoted a much more diversified and orderly competitive market for medical service providers.

This review summarised and compared the contents and methods of America,s Health Rankings (AHR)and the County Health Rankings(CHR)in the United States by using literature review.AHR and CHR are the currently widely used population health assessment index ranking systems in the United States,respectively,which provided an analysis of population health on a state-by-state basis and a county-by-county basis by evaluating a histori-cal and comprehensive set of health outcomes and health determinants data to determine the health benchmarks and state/county rankings.The selection criteria of each indicator take into account of reliability, availability, stability, and intervention.The determination of weights of each indicator took into considerations the literature review,a histori-cal perspective,weights used by other rankings,internal analyses of the variation in outcomes explained by each factor, and pragmatic issues involving communications and stakeholder engagement.By comparison, it was found that AHR and CHR have a higher level of accuracy in the classification as they are well -defined by population demographics and geography respectively.The evaluation of health cities and health villages and towns in China is more complicated. There are few studies on village and town health rankings systems.This article reviewed the evaluation methods of AHR and CHR with a view to providing a reference for research on the evaluation system of City Health Rankings and the Village and Town Health Rankings in China.