The establishment of a scientific and reasonable medical service price dynamic adjustment mechanism is the focus of the current reform of public hospitals in China.This paper analyzed the medical service price reform history in the United States, the price dynamic adjustment of the main body and its process, as well as the development trend of medical service price reform.At the same time, the existing problems of medical service price adjustment in China were briefly analyzed, and put forward 1) the establishment of multi-participant dynamic adjustment model;2) the establishment of the medical service standard value system, strengthening Medicare payment standard construction;3) and gradually changing the current fee-for-service payment system and establishing DRGs and performance based payment mechanism and other policy recommendations.

Objective To discuss clinical effects of combined use of duodenoscopy and laparoscopy in the treatment of acute billiary pancreatitis(ABP).Methods The clinical data of 94 ABP patients who underwent minimally invasive treatment from February 2001 to Feburary 2006 were retrospectively reviewed.Among 94 ABP patients,59 patients had gallbladder stones were given laparoscopic cholecystectomy(LC)alone;14 patients had common bile duct stones received endoscopic nasobiliary drainage(ENBD),combined endoscopic sphincterotomy(EST)and LC;21 patients had both gallbladder and common bile duct stones received combined EST and LC.Results Postoperatively,in the whole group,only one patient had recurrent pancreatitis,one patient had hemobilia,and both cases followed ERCP+EST;two cases had lung infection,and one case had infection of abdominal incision.All of the 5 cases with postoperative compllcations were successfully treated by conservative therapy.The effective rate for the whole group was 100%.Conclusions Combined use of duodenoscopy and laparoscopy is significantly effective for treatment of acute biliary pancreatitis and this minimally invasive treatment is the ideal therapy for acute biliary pancreatitis.

Although the Shanghai's basic health insurance always takes the leading position nationwide in the aspects of coverage, funding level, security level, etc, it still cannot avoid the contradictory problems brought by the rapidly rising demand for health care, poor results of funds management, etc. Commercial health insurance has its u-nique advantages in terms of funds and personnel management. Therefore, they can play their complementary role to the basic medical insurance in order to improve the basic health insurance system. Based on the perspective of com-mercial health insurances, this paper explores the basic health insurance system in Shanghai from the aspects of man-agement patterns, governing body, insurance objects, funding modalities and insurance programs.

According to the target-model of the health care system and characteristics of the health financing system,it is proposed in the paper that the charges of medical services should be the main revenue of public hospital compensation.Efforts should be made to adjust health care service prices and strengthen pharmaceutical management simultaneously so as to rebuild the structure of medical service charge.Medical insurance should make the majority in the compensation to cover most the medical expenses,with government subsidies supporting development.Both government financial investment and medical insurance should join their efforts for planning-guidance and performance-guidance.The authors also suggested to improve a graded and normative diagnoses and treatment system,regulate medical behaviors of public hospitals and their cost standards,justifying the total compensation and standard verification of such hospitals.

The paper summarized the explorations of public hospital pilots in the compensation mechanism and identified the following findings.For example,by means of fiscal support of public hospital infrastructure and development spending,cancellation of drug markup,higher service prices, and reformed payment mode of medical insurance,these hospitals have made initial changes at their business operating mechanism, motivation-guidance of compensation, and their makeup of medical revenue.In addition,such hospitals are found with lower cost of medical care per visit,and higher income of medical workers.The authors also pointed out such problems as inflated drug pricing and expenses,lack of scientific pricing mechanism for medical services,vague definition of policy-related losses,and old-fashioned practice of government investment and health insurance payment.Based on such findings,the paper advised to adjust health care prices by stages and to improve the management of health insurance and the coherence of compensation mechanism.

Objective To evaluate the effect of percutaneous coronary intervention (PCI) on left ventricular function in patients with different types of myocardial infarction and to explore the correlation factors for the left ventricular function.Methods A total of 43 patients diagnosed as acute myocardial iffarction were enrolled in this study.The perfusion and delayed enhancement magnetic resonance imaging (DE-MRI) was applied to observe the following parameters before the PCI and at month 6 after the procedure:infarct mass,left ventricular ejection fraction (LVEF) and abnormal wall motion score.The subjects were divided into the following three groups by the transmural extent of myocardial infarction manifested in the DE-MRI:the transmural enhancement group,the nontransmural group and the mixed group.Laboratory test was done to detect the level of endothelin (ET),matrix metal enzyme 9 (MMP-9) and high sensitive C reactive protein (hsCRP) before PCI and at month 6 after the procedure.The t test was used to compare the differences among the groups and the multiple regression analysis was taken to explore the correlation factors for the left ventricular function.Results Compared with the parameters before PCI,the infarct mass after PCI significantly decreased in the nontransmural group and the mixed group [(4.0 ± 2.9) g/cm3 vs (9.8 ±5.6) g/cm3 and (6.0 ±3.5) g/cm3 vs (11.8 ±6.2) g/cm3,all P ＜0.05],while LVEF was significantly improved after PCI in both groups [(52.6 ± 15.4) ％ vs (41.9 ± 16.3) ％,(45.6 ± 15.4)％ vs (38.9 ± 16.3)％,all P ＜0.05].The infarct mass was an independent correlation factor for LVEF before PCI (RR =0.318,P ＜0.05) and LVEF after PCI(RR =0.293,P ＜0.05).LVEF before PCI was independently correlated with the level of hsCRP (RR =0.318,P ＜ 0.05).Conclusion The effect of PCI on the improvement of left ventricular function differs in patients with different extent of myocardial infarction,which is correlated with the amount of survival myocardium and the inflammatory factors.

The purpose of this study was to reveal the current situation of health technology transfer in Shanghai hospitals,and to analyze the problems and needs.Questionnaire and interview were adopted for the study.We found that in the past 3 years,the transformation rate of patent technologies at Shanghai Tertiary Hospitals was 5.88％.The transfer routes mainly involves proactive enlist of enterprises by project leader,technology brokerage,exhibitions of patents achievements,friends' recommendation,etc..The main factors impacted the transfer included poorer quality of patent,lacking efficient management,and lacking channels for transfer.In order to improve the transfer of patents,hospitals need to provide information service,technology assessment,project packaging,patents application,consultant,and relevant trainings etc.Other things that could promote health technology transfer are to improve scientific research system,to enhance the quality of scientific achievements,and to develop technology brokerage.

Objective Establishing the scientific research competitiveness evaluation index system of Shanghai hospitals.Methods Delphi method and Analytic Hierarchy Process were applied.Results Thirty-four experts were invited to provide evaluation index and weighted scores.The positive coefficient from two rounds of expert's consultation were 88.24％ and 94％.The expert's opinion of authority coefficient of each indicator's was greater than 0.7.The degrees of coordinative consistency was high.Kendall concordance coefficient was increasing with the increasing of consulting times.After two rounds of Delphi expert consultation,2 level-one indictors,10 level-two indictors and 47 level-three indictors were confirmed.Conclusions After two rounds of Delphi expert consultation,using all objective indicators,an Index System for research competitiveness evaluation in the hospitals in Shanghai has been created and could be used with scientific,objectivity and feasibility.

Objective This paper analyzed the development and current situation of patents from first class hospitals in Shanghai,reflecting the development of scientific researches,providing medical science research management with data support as the basis of decision making.Methods Based on patent search and analysis of State Intellectual Property Office of The P.R.C and Incopat,a technology innovation intelligence platform with global patent information,patents from first class hospitals in Shanghai published before the year of 2015 are analyzed from aspects including patent category,legal status,time trend,applicants of invention patent,proprietor and inventors of authorized invention patents,transfer of invention patents,etc.Results First class hospitals in Shanghai had 1979 invention patents,which accounted to 56.38％ of the total.71.21％ of invalid invention patents fell into abeyance because of withdraw,rejection,and abandon,which was 2.47 times of those due to termination.Eight hospitals including Shanghai Ninth People's Hospital and Huashan Hospital were at the top of both the invention patent application list and the authorized invention patent list,both accounting to more than sixty percent.Conclusions The number of invention patents has gone through germination stage,developing rapidly in recent years,the ratio of authorized inventions appears to decline slightly after rise.The reasons of patent invalidation are worthy of attention,the information about legal status of patents can be reasonably used,applicants and inventors shows uneven distribution,patent quality should be emphasized with quantity rise,cross regional and cross border cooperation can bring about complementary advantages.

Although private hospitals are generally encountering development difficulties, some private non-profit medical institutions thrived in the medical market. These hospitals have rich experiences in terms of manage-ment system, operation mechanism, and competition methods. In this paper, we summarize the experiences of those well-functioning private non-profit hospitals and analyze the essential conditions for developing private non-profit med-ical institutions. These conditions include meeting local health market needs, ensuring that the hospital management system and operation mechanism result in high-quality health services, ensuring hospital development meets local health plans ( in order to obtain policy support) , ensuring the goal of the hospital is public welfare and that the hospital has strong financial support, obtaining certain social and political capital, and ensuring high-quality managers and staff.