This paper analyzed the procedure and organization for developing the clinical guidance by the National Institute for Health and Clinical Excellence(NICE).Focusing on the balancer role of NICE in the UK healthcare system as a statutory criteria maker,it analyzed the implementation and assurance mechanism of the clinical guidance for policy recommendations to the making and effective implantation of such a guidance in China.

Objective Analysis of roadblocks found in the reform of performance-based salary mechanism in public hospitals, along with recommendations for the implementation strategies. Methods Both the historical document method and qualitative method are called into play to identify the characteristics and measures for performance-based salary mechanism in public hospitals. Results Such roadblocks are mostly found in value measurement of the hospital services of welfare nature, criteria of appraisal and establishment of the indicator system, job evaluation and the extent of incentives to use. The authors hold that such reforms should go in parallel with the reform, development, management level upgrading, and cultural building of the hospitals, and should call into play roles of intermediacies. Conclusion Reform for performance-based salary mechanism will be inevitable in public hospitals, as it has a direct bearing on the mission and functionality of public hospitals. In spite of the difficulties met, appropriate strategies may powerfully push forward reforms and development of such hospitals.

External evaluation of large medical institutions is key to performance management in the medical sector,which is both a major means for the government to manage such institutions and a key guideline for their internal performance management. Based on a study on the pathways of such institutions in the UK,the USA and Japan in their external evaluation of performance,the paper summarized practices of Shanghai,Shenzhen,Zhenjiang and Beijing,in an attempt to offer references for building the external evaluation system for such institutions in China.

Objective To explore the job tasks and qualifications of midwives in China for the next five years.Methods Anonymous surveys were sent by email to 80 professionals to learn the job tasks and qualifications of midwives in China using the Delphi method.The recipients include senior midwives, nursing administrators and nursing educators,senior obstetricians and gynecology department chiefs,as well as health administrators.Results Learnt in the survey were the qualifications and job tasks of professional midwives in China for the next five years.The system concludes 77 job tasks of midwives, among which 31 items are supposed to be completed independently.Conclusion China should develop the midwife system as soon as possible,strengthen the midwife training and education,develop the midwife access system and the corresponding laws and regulations for midwives,standardize midwife management,clear the midwife qualifications and job tasks,formulate normative midwife promotion system,and realize the midwifery scientific management.

OBJECTIVE:To provide policy selection for pharmacy service fee reform in China under New Health Reform that drug addition in public hospitals is abolished completely throughout the country. METHODS:The situation and general characteristics of pharmacy service fee reform were summarized since New Health Reform. The multi-dimension of pharmacy service fee was analyzed to define the connotation of pharmacy service fee again. The solution to pharmacy service fee and clinical pharmaceutical care fee reform were put forward. RESULTS:There were many theoretical discussions on the establishment of pharmacy service fee since New Medical Reform,but no achievements had been made in reform practice. The connotation of pharmacy service fee should be subdivided,and the"pharmacy service fee"should be used as the content of the cost compensation for the public service provided by the hospital;"clinical pharmaceutical care fee"should be set up as the cost compensation content of the professional technical service;according to the different natures of the service,the corresponding policy could be designed. CONCLUSIONS:It is suggested that"pharmacy service fee",as lump sum fee,could be solved in the dynamic adjustment of medical service price;"clinical pharmaceutical care fee"should be approved independently and included in the standard charge items according to the individual project.At the same time,local pilot is encouraged,the charge of clinical pharmaceutical care is included in the national charge catalogue,and national standards are studied and formulated. The performance management model of pharmaceutical personnel can be adjusted to promote the healthy development of pharmacy subject.

Objective To explore the construction of professional system of midwives in China so as to provide the reference for formulating the midwife system , normalizing the midwife professional qualification and duty and responsibility , and promote the midwife subject toward more standardization and reasonable direction in our country .Methods Forty-one professionals who were from eight provinces and cities , twenty-six different levels of general hospitals and maternal and child health hospitals including business deans , directors of obstetric, obstetric doctors, midwives and nurses were interviewed through semi-structured interview, and the construction of professional system of midwives was researched .Results Four themes were refined through in-depth interviews and analysis including the structure of personnel currently engaged in midwifery ; the status of midwives’ duty and responsibility; the importance, necessity and contents of the construction of professional system of midwives; the contents of midwives ’ professional qualification and duty and responsibility . Conclusions We should develop the midwife system as soon as possible , and strengthen the midwife training and education , and formulate the midwife access system and the corresponding laws and regulations , and standard midwife management , and clear the midwife qualifications and duties , and formulate midwife promotion system so as to realize the scientific management of midwife , and promote the development of midwife subject , and further promote mother and child health , and protect the mother and child safety in our country .

Objective Based on social cognitive theory,to explore the main factors influencing the behavioral inten-tion of medical staff in merged medical community and the differences among county-township-village three levels medical staff.Methods The stratified random sampling was used to investigate the county-township-village three levels medical staff in merged county medical community,and multiple linear regression method and seemingly unrelated model(SUEST)were used to quantitatively analyze the influencing factors and differences among coun-ty-township-village three level medical staff's behavioral intention.Results The environmental factors including or-ganizational support(0.098),team integration(0.227),incentive mechanism(0.126)and individual factors including cognitive degree(0.118)and participation ability(0.053)can impact the behavioral intention of medical staff,and team integration has the greatest impact on the behavioral intention of medical staff at all levels.The incentive mecha-nism has more influence on the behavioral intention of medical staff at township(0.190)and county(0.165)level than village(0.083)level.Participation ability had more influence on the of village(0.187)level than township(0.129)and county(0.126)level.Cognition had a moderate effect,and organizational support had a smaller effect.Conclusion There are both similarities and differences in the influencing factors of medical staff's behavioral inten-tion,and targeted reforms should be carried out according to different characteristics.

Healthy Sanming is a new stage, a new goal and a new station of Sanming′s reform of medical and health system. Based on the rainbow model, the author summarized and analyzed the theoretical logic, content framework and practical effectiveness of the health protection system in new era, summarized the advanced experience and practices in the construction of Healthy Sanming, and systematically interpreted the Sanming practice in Healthy China. Vertically, the macro-level of institutional integration constructed a regional healthcare mechanism to improve the protection system, the meso-level of organizational integration promoted the four-tier referral mode to build a protection network, the micro-level of the professional integration carried out in-depth medical and preventive synergy and fusion to protect the key populations, and the service integration provided life-cycle health services to consolidate the health coverage. Horizontally, the instrumental level drived health performance through the innovation of the health insurance fund and payment method, and the value level standardized and balanced the layout of resources by enhancing the primary medical service capacity. Constructing the health protection system in new era is an important initiative for the construction of healthy Sanming, public hospitals have shifted their focus from treating diseases to treating diseases and health management, the service system has shifted from the program system of health care and health to the synergy and integration of medical and preventive care, and medical insurance payment has shifted from regulating the behavior of doctors′ practice to encouraging the development of health promotion. These health transformations have resulted in a series of experiences that can inform the articulation of the reform of medical and health system with the construction of Healthy China.

Objective:To evaluate the effectiveness of the new operation mechanism of public hospitals in Sanming, so as to provide a theoretical basis for the sustainable development of the new operation mechanism for public hospitals.Methods:The data on medical income and patient costs of public hospitals in Sanming and the whole country from 2011 to 2021 were selected, structural variation analysis was used to analyze and compare the changes in the structure of medical income of public hospitals in Sanming City and the whole country, and descriptive analysis was carried out on the patient burden costs, in order to validate the effect of the new operation mechanism for public hospitals in Sanming.Results:From 2012 to 2021, the cumulative values of structure variation in medical service revenue and drug/consumable revenue of public hospitals in Sanming City were 29.58% and -32.29% respectively, better than the national figures of -0.95% and -0.68%; the annual contribution rate of structural variation in the medical service revenue and drug/consumable revenue of public hospitals in Sanming were 78.10% on average, higher than the national figure of 49.43%. From 2011 to 2021, the average increase in the average outpatient and emergency care costs per patient in public hospitals in Sanming was 4.35%, lower than the national average of 5.97%; the average increase in the average inpatient costs per patient was 3.91%, lower than the national average of 5.40%.Conclusions:The new mechanism for the operation of public hospitals in Sanming is effective and sustainable under certain policy conditions.

The reform of medical insurance payment methods is one of the important measures for Sanming City to achieve universal health. This study explored the design and implementation of DRG payment method under global budget based on the case of Sanming, in order to promote the transformation from disease treatment to health promotion. The transformation practice of Sanming City involved three aspects: concept reshaping, structural reconstruction, and functional reconstruction, which were promoted from the dimensions of goals, paths, and methods, and have achieved significant results. The author proposed three recommendations, including adhering to and improving DRG payments under global budget, attaching importance to medical quality assessment and monitoring, and designing a global budget plus composite payment method that is suitable for various health scenarios.