The author earmarked institutional defects as the key to China's medical and health system reform during the economic reform.Main progress and fruits of this reform during the past three years are listed as follows:theory and system innovation,initial establishment of the primary healthcare security system of nationwide coverage,establishment and implementation of the essential drug system,establishment and perfection of the primary healthcare system,equity of primary public health service,and general startup of public hospitals reform.In addition,the author identified such reform roadblocks and challenges as growing conflicts between the demand and supply of healthcare services,resistance for furthering the system reform,conflicts in drug production and circulation,lack of top-tier design for public hospital reform,and lack of systematic planning for talent development.

China ; Health Policy ; Public Health

Discussed in the paper are case-based payment practice in China,and outcomes of this practice for the past ten years.The authors pointed out that compared with DRGs,such a practice is exposed to such risks as low coverage of diseases,incompatible policies,defective pricing method,and lack of comprehensive evaluation.It indicates that China is on the initial stage of case-based payment reform which should be promoted with reference to international experiences.

Objective Constructing a hospital informatization level evaluation model and carry out an empirical research.Methods Based on experts' suggestions and comprehensive scoring method,a evaluation model of hospital informatization level has been formed,and 1,221 Chinese hospitals have been selected randomly in this empirical research.Results The evaluation model and rating scale is reliable,valid and sensitive,and it can be used to evaluate hospital informatization level at larger scope.The difference of informtization level between hospitals in different areas,different type is evident and the development situation in hospitals is imblalace also.Conclusion The hospilal should emphasis on the informatization,and improve the application of information technology.

Objective To investigate the impact of high plasma LDL-C level with or without metabolic syndrome(MS) on the incidence of stroke in Chinese adults. Methods Totally 42 626 subjects (25 -75 years old) from Chinese National Health and Nutrition Survey in 2002 were stratified four groups based on plasma LDL-C level: < 2. 00 mmol/L group, 2. 00 -2. 50 mmol/L group, 2. 51 -3.31 mmol/L group, and ≥ 3.32 mmol/L group. The prevalence of MS (with 2005 International Diabetes Federation criteria) and stroke and the risk factors of stroke were compared among the four groups. Results ( 1 ) The prevalence of MS and stroke increased with rising of LDL-C level. The prevalence of MS in LDL-C≥3. 32 mmol/L group increased 2. 5 times (7, 9% vs 20. 1% ) as compared with that in LDL-C < 2. 00 mmol/L group and the prevalence of stroke increased 4. 2 times(0. 5% vs 2. 1% ), all P <0. 01. (2) In subjects with similar LDL-C level, the prevalence of stroke was significantly higher in a subgroup with MS than that without (P <0. 01 ). (3) After adjustment for age, sex and smoking, logistic regression analysis showed that both LDL-C level and MS were positively associated with the development of stroke; the odds ratio (OR) was 2. 35 and 3. 15 ( P < 0. 0001 ), respectively. (4) Compared with the subgroup of LDL-C < 2. 00 mmol/L without MS, OR for stroke in the subgroups of LDL-C 2. 00 -2. 50 mmol/L, 2. 51 -3. 31 mmol/L, and ≥ 3. 32 mmol / L without MS was 1.03, 1. 89, and 2.08, whereas the OR for stroke in the subgroups with MS and similar level of LDL-C was 4. 38, 5.23 and 6. 15 ; this indicated that the risk of stroke in subjects with MS increased by 3 - 4 times compared with subjects without ( P < 0. 0001 ). Conclusion Both high LDL-C level and MS are independent risk factors of stroke, but the risk of stroke will be further increased in the presence of high LDL-C level plus MS. It is suggested that combined intervention therapy of LDL-C and MS will play an important role in the prevention of stroke.

Based on a description of the evolution,main reform practices and effects of public hospital payment system reforms,this paper focused on analyzing the existing problems found in the reforms.Such problems namely include lack of scientific and reasonable design of payment standards,lack of systemic and coordinated system reforms,and failure to fully mobilize the enthusiasm of medical workers to participate in the reforms,as well as other underlying causes.Based on such suggestions were put forward to promote public hospital payment system reforms,as negotiation of the payment standard between purchasers and providers,combined approaches in innovation in payment methods,advancing systemic payment system reform,and establishing a transmission mechanism of incentive to the medical personnel.

The paper presented the payment system theory of the primary health care service in China,the current status of the health service system,and analyzed main challenges for the time being.Based on such studies,the authors made the following policy proposals.The first is adjustment of the fiscal payment method of the government to such institutions in line with the classification guidance principle; the second is to shift the payment method of primary public health services to the post payment of fee-for-service; the third is reform of the performance-based salary system to link payment to medical workers directly with the amount and quality of their services; the fourth is a set of result-oriented performance appraisal indicators,with rising proportion of performance pay; the fifth is to integrate the outpatient clinic fund covered by medical insurance and the primary public health service fund,into a capitation payment.

Based on summarizing the international experiences and reviewing the historical evolution and current situation of the physicians'compensation system of public hospitals in China,this paper clarified the existing problems of the current compensation system.Such problems namely included lack of security on the source of the physicians'compensation,low level of sunshine salary which caused thecompensatory mechanism,lack of scientific design of the salary structure and allocation,as well as other underlying causes.Drawing lessons from reform practices at home and abroad,the basic principles and reform directions were put forward,as well as 4 route selections,namely establishing an security investment system to guarantee a stable and higher level salary under the current compensation system, implementing a high level of flip-type annual compensation with locking the current salary into files, establishing an appropriate compensation system referring to an innovated evaluation system of physicians in public hospitals,and coordinating closely with public institution reforms to promote physicians' compensation system reform.

Following an analysis of the problems and challenges of hospitals regulation in China and a comparative study of situations at home and abroad,this paper presented six policy proposals for the reform of public hospitals regulatory system in China.The policy suggestions included definite regulatory objectives,defined relationship between public hospitals and government,strengthening both economic regulation and social regulation, establishing multivariate regulatory system, introducing flexible regulatory methods and full utilization of the third-party impact,which met the requirements of public hospital in healthcare reform in China and propelled the reform forward.

Based on a definition of the concept and its connotation,and summary of the evolution and practice of global budget in China,this paper focused on analyzing the existing problems,namely a defective mechanism in the determination and adj ustment of the total budget,unreasonable settlement, absence of a regulatory mechanism and poor linkage of this system with other payment modes reform.Thus the authors proposed such policy recommendations as designated management of those covered by health insurance,and experiments with the global budget mode for regional groups,scientific estimation and adj ustment of the total budget,reasonable setting of settlement standards and rules,and enhanced supervision and appraisal,as well as various payment system reforms based on global budget.