Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To investigate the influencing factors of cardiac autonomic dysfunction in maintenance hemodialysis (MHD) patients by recording 48 h heart rate variability.Methods:It was a single-center cross-sectional study. MHD patients at the Hemodialysis Center of Peking University People's Hospital between October 1, 2021 and December 31, 2022 were enrolled in the study. These patients initiated hemodialysis for more than three months and were older than 18 years old, and patients with tachyarrhythmia, implanted cardiac pacemaker and the recording time less than 48 h were excluded. Demographic data, comorbidity, laboratory data, hemodialysis session data and heart rate variability were collected. Multivariate linear regression model was used to analyze the influencing factors for cardiac autonomic dysfunction in MHD patients.Results:A total of 110 patients were enrolled in the study, including 37 females (33.6%) and 36 diabetic patients (32.7%). The age of the patients was (57.8±14.8) years old, and the median dialysis vintage was 73.00(27.75±130.25) months. At baseline, the serum phosphate level was (1.6±0.4) mmol/L, and the N-terminal pro B-type natriuretic peptide (NT-proBNP) after ln transformed {ln[NT-proBNP(ng/L)]} was 8.4±1.2. The standard deviation of all normal R-R interval (SDNN) was (90.6±27.9) ms, ln[root mean square of successive differences in R-R interval (RMSSD, ms)] 3.2±0.8, ln[low frequency (ms 2)] 3.4±1.3, ln[high frequency (ms 2)] 3.1±1.4, and ln[low frequency/high frequency ratio] 0.28±0.64. After adjusting the age, coronary heart disease, diabetes, hemoglobin, serum phosphate and 25-hydroxy-vitamin D, serum natrium ( β=2.042, 95% CI 0.021–4.064, P=0.048) and ln[NT-proBNP (ng/L)] ( β=-7.027, 95% CI -12.247–-1.808, P=0.009) were independently correlated with SDNN (adjusted R2=0.218). Univariate linear regression model showed that diabetes was correlated with ln[low frequency(ms 2)] of MHD patients ( β=-0.659, 95% CI -1.171–-0.146, P=0.012), but in the multivariate linear regression model, significant correlation between diabetes and low frequency was not found. After adjusting the diabetes, coronary heart disease, dialysis vintage, hemoglobin, serum phosphate, serum albumin, pre-dialysis systolic blood pressure, post-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, increasing age ( β=-0.011, 95% CI -0.019–-0.003, P=0.007) and ln[NT-proBNP(ng/L)] ( β=-0.151, 95% CI -0.253–-0.048, P=0.004) were independently correlated with a decrease in the ln[low frequency/high frequency ratio]. In the multivariate linear regression model with ln[high frequency(ms 2)] or ln[RMSSD(ms)] as dependent variable, after adjusting the relevant factors, serum phosphate level was independently correlated with ln[RMSSD(ms)] ( β=-0.421, 95% CI -0.777–-0.065, P=0.021) or ln[high frequency(ms 2)] ( β=-0.752, 95% CI -1.325–-0.180, P=0.010). Conclusions:Hyperphosphatemia is an independent influencing factor of parasympathetic nervous system in MHD patients. Higher NT-proBNP is associated with lower SDNN and lower ratio of low frequency/high frequency, so serum phosphate control and volume control should be highlighted. Age is associated with autonomic dysfunction in MHD patients, so more attention should be paid to elder patients.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.

Objective:To assess the impact of health insurance packaged payment in medical communities on the economicburden of patients,income and satisfaction of medical staff in counties.Methods:Using sample data from 2018-2022 from the national monitoring counties of medical communities,taking 2020 as the year of implementation of packaged payment,a double difference model was constructed with county population density and county per capita GDP as the control variables to assess the impact of packaged payment on the economic burden of patients,medical staff income and satisfaction in the county.Results:The packaged payment policy reduced the economic burden of patients to a certain extent and had a statistically significant positive effect on medical staff income in 2021,but it did not significantly increase the satisfaction of both supply and demand.Conclusion:The implementation of health insurance packaged payment of the MEC will not increase the economic burden of patients.It has a good pro-poor effect,and the income of medical staff has been improved to some extent,but there is still room for optimisation and improvement of the policy.