Objective:To analyze the characteristics of health financing at the provincial level according to the total health expenditure since China health system reform began in 2009 and provide evidence for improving health fi-nancing policy. Methods:20 provinces were chosen and vertical and horizontal Comparative approach was used to an-alyze the data. Results:Total health expenditure increased for all regions, of which the biggest rate was Anhui prov-ince, about 82. 97%, while the largest increasing for government health care expenditure was Ningxia province, a-bout 108 . 71%. In 2012 , the provinces with social health expenditure share of total above 40% were allocated in the east region, and the number of provinces with out-of pocket payment share of total above 40% reduces to 5. Conclu-sion:Total health expenditure grew in all regions, but there were differences in the degree that this spending matched the economic level;The financing structure was optimized, but the characteristic of regional financing was different. Some provinces were under huge pressure to reduce out-of pocket payments. Suggestions: Under the premise of im-proving the funding level, financing structure adjustment must be focused, and public funding should play a bigger role and out-of pocket payments should be reduced.

Objective:It aims to investigate the impact of tobacco use on Catastrophic Health Expenditure(CHE),providing a ba-sis for government investment in tobacco control and the formulation of effective anti-smoking policies.Methods:Based on the 2018 National Health Service Survey data from Shandong Province,the incidence rate,average overshoot gap,and relative overshoot gap of CHE under different thresholds for different household were calculated to analyze the distribution of tobacco-related diseases for smoking households.Results:In 2018,the overall incidence rate of CHE for current smoking households in Shandong Province was 13.56%(at a 40%threshold),with average overshoot gap and relative overshoot gap of 4.61%and 34.02%,respectively.As income levels decreased,the overall incidence rate of CHE increased.Rural current smoking households had higher overall incidence rates of CHE,average overshoot gap,and relative overshoot gap than urban households.Smoking households that experienced CHE were pri-marily afflicted with chronic diseases.Conclusion:The CHE risk is significantly higher in smoking households,particularly in rural and low-income households.It is recommend implementing a diverse range of promotional methods to strengthen anti-smoking health education,with a specific focus on intensifying awareness of the dangers of tobacco use in rural areas.Additionally,it is suggested to further increase tobacco taxes so as to reduce the motivation for smoking among low-income populations.

Objective:To investigate the overall clinical performance of nursing students and analyze its influencing factors to provide evidence for the improvement.Methods:A questionnaire survey was carried out among 288 nursing students from Qilu Hospital of Shandong University in March to May 2020. The survey included a general data questionnaire, Holistic Clinical Assessment Tool, Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, Medical Student Safety Attitudes and Professionalism Survey of nursing students. The factors associated with overall clinical performance of nursing students were analyzed by t test, analysis of variance, Pearson correlation analysis and multiple linear regression. Results:The total score of Holistic Clinical Assessment Tool was 114.95 ± 22.91. The total score of Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale was 156.70 ± 26.98. The total score of Medical Student Safety Attitudes and Professionalism Survey was 123.65 ± 31.00. The influencing factors included social practice experience and clinical learning environment, which accounted for 28.0% of the total variation of overall clinical performance of nursing students.Conclusions:Educators and managers of nursing students' schools and internship hospitals should actively explore the educational reform practice to promote the improvement of clinical ability, so as to promote the improvement of the overall clinical ability of nursing students.

The reform on the outpatient coordination of Employee Medical Insurance is very important in the field of medical secu-rity.It sorts out the design of outpatient treatment in areas where general outpatient coordination has been carried out before the na-tional reform of outpatient security launched in 2021,summarizes the institutional design and main characteristics of"two lines and one ratio",and provides a decision-making basis for further promoting the reform of total outpatient security in various regions.

Objective:To calculate the scale of China's mental health treatment costs,analyze its financing structure,and provide a decision-making basis for optimizing China's mental health disease financing,prevention and control policies.Methods:System of Health Account 2011 was employed to calculate mental disorders(MDs)curative expenditure,and analyze the expenditure by health function,health provider and financing schemes.Results:In 2018,MDs curative expenditure in China was 87.17 billion yuan.Of MDs curative expenditure,over 84%occurred in hospitals,and over 66%was spent on inpatient care.31.80%of MDs curative expenditure was financed by Out-of-Pocket(OOP).Conclusion:China's mental health and mental disorders treatment costs are developing rapidly,the existing resource allocation is unreasonable,and there is an urgent need to optimize the function and institutional configuration.MDs patients and their families bare a high burden on MDs curative expenditure,and the financing policy needs to be further improved.