OBJECTIVE:To provide reference for further improving negotiation mechanism of drug medical insurance in Chi-na. METHODS:Questionnaire investigation was conducted among the medical insurance agency and pharmaceutical company staff who participated in drug medical insurance negotiation in Jiangsu province,Jiangxi province,Qingdao,Chengdu. Their business fa-miliarity and recognition of the negotiating mechanism were also investigated. The descriptive analysis,independent sample t test and other methods were adopted to analyze the data statistically. RESULTS:A total of 70 questionnaires were distributed and 68 val-id questionnaires were collected with effective recovery rate of 97.14%. Respondents included 21 staff members of medical insur-ance agencies and 47 of pharmaceutical companies. In terms of business familiarity,the average score of respondents in all aspects was greater than 3(4 points system),the lowest score wasmanagement of the implementation of drug negotiation projects. There were statistical significances in scores of 3 items between 2 parties in the negotiation(P<0.05):basic principles of the drug negotiation process should be followednegotiation objectives in the substantive negotiation process total score of busi-ness familiarity. The scores of respondents in pharmaceutical companies were higher than those of health insurance agencies. In the recognition of the negotiating mechanism,average score of each survey item was ≥4(5 points system)in the recognition of the overall effect of the negotiation mechanism except forwhich is conducive to maintaining the price system of pharmaceutical com-panies. The average score of all aspects of preparation of the negotiations,substantive negotiation,implementation of the negotia-tion agreement and negotiation project's supervision and evaluation was >4 except forpatients taking drugs is quick and easy. There was no statistical significance between 2 types of respondents in all aspects of overall effect of the negotiation mechanism, preparation of the negotiations and negotiation project's supervision and evaluation(P>0.05). But in the recognition of the substan-tive negotiation,there was statistically significance between 2 types of respondents innegotiations between the two sides in an equal,cooperative,harmonious atmosphere(P<0.05). Healthcare agencies'respondents had higher scores than pharmaceutical companies'ones. And in the recognition of the implementation of the negotiation agreement,there was statistical significance be-tween 2 types of respondents in theafter the agreement entered into force,the medical insurance agency will be strictly in accor-dance with the agreementandfund pay to pharmaceutical companies timely and reasonable(P≤0.05). Healthcare agencies're-spondents have higher scores for than pharmaceutical companies'ones. CONCLUSIONS:The current drug medical insurance nego-tiation mechanism shows good overall effect and runs smoothly. But there are still some shortages,such as collected information the preparation stage is not sufficient;the procedures of patients taking the drug is complicated;negotiating parties do not have equal status;the fund is not paid to the pharmaceutical enterprise timely;evaluation is not perfect.

The paper analyzes the current status of and problems in the development of non-government medical institutions in Shanghai, the advantages non-government medical institutions possess and the difficulties they face in the process of development. It advances the development orientation of non-government medical institutions, arguing that it is imperative to create circumstances and conditions for fair competition, formulate perfect supporting policies, and lead non-government medical institutions to the integration of their own development with the reform and development of the medical and health cause of the country. It argues, on the other hand, that non-government medical institutions must stress simultaneously the accumulation and the operation of capital so as to have a niche in the fierce competitions of the medical market.

Objective To use the nested PCR technology to diagnose and identify a case of imported Plasmodium ovale wallikeri subspecies .Methods Blood sample was collected from 1 case of initially diagnosed imported tertian malaria and performed the ex‐amination of microscopy ,rapid diagnostic tests (RDTs) and nested‐PCR .Moreover the sequencing was conduced .Results RDTs showed the negative result ;the ring form and trophozoite of Plasmodium could be observed in the blood smear by microscopy ;the Plasmodium ovale wallikeri subspecies specific primer rOVA 1v/rOVA2v was adopted for conducting nested PCR ,the specicific am‐plification band appeared at 760 bp ,after sequencing and Blast aligning ,its coincidence with the partial sequence of Plasmodium ovale wallikeri subspecies in the Genbank database was 99% .Conclusion This patient is the first case of Plasmodium ovale wallik‐eri subspecies infection in Hubei province by nested PCR and sequencing analysis .

Objective To analyze the malaria control measures and epidemic trend in Hubei Province from 1974 to 2015, so as to provide the evidence for malaria elimination path analysis. Methods The malaria control data in Hubei Province from 1974 to 2015 were collected and analyzed retrospectively by descriptive epidemiological methods. Results The epidemic pro?cess of malaria in Hubei Province was divided into four stages. From 1974 to 1979,it was high prevalence state of malaria,and the average annual incidence was 174.47/10 000. From 1980 to 1999,the main control strategies were to control the infection source and mosquitoes,and the average annual incidence was 17.30/10 000,significantly downward. From 2000 to 2009, through the surveillance of infection sources and controlling malaria outbreaks and strengthening the floating population manage?ment,the average annual incidence was 0.42/10 000. After 2010,followed by the elimination phase of malaria,the incidence continued to decline. In 2013,there was no local infection for the first time. The difference of average annual incidence among above?mentioned stages was statistically significant(χ2=1 254.36,P<0.05). Conclusions The malaria epidemic process in Hubei Provincial experienced the high epidemic stage,sharply drop stage,low incidence phase and the elimination phase. How?ever,the natural factors affecting malaria still exist. Therefore,strengthening the control of imported malaria and surveillance should be the main task in the process of eliminating malaria in the future.

Objective To understand the malaria epidemic situation in Hubei Province from 2010 to 2014,so as to provide the evidence for formulating the effective malaria elimination strategies and measures in this province. Methods The data from the Disease Reporting Information System of Chinese Center for Disease Control and Prevention were collected and analyzed with the descriptive epidemiological method for the epidemiological characteristics of malaria in Hubei Province from 2010 to 2014. Results A total of 997 malaria cases were reported in Hubei Province from 2010 to 2014,there were 618 cases of vivax malaria,352 cases of falciparum malaria,18 cases of Plasmodium ovale infection,and 9 cases of Plasmodium malariae infec?tion. Among all the reported cases,479 were local cases and 518 were imported cases. No local malaria cases were reported from Hubei Province since 2013. The overall imported malaria cases showed a gradual increasing trend from 2010 to 2014,the pro?portion of falciparum malaria increased quite significantly from 2010 to 2014. The malaria cases were mainly distributed in Xiangyang,Wuhan,Xiaogan,Yichang,Jingmen and Suizhou cities,reaching 81.85%of the cases of the whole province. There were 810 male cases and 187 female cases,with a sex ratio of 4.33∶1. The local malaria cases were mainly aged from 40 to 69 years,accounted for 78.29%of the total local cases,and 88.22%(457/518)of the whole local cases were concentrated in 20-49 age groups. The local cases were mainly farmers(67.01%). Among the imported malaria cases,the occupation distribution concentrated mainly on the worker,migrant worker,and farmer(63.90%). Conclusions The local malaria epidemic situation has been effectively controlled in Hubei Province,which reflects the initiative achievements of malaria elimination. However, there are still many imported malaria cases from abroad. Therefore,the imported malaria from abroad still remains the key of ma?laria control in Hubei Province.

Objective To evaluate the effectiveness of the application of Wondfo Rapid Diagnostic Kit (RDTs) in the diagnosis of imported malaria cases in the Malaria Reference Laboratory of Hubei Provence. Methods The complete blood samples of malaria cases and negative card deletion cases reported in Hubei Province from January 2015 to June 2018 were collected and retrospectively analyzed. The results of the provincial malaria reference laboratory were used as the standard, and were compared with those results detected by RDTs, microscopic examination and nested PCR. The differences were statistically analyzed. Results A total of 440 complete samples were collected by the Malaria Reference Laboratory of Hubei Provence, of which 418 samples were confirmed as positive, and 22 samples were confirmed as negative. In terms of the identification ability of P. falciparum, RDTs performed the best, with a coincidence rate of 100.00%, and the coincidence rates nested PCR and microscopic examination were 97.49% and 91.40%, respectively. In terms of the identification specificity for another 3 species of Plasmodium (P. vivax, P. ovarian and P. vivax), nested PCR was the best, the microscopy method was the second best, and RDTs was the lowest. Based on the comprehensive analysis of 12 individual indicators, RDTs had the highest score (32), while the microscopic examination and nested PCR scored 24 and 19, respectively. Conclusion RDTs had certain advantages in the detection of malaria, but they had a low identification specificity for different species. Thus, they can be used as auxiliary tools for microscopic examination and widely used in surveillance work after malaria elimination in Hubei Province.

Objective To understand the number and prevalence of chronic filariasis patients in Hubei Province, and to provide a basis for effective care for patients. Methods The chronic filariasis patients registered in Hubei Province were interviewed to investigate the general condition of patients, the results of previous microfilaria examinations, and the current clinical symptoms, signs and onset of illness. Results A total of 487 chronic filariasis patients were investigated. The youngest was 32 years old, the oldest was 97 years old, and the average age was 76 years old. The 80-89 years old group had the largest number, accounting for 44.97%. The male accounted for 46.61%, and the female accounted for 54.39%. The occupation was dominated by farmers, accounting for 89.94%. Patients with lymphangitis accounted for 72.28%, with dermatitis accounted for 89.12%, with chyluria accounted for 11.29%, and with hydrocele accounted for 6.16%. Among the 352 patients with lymphangitis/lymphadenitis, the site of the attack was mainly at groin and lower limbs, accounting for 96.02%. Among the 433 patients with lymphedema/elephantiasis, the disease staging of the left and right legs was mainly concentrated in stage I-III, and there was no stage VII patient. Among the 55 patients with chyluria, the dysuria accounted for 30.91%. Of the 30 patients with hydrocele, 17 had tenderness, and 8 had positive light transmission tests. Conclusions Chronic filariasis patients in Hubei Province gradually decreased with the natural attrition. More care should be given by CDC at all levels and primary medical units to patients with chronic filariasis to alleviate their symptoms and improve their quality of life. Since the filariasis has not been eliminated globally, it is still necessary to strengthen the surveillance of migrant workers who go abroad to filariasis-endemic areas.