Performance agreements management plays an important role in transforming government functions, improving public management efficiency and quality of public services. The international experience shows that: performance agreements management, as a new tool, is also applicable to public hospital governance yet calling for basic policy environment,incentive mechanism and technical support.This paper analyzed the performance agreements managements'applicability in the governance of public hospitals,the implementation conditions and environment,the mechanism and so on,in order to provide a theoretical reference for the introduction of performance agreements for the pilot cities of the public hospital reform.

This study reviewed the history and major issues of the reimbursement system reform on public hospitals in China,and analyzed the impact mechanism of specific reform approaches including price adjustment of health service and government special appropriation on the health care services provided by hospitals using qualitative analysis methods.This study has the following findings:if the public hospital is allowed to operate independently,the compensation by health service price adjustment will encourage hospitals to increase their service provision;the compensation method of government special appropriation will decrease the amount of service,and probably cut back the amount of drugs sold;with both reforms combined,hospitals will be encouraged to increase their medical service provision to make up for the revenue lost caused by canceling drug mark-ups.Finally,there were several policy suggestions.

The objective of this article is to review the health decision support system and improve scientific decision-making and service. Based on the population and health data resources, the article designed the health deci-sion support system, covering public health, primary health, medical services, drug administration, and medical in-surance, with five core functions and function model, such as information support, monitoring, analysis and evalua-tion, forecast, and comprehensive optimization. It has also designed a system framework comprising data layer, busi-ness layer, presentation layer, as well as decision support databases including data warehouse, model base, method base and knowledge base were designed. Meanwhile, Taking medical insurance as an example, aiming at decision-making needs, the auxiliary decision making function was designed and successfully implemented.

The division of specialists and general practitioners is the important of the establishment of a GP system. According to the theory of labor division, the study analyzes the evolution mechanism on the division of spe-cialists and general practitioners and discusses the main factors influencing the division in China. It is found that transaction costs of general practices are not much lower than that of specialist medical care, which encourages outpa-tients to visit specialists in hospitals. Additionally, transaction costs of referral are much higher than profits. There-fore, while there is no division of specialists and general practitioners, it has been difficult to address competition between them and the quality and the efficiency of general practice care in community health centers. Moreover, the income gap does not attract medical students to work in general practices, which has worsened the quality and effi-ciency of general practices. Finally, the transaction costs of general practices have continually increased. This vicious cycle has hindered the division of specialists and general practitioners in China.

The health care alliance in county was the vertical integration of medical service system,which was conductive to improve the overall efficiency of the county medical service,achieve tiered health care system,optimize regional health resources and enhance the capacity of primary health care services.It took Tianchang County,Anhui as a case study.It investigated and analyzed how the local took measures to carry out the health care alliance reform in organization structure,interest distribution,health human resources construction,information construction,division and coordination mechanism,medical service pattern,etc.,so as to provide references for implementing county medical alliance reform in other regions.

Objective To study and compare the clinical and MR imaging characteristics of common intracranial ring enhanced lesions.Methods MR imaging studies of 65 intracranial ring enhanced lesions were reviewed retrospectively. The lesions included 17 glioblastomas, 17 metastasises, 12 brain abscesses, 8 acoustic neurinomas, 7 craniopharyngiomas, 3 neurocysticercosises, 1 malignant lymphoma. All cases were confirmed by surgery and pathology. Results The ring enhancement of tumors presented heterogenous thickness of thick walls and irregular forms. Among them, the highly malignant tumors appeared very obviously heterogeneous thickness of the walls, especially the inner walls were uneven and coarse. While the ring enhancement of the non-tumor lesions usually were of homogeneous thickness of the walls, regular shapes and smooth inner walls. Conclusion The different patterns of intracranial ring enhanced lesions on MR can supply important diagnostic information. Combining the patients' history, age, location and the information of magnetic resonance imaging, we may make correct diagnosis.

[Objective]To explore the relationship between Pglycoprotein,survivin expression and chemotherapy outcome.[Method]The expressions of P-glycoprotein,and of survivin were examined by the immunohistochemistry in 38 specimens of preoperation biopsy of osteosarecomas.[Result]The response rate of the P-glycoprotein positive group was lower than that of P-glycoprotein negative group.The response rate of the survivin overexpression group was significant lower than survivin was found to be more valuable in predicting chemotherapy results.[Conclusion]The expressions of P-glycoprotein,and of survivin are clearly associated with osteosarcomas response to chemotherapy in osteosarecoma and survivin is a more valuable parameter.

[Objective]To observe expression of inducible nitric oxide synthase and peroxynitrite anion around the prostheses,and study the relationship between the osteolysis and inducible nitric oxide synthase peroxyni-trite.[Method]Interface tissues were obtained at three Delee-Charnley acetabular sections and seven Gruen femur sections in six revision total hip arthroplasty surgery. The tissues were prepared for immunohistochemical assays to determine the expression of iNOS and nit rotyrosine (NT)-a specific“footprint”of peroxynitrite. Pre-revision X-ray films were observed to determine the incidence of osteolysis regions and non-osteolysis regions. The correlation between the positive cells and the severity of osteolysis were analyzed and compared.[Result]Data showed that zone Ⅲ has much higher iNOS positive immunostaining than that of zone Ⅰ and Ⅱ at acetabulum, and the expression of zone 1、2、6、7 was significantly higher than the other zone at femur(P

This paper reviews practices and features of health service system planning in some countries, and analyze its implications for China’s system planning. It is an international common practice to perform health service system planning to improve resource allocation efficiency, to meet multilevel demands of medical services, and to control dramatic growth of medical expenditures. Governments and their affiliated departments are the main body to formulate and implement the plans, and different levels of governments have different responsibilities in planning. During the procedure of formulating and implementing plans, collaborative governance network can be utilized to en-courage multi-party stakeholders to participate. The government should play an active role in planning to ensure the equity and accessibility of health services. The authority of planning can be achieved mainly through the comprehen-sive measures in legislation, political regulation, economic incentives, etc. Improved tools and methods based on multidisciplinary theories can be used to improve plan’s scientificity and delicacy. China can learn from international experience in formulating and implementing health service system plans.

Objective To learn the business operations of the pilot county-level public hospitals chosen for the 2014 experiment,which were subsidized at different levels in the financial subsidy mechanism reform.Methods County-level public hospitals from 109 counties were sampled as pilots from two provinces of the eastern,central and western regions of China.Descriptive analysis and correlation analysis were made to study their business operations at various subsidy levels.Results Proportional differences in the governmental financial subsidy level make a difference in the revenue and expenditure of county-level public hospitals.The higher the subsidy proportion,the lower the annual average of the total workload of the hospital(P <0.01),the less the inpatient expenditure per hospitalization(P =0.01),and the lower the drug proportion as well(P <0.01 ).Conclusions Financial subsidy plays a key role in the financial balance and business operation of such hospitals.Hence the government is proposed to guarantee its financial subsidy responsibility,to build a long-term financial subsidy mechanism.