To discuss background of Medicare hospital payment system reform in the U.S., its legislative and administrative system and the key issues incurred during the design and implementation process, then summarized the experiences and lessons and suggestions were proposed for current provider payment reforms in China.

With the development of payment system reform for New Rural Cooperative Medical Scheme, inpatient case-based payment reform had been exploring in local counties. Based on the case study of one county in central China and synthesis of international evidences and experiences, to introduce the disease grouping principles, the cost calculating method, and the control measures of case-based payment mechanism by case-mix and provide significant lessons for other counties’ design and implementation of inpatient case-based payment reform.

The per-diem payment is a unit packaged payment used for the medical cost of hospitalization. At present some areas in our country explored the per-diem payment in hospitalization and have received obvious effect. The experiences of different areas carrying out the per-diem payment in our country were compared to find the strengths and weaknesses, and provide references for other areas.

Objective To screen mutations in genes including ASXL1, TET2, IDH1, IDH2, SETBP1, MPL515, JAK2 exon 12 and JAK2V617 in 135 polycythemia vera (PV) patients. To assess progreasson and genomics characteristics post polycythemic myelofibrosis. Methods DNA sequencing of ASXL1(Exon12),TET2 (Exons 3-11),IDH1(Exon4),IDH2(Ex-on4),SEPBP1(Exon4),JAK2 exon 12 and MPL515 (Exon 10) genes were carried out using Sanger method. JAK2V617 muta-tion was detected by allele-specific PCR in patients with PV. In the mean time, the mutation load of JAK2V617F allele (V617F%) was evaluated by real-time PCR using Tagman MGB probe. Then, the significant of gene mutations and clinical outcomes of post-PV Myelofibrosis(PPMF)was analyzed. To study risk factors of PPMF, logistic regression were employed. Results ASXL1, TET2, IDH1, IDH2 were mutated in 7.69%(8/104), 5.26%(1/19) , 0.08%(1/120) and 0.08%(1/121) of all PV patient respectively. JAK2 was mutated in 82.22%(111/135) of PV patients with mutation rate of exon12 of 2.96%(4/135) and there were no mutation of MPL515 and SETBP1 in PV patients. ASXL1 mutation was found in 31.82%(7/22) PPMF patients. Spearman analysis showed that ASXL1 is correlated with JAK2V617F (V617F%) (rs=0.298,P=0.002). The hemo-globin was lower in patients with ASXL1 mutation than patient without mutation (wild type). Leukocyte count, V617F%>50%rate, thrombosis and PPMF were higher in patients with ASXL1 mutation than that of ASXL1 wild type(P＜0.05). ASXL1 mu-tation, V617F%>50% rate and splenomegaly were all risk factors of PPMF. Conclusion ASXL1 mutation is the risk-fac-tor of PPMF and may promote V617F%by some mechanism.