Objective:Evaluating the impact of various hypoglycemic events on the Health-Related Quality of Life(HRQoL)of diabetes patients to provide empirical data for health technology assessment.Methods:The data was collected from a tertiary hospital in Jinan,Shandong Province,China.Health utility was measured using the Time Trade-off(TTO)method,and disutility was calculated based on the formula.Subsequently,the intergroup differences among various hypoglycemic event groups were analyzed.Results:The hypoglycemic events'average utility was all lower than the average utility for diabetics without hypoglycemic events(baseline status).Severe hypoglycemic events(0.108)had higher disutility compared to non-severe hypoglycemic events(0.008).Furthermore,nocturnal severe/non-severe hypoglycemic events(0.118/0.008)exhibited higher average disutility than daytime severe/non-severe hypoglycemic events(0.098/0.007).Conclusion:Optimal diabetes management demands prioritizing the prevention of both severe hypoglycemic events and nocturnal hypoglycemic events.

In recent years,the physician-patient relationship has been tense,the physician-patient conflict has been escalating,and the number of irrational medical complaints has been constantly increasing,all of which have a negative impact on the public image of the hospital and the legal environment of medical treatment.From the perspective of behavioral economics,it analyzes the reasons for the occurrence of irrational medical complaints among outpatient patients by applying behavioral economics theories such as bounded rationality,social influence,herd effect,loss aversion,endowment effect,and mental accounting.It constructs a model of irrational complaint behaviors of outpatient patients based on behavioral economics theory,and tries to draw lessons from framing effect and nudge theory to propose countermeasures for hospitals to reduce irrational medical complaints and boost the complaint prevention management of medical institutions.

Objective:To discuss how to construct the medical insurance access for medical service items based on Health Tech-nology Assessment(HTA)applicable to China.Methods:This study consolidated the current medical insurance access in some prov-inces and cities from China and identified deficiencies through the expert interview.We summarized the experience and indicators contained in the HTA report in UK and Singapore by using literature analysis.Results:In most regions of China,the management of medical services price is gradually moving from exclusion items based on certain conditions to access approach,lacking of tools for assessment.In UK and Singapore,the medical insurance access mechanism mainly consists of subject selection,scoping,HTA imple-mentation and decision-making,in the HTA report,with the data including clinical evidence,cost evidence and budget impact on health system,etc.Conclusion:Building an evidence-based health policy decision-making framework through multi-criteria deci-sion analysis and the construction of medical insurance access mechanism based on HTA can be achieved by developing national guidelines,multi-scenario HTA systems,and enhancing the supervision on the process of HTA.

Objective:To provide suggestions for exploring the ICER threshold's calculation method and reasonable estimation in China.Methods:It summarizes the consensus and analyze the disputes on thresholds in China based on theoretical and empirical research by literature review,compares the thresholds derived from willingness to pay versus opportunity cost methods.Results:Theoretical researches on threshold of China mainly focus on method for calculation,health output index,and health equity,etc.The controversy persists over the threshold's characteristics.The health care demand-side perspective willingness-to-pay method was the most widely used in the empirical studies,but the results of the thresholds measured by this method varied widely;the thresholds measured by the health care supply-side perspective opportunity cost method were lower than the thresholds obtained from the demand-side perspective.Conclusion:It is still essential to discuss the threshold's characteristics and establish the methods framework complementing both demand and supply side for Chinese health insurance,and to standardize and normalize the measurement methods,as well as to set up multi-level thresholds according to the preferences of the population,the severity of the disease,and so on,in order to take into account both economy and equity.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

The DRG payment has a significant impact on controlling the escalation of medical expenses and enhancing the quality and efficiency of healthcare.Ensuring the accuracy of diagnostic coding is the fundamental requirement for the DRG payment to be enforced.Based on the lens model,dual-system theory and prospect theory of behavioral economics,the cognition and motivation logic behind the coding of medical institutions under DRG are analyzed.It puts forward the corresponding suggestions,so as to provide a new theoretical perspective for improving the accuracy of DRG coding and advancing the implementation of the DRG payment reform.

Objective Explore the relationship between hospital characteristics and medical costs and length of stay,and thus provide policy recommendations for promoting the system of stroke classification and treatment.Methods Social Network Analysis methods were employed to explore the characteristics of medical institutions in stroke referral network,with multiple linear regression analysis used to explore the impact of network structure metrics on patients'length of stay,total hospitalization costs,and out-of-pocket expenses.Results A total of 11 918 stroke inpatients and 158 hospitals were included in the initial network.As the network threshold increases,the average length of stay per admission decreased from 15.76 days to 15.60 days,the average total hospitalization cost per admission decreased from 12 570.57 yuan to 1 1 897.40 yuan;and the average out-of-pocket cost per admission decreased from 1 745.66 yuan to 1 558.91 yuan.In the network with a threshold of 16,patients were referred a total of 89 740 times,with tertiary hospitals having the highest number of referrals(23 485 times for referral out and 21 371 times for referral in).Tertiary hospitals had the highest proportion of hospitals and centrality metrics in the referral network,except for degree centrality in the densest network.Higher centrality was associated with lower total hospitalization costs and out-of-pocket expenses,while higher closeness centrality was associated with shorter length of stay.Conclusion Tertiary hospitals occupied a dominant position in the stroke referral network.Secondary hospitals did not play an intermediary role in the system of stroke classification and treatment.Increasing the closeness of the referral network and forming closer and faster cooperation between medical institutions is beneficial to lower medical costs and length of stay.

The prevention and treatment of rare diseases is an important public health issue in China.Rare diseases are characterized by diverse types,complex conditions,and heavy burdened to patients,leading to a series of issues in the urgent demand in prevention and treatment of rare diseases in terms of individuals'health and the national responsibilities.Related legislation is an effective way to promote multi-disease preven-tion and treatment of rare diseases,and patients'protection in multi-level.We tease out and analyze the legal system on national and local level related to rare diseases,and recommend the coping strategies and give sug-gestions to improve and optimize the legal system for the prevention and treatment of rare diseases from the three dimensions of completeness,normalization and feasibility of the legislation,hoping to improve the competence of China's rare disease prevention and treatment and raise the level of protection for the patients.

Objective To quantitatively evaluate the structure and content of the long-term care policy for the older people in the 14th Five-Year Plan in China. Methods The primary indicators were constructed based on multi-source flow model,using Policy Modeling Consisten-cy(PMC)model,and the secondary indicators were constructed based on World Health Organization reports Long-term care for older people:Package for universal health coverage and Decade of healthy ageing:Plan of action.An evaluation system was formed,containing nine primary indicators and 35 secondary indicators.A total of eight policies issued by the nation between November,2021 and January,2024 were included.High-frequency words were extracted using ROSTCM 6.0,a semantic network map of keywords was created using Gephi,and the policies were analyzed using the evaluation system. Results The policies mainly focused on nursing,community,rehabilitation and nursing home,etc.The average PMC in-dex was 6.77.For the policy content coverage,one policy was perfect,five were excellent and two were accept-able.In the dimension of policy content,the indexes of three primary indicators of policy function,policy recep-tors and infrastructure construction were 0.85 or more;while the indexes of three primary indicators of caregiver assistance,support for the elderly and human resources building were 0.7 or less. Conclusion The content of long-term care policies for the older people issued in the 14th Five-Year Plan in China covers well in policy functions,policy recipients and infrastructure,and needs to be upgraded in the three dimensions of caregiver assistance,support for the elderly and human resource building.It is important to strengthen the policy content and measures in three areas,namely,the comprehensive care support network,the creation of an age-friendly environment and support for informal care.

Objective:To analyze the health responsibilities of both the supply and demand sides in the process of community chronic disease management for the elderly,as well as to provide a reference for the fulfillment of the health responsibilities of both the supply and demand sides in the process of chronic disease management.Methods:Elderly people were extracted as research subjects from communities,that were under the jurisdiction of the 27 community health service centers we selected.By using the method of questionnaire surveys and in-depth interviews,this paper analyzed the health responsibilities of both the supply and demand sides from the perspective of chronic diseases and health awareness among the elderly,self-management responsibilities of the elderly,and the health responsibility of community health service institutions.Results:There was still room for improvement in the fulfillment of health responsibilities by both the supply and demand sides,and the ability of elderly people to fulfill self-management responsibilities needs to be improved.Under the guidance of the three-level prevention theory,there were varying degrees of deficiencies in the fulfillment of health responsibilities by community health service institutions in all dimensions.Conclusion:It is suggested to clarify the health responsibilities of both the supply and demand sides for chronic disease management,with the goal of achieving the health of the elderly population,to complete both the supply and demand sides to jointly build an interactive model of health responsibility of chronic disease management in the elderly community,and to realize the health co-construction and sharing.