Health technology assessment(HTA)is an important tool to inform health decision-making.Although highly related to ethical issues in the context of HTA,equity has attracted much attention from the academia,a consensus has not yet been reached on how to define and evaluate equity in China and abroad.It introduces the concept of equity,pointes out the necessity to realize health equity and the reflection of equity in healthcare sector,and further elaborates four ways to consider equity,and described the official practice of equity in HTA at home and abroad.It proposes several suggestions for China's HTA:considering equity in HTA and the discussion of equity should depend on specific decision-making scenarios;clarifying what health measurement perspective should be adopted before measuring health equity;paying attention to the value judgment of equity adopted by various stakeholders;conducting basic researches on the general population's preference for health measurement perspectives and value judgments of equity in China in a gesture to improve the evaluation system of equity in HTA.

In vitro diagnostic technology is an important aid for disease prevention,treatment,and prognostic monitoring.The de-velopment of its new technologies,methods and products is of great significance for improving medical quality and protecting public health.On the basis of exploring the mechanism of health impact of in vitro diagnostic technology,it takes dry chemical method and wet chemical method as an example,and compares the economy of the two diagnostic technologies for hyperkalemia diagnosis from the perspective of health system,with a view to draw references for the practical application and evaluation of new in vitro diagnostic techniques,methods and products in the future.

The payment methods,such as Diagnosis Related Group(DRG)for hospitalization and capitation for outpatient treat-ment,have achieved positive results in protecting the rights and interests of insured persons and improving the efficiency of the use of medical insurance funds.However,for patients with chronic diseases and rehabilitation nursing,the hospitalization period is long and the conditions complicated,and the payment method of DRGs is not reasonable.It analyzes the experiences of paying for long-term hospital cases in the US.and Germany from the aspect of reform process,payment method and regulatory measures.In order to pro-vide references for the reform of per-diem payment in rehabilitation nursing and other long-term hospitalized cases,it puts forward suggestions from aspects of realizing value care,reflecting individual differences,exploring complex payment methods,improving data quality and establishing constraint mechanism.

Objective:Based on the cost-effectiveness,it aimed to assess the health benefits amd economic value of screening,di-agnosis,treatment,and optimal delicacy management of liver disease in hepatocellular carcinoma(HCC)patients.Methods:A Deci-sion tree-Markov model was developed to compare the cost-effectiveness of HCC screening and long-term surveillance versus no screening in population at risk from the health care system perspective.Results:It is found that HCC screening was a cost-effective approach compared to no screening(Incremental Cost-Effectiveness Ratio[ICER]:17 790 yuan/QALY).Scenario analyses suggested that initiating HCC screening at the age of 40,as recommended by clinical guidelines,and implementing long-term surveillance based on risk stratification were more cost-effective.Conclusions:For the implementation of HCC screening programs,attention should be paid to improving participation and compliance among the population at risk,incorporating advanced screening methods,improving management efficiency with digital tools,and introducing innovative payment methods to reduce economic burden.

Based on the relevant policy documents of deepening medical service price reform in the pilot cities,combined with research and interviews,it analyzes the practical progress of measuring the total amount of medical service price adjustments in the pilot cities and the overall distribution of the total amount,the classification of items for pricing and dynamic adjustment,and the monitoring and assessment.It is suggested to explore the construction of a concise indicator system and a practical measurement method,consider the sustainability of the total price adjustment of medical services,and continue to optimize and improve the price adjustment mechanism of medical service price items.

BACKGROUND:Mechanical stimulation has been confirmed to promote osteogenic differentiation of bone marrow stromal stem cells,but the mechanism is unknown.Primary cilia are important mechanoreceptors and regulate various signaling pathways such as TGF-β1/BMP-2/SMAD.They are likely to be important targets for mechanical regulation of bone marrow stromal stem cells. OBJECTIVE:To investigate the effect and mechanism of fluid shear stress on osteogenic differentiation of bone marrow stromal stem cells. METHODS:Rat bone marrow stromal stem cells were divided into control group,mechanical stimulation group(fluid shear mechanics intervention by shaking table),mechanical stimulation + IFT88 silencing group(mechanical stimulation + silencing IFT88 expression with siRNA).After 24 hours of intervention,qRT-PCR was utilized to determine the expression of transforming growth factor β1 and bone morphogenetic protein 2.Western blot assay was used to detect the expression of phosphorylated SMAD2/3 protein.Immunofluorescent staining of primary cilia was conducted and morphology was analyzed. RESULTS AND CONCLUSION:Shear stress stimulation could promote the transcriptional activity of transforming growth factor β1 and bone morphogenetic protein 2 genes,and increase the expression of phosphorylated SMAD2/3 protein.After siRNA interfered with primary cilia,this mechanical response effect was significantly reduced.There was a Spearman correlation between the change ratio of the primary cilium area of bone marrow stromal stem cells and the increased ratio of transforming growth factor β1 and bone morphogenetic protein 2 gene transcription.These findings indicate that primary cilia/intraflagellar transport mediates the activation of fluid shear stress-responsive transforming growth factor β1/bone morphogenetic protein 2/SMAD signaling pathway and promotes osteogenic differentiation of bone marrow stromal stem cells.

BACKGROUND:Cervical neutral position magnetic resonance imaging is widely used for the diagnosis and treatment of cervical spondylotic myelopathy.However,it is not possible for patients to maintain the exact same position of the head and neck during repeated cervical magnetic resonance imaging examinations.The cervical spine undergoes minor flexion and extension movements in the sagittal plane,and the head may have a certain degree of variation in flexion and extension.Whether these changes in the neutral position of the cervical spine affect the volume of cervical discs herniation and cervical curvature is unclear. OBJECTIVE:Using artificial intelligence-assisted measurement,this study aimed to analyze the accuracy and reliability of magnetic resonance imaging examinations for measuring the volume of cervical discs herniation and cervical curvature in patients with cervical spondylotic myelopathy undergoing two consecutive cervical neutral positions in the short term. METHODS:A retrospective study was conducted on patients with cervical spondylotic myelopathy who underwent conservative treatment and underwent two consecutive cervical magnetic resonance imaging examinations within three months between June 2012 and June 2023.We proposed the use of occipital-thoracic distance and occipital-thoracic angle to evaluate the variation in flexion and extension of the head in the neutral position of the cervical spine.Based on the changes in occipital-thoracic angle,patients were divided into occipital-thoracic angle increase group and occipital-thoracic angle decrease group.Cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature were measured using artificial intelligence-assisted measurement software.Normal distribution data were represented by mean±SD,while non-normal distribution data were represented by the median(interquartile range).Spearman's rank correlation coefficient was used to analyze the correlation between changes in Cobb angle,cervical(C3-C7)curvature,and cervical discs herniation volume. RESULTS AND CONCLUSION:(1)A total of 104 patients and 326 cervical discs herniation were included in the study.There were 47 patients in the occipital-thoracic angle increase group and 57 patients in the occipital-thoracic angle decrease group.(2)Extension and flexion index of the head:There were no significant differences in occipital-thoracic distance and occipital-thoracic angle during the initial diagnosis and follow-up examination.The variation of occipital-thoracic distance was 0.035(3.23)mm,and the variation of occipital-thoracic angle was-0.31(3.28)°.The deviation range of occipital-thoracic distance and occipital-thoracic angle was small,and there was no significant correlation.(3)Cervical curvature index:There were no significant differences in C2-6 Cobb angle and C3-C7 curvature during the initial diagnosis and follow-up examination.There were no significant differences in C2-6 Cobb angle and C3-C7 curvature between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.(4)There was no significant difference in volume of cervical discs herniation during the initial diagnosis and follow-up examination.There was no significant difference in volume of cervical discs herniation between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.There was no significant correlation between the change of cervical discs herniation volume and the change of C2-6 Cobb angle and the cervical(C3-C7)curvature.(5)These results indicate that in the neutral position of the cervical spine,there were negligible minor flexion and extension movements in the sagittal plane,and the head was limited to a specific position.Although the head has a certain range of flexion and extension variation,it does not affect the accuracy and reliability of parameters including cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature.

The policy of long-term prescription for chronic diseases in China is gradually being improved and implemented， and external long-term prescription dispensing is being encouraged. The long-term prescription policy runs through the links of drug supply， equipment， use and policy， involving government departments such as medical security and health， as well as stakeholders such as patients， medical institutions and designated detail pharmacies. There are still some problems in the external dispensing of long-term prescriptions， such as the disunity of drug catalogue and the need for coordination among regulatory parties in the policy link； the need to improve the participation enthusiasm and service ability in the equipment link； the increased difficulty of prescription management， the need to improve the circulation platform in the use link. The promotion of external long-term prescription policy requires health insurance， medical service， and the medicine industry co-development， multi-party participation， and policy coordination. Among them， the “dual channel” policy， the policy of centralized medicine procurement， and the pharmacy included in outpatient overall management policy have all played a positive role in promoting the implementation of external long-term prescription dispensing for chronic diseases. It is necessary to improve supporting policies and implement regulatory responsibilities in the policy link， promote drug classification and service capabilities in the equipment link， improve the electronic prescription circulation platform， and strengthen prescription management in use link， so as to promote the implementation of external long-term prescription dispensing.

It analyzes the development achievements of the construction of the basic medical security system and the key issues of its high-quality development in China,and puts forward the countermeasures of promoting the high-quality development of the basic medical security system.In recent years,China's basic medical security system has made remarkable development achievements,but it is still facing a series of problems in the areas of participation,financing,treatment guarantee security and fund supervision.The implementation of accurate participation and expansion,the improvement of the financing mechanism,and the promotion of synergistic development and governance of medical care,medical insurance and pharmaceuticals are the keys to meeting the residents'growing health needs and promoting the high-quality development of China's basic medical security system.

Objective:To explore the structural characteristics of the medical service price network in the Yangtze River Delta,and provide a new management perspective for the collaborative governance of medical service prices in the Yangtze River Delta.Methods:Taking the related medical security bureaus of some core cities in the Yangtze River Delta as samples,based on the social network analysis method,the structural characteristics of price linkage network are analyzed from the perspectives of network density and correlation,individual centrality and block model analysis.Results:Firstly,the price network is not tight and has poor stability;secondly,the price network is unbalanced,with the Municipal Medical Insurance Bureau playing different roles;thirdly,the price network has obvious spatial aggregation and spatial spillover.Conclusion:The overall situation of the medical service price linkage network is not optimistic,and the network advantages should be fully integrated to promote the coordinated development of medical service prices in the Yangtze River Delta Region.