Objective:It aims to analyze the implementation effects of Tianjin's medical insurance incentive pilot policies,with the objective of providing empirical references for regions across China in refining medical insurance incentive mechanisms.Methods:Through macro statistics and industry-related data,comparative analysis is used to assess the impact of Tianjin's medical insurance incentives on residents' enrollment rate and healthcare service utilization.Results:Tianjin's policies have enhanced the willingness of residents to continue to participate in the insurance,and guided participants to rationally use medical services.Conclusion:It is needed to focus on the accessibility of medical insurance incentives,increase the amount of outpatient treatment for zero-reimbursement personnel,and reduce the deductible of the next year's hospitalization.

The medical service price is an important source for public hospitals to compensate the cost of medical service.There are many kinds of diseases and complicated treatment plan.The price formation should reflect the characteristics of medical service.On the basis of reviewing the policy of medical service price classification formation and combining with the practice of medical service price classification formation in typical areas,it analyzes the influencing factors and mechanism of price formation,and obtains the enlightenment for other regions to improve the medical service price formation mechanism:cost pricing,value pricing and reference pricing methods reflect the value of technical labor and reasonable price comparison relationship;distinguish the types and disciplines of medical service items,explore the same price in the same city,high quality and high price,and promote hierarchical diagnosis and treatment;build an intelligent cost and price management platform to promote the coordination of medical service prices and regional economic development level.

Objective:To explore the differences in the characteristics of policies and the synergies between policy objectives and policy tools of health and wellness policies in Beijing-Tianjin-Hebei.Methods:The policy characteristics of the policies in Beijing-Tianjin-Hebei were analyzed with the help of Latent Dirichlet Allocation(LDA)theme model and text mining method.Correlation analysis and policy consistency modeling were used to analyze the consistency of policies issued from 2014 to 2023 in Beijing-Tianjin-Hebei in nine dimensions,including health care,training,emergency response,quality control,evaluation,regulation,medical insurance,medicine,and health care.Results:Beijing,Tianjin and Hebei have differentiated policy concerns at different stages,with Beijing focusing on healthcare integration and nursing care,Tianjin focusing on quality control and cost management,and Hebei focusing on physician qualification assessment and equipment management.Beijing,Tianjin and Hebei have steadily improved medical insurance interoperability and emergency response synergies,and lacked coherence in policy synergies in other dimensions.Hebei showed a stronger willingness to synergize the policy subjects.Conclusion:There is still a lack of long-term policy harmonization within Beijing-Tianjin-Hebei.In the future,efforts should be made to promote the process of policy synergization and coordination among the three regions of Beijing-Tianjin-Hebei in policy implementation.

Objective:To explore screening pathways and practical implementation strategies for primary care disease groups un-der the Diagnosis-Intervention Packet(DIP)payment.Methods:Matching and expert consultation methods were used to select primary care conditions,and experts included DIP National Steering Group experts,DIP experts from a sample municipal health-care security bureau,health policy researchers,coders from a tertiary hospital in Beijing,and big data engineers.Results:The DIP primary disease of"conservative treatment groups"in primary and secondary medical institutions were 104 and 105,repective-ly.The DIP primary disease of"primary can be completed groups"were 74 and 171,respectively.The final number of primary diseases in primary and secondary hospital was determined to be 178 and 276,respectively.Conclusions:The number of primary care disease groups varies from place to place,but it still needs to be dynamically adjusted and optimized in conjunction with big data methods and expert consultation,evaluated and corrected in a timely manner to ensure scientificity and effectiveness.The pri-mary care disease groups implement"same price for the same disease"across different levels of medical institutions,eliminating the differentiation of medical institution grade coefficients to promote hierarchical diagnosis and treatment.Cost-value measurement of disease group,scientific development of payment criteria for disease group,lack of regulatory tools for big data,and high sets of codes are key barriers to primary care implementation.

Objective:To investigate the clinical characteristics,contributing factors,and impacts of low-ratio cases under the Diagnosis-Intervention Packet(DIP)in tertiary hospitals,and propose actionable management strategies to promote the compliance and efficiency of medical insurance payment in tertiary hospitals.Methods:Based on retrospective analysis of 98 298 DIP-settled cases(January-October 2024)from a tertiary hospital in Henan,18 126 low-ratio and 80 172 normal-ratio cases were selected.Comparative metrics(demographics,hospitalization duration,primary care-sensitive conditions,medical insurance reimbursement ratios)were analyzed using non-parametric tests.Pareto analysis was applied to identify key diagnostic clusters.Results:Low-ratio cases exhibited distinct features:38.6％patients aged ≥61 years,32.5％hospital stays＜48 hours,l.0％primary care-sensitive conditions,Median reimbursement ratio was 0.69,with significant differences compared with general group.Seven diagnostic clusters(myeloproliferative disorders,poorly differentiated tumors,impact factors for health,medical treatment situation,etc.)accounted for 75.36％of low-ratio cases.Conclusion:It is suggested to optimize the medical service management under DIP payment through standardizing clinical pathways,enhanced coding quality,establishing policy feedback mechanisms,and promoting data governance.

China's Medical Service Price(MSP)reform has entered a new phase,implementing management measures.The compilation,implementation,and coordination of MSP item guidelines and the existing contradictions and problems were reviewed.It proposes strengthening price item management in planning under the background of the new era,itemizing in the alignment particle size,and comparing prices in the same coordinate system.This can offer systematic approaches and innovative strategies for improving the quality and efficiency of deepening MSP reform.

Objective:It aims to further optimize the Hospital Financial System to better adapt to the high-quality development of public hospitals.Methods:The implementation difficulties of the current Hospital Financial System is analyzed to explore its optimization logic from the perspective of policy synergy.Results:The optimization of the Hospital Financial System should reflect the achievements and directions of government accounting reform,scientifically reflect the laws of fund movement and policy management requirements,and further implement the spirit of financial and accounting supervision.Conclusion:It is suggested to comprehensively optimize the Hospital Financial System from the basic principles,main tasks,and other clauses,so as to better regulate the operation of funds,improve the level of hospital financial management,and help public hospitals achieve high-quality and sustainable development.

Objective:To provide evidence-based support and policy recommendations for improving the prevention and management of stable angina pectoris(SAP)within the current government chronic disease control system,based on the theory of Ambulatory Care Sensitive Conditions(ACSCs).Methods:A total of 104 066 hospitalized cases of angina pectoris were included.Using the SHA 2011 framework for total health expenditure analysis,factors influencing avoidable hospitalization for SAP were identified.Multivariable logistic regression analysis was conducted to examine the associations between these factors and hospitalization costs for SAP.Results:Avoidable hospitalizations were predominantly concentrated in tertiary hospitals(82.01％),where hospitalization costs were significantly higher than those in primary healthcare institutions.Multivariable logistic regression analysis revealed that insurance type had a significant effect on hospitalization costs,and patients treated in tertiary hospitals were more likely to incur high medical expenses.Conclusions:The current SAP prevention and treatment system faces challenges such as insufficient capacity of primary healthcare,resource concentration in tertiary hospitals,and the impact of medical insurance policies on hospital choice.It is recommended to strengthen primary healthcare services and include SAP in chronic disease management programs to reduce unnecessary hospitalizations.Additionally,expanding insurance coverage could help reduce the risk of catastrophic health expenditure among self-paying patients.

The Diagnosis-Intervention Packet(DIP)payment exerts notable effects on hospitals' economic operations.As centralized hubs of high-quality medical resources,tertiary hospitals face a functional mismatch with the provision of services for primary care diseases.By analyzing the admission and payment practices for primary care diseases in sample hospitals in Henan Province,it identifies key challenges,including inadequate alignment between healthcare payment reform policies and management systems,weak foundational capabilities in hospital health insurance informatization,and insufficient awareness of health insurance policies among medical staff.It is recommended that hospitals should strengthen communication and coordination with health insurance administration agencies to foster positive interactions between healthcare providers and insurers;continuously advance in-house health insurance informatization and enhance data governance capabilities;improve strategic awareness and innovate value-based health insurance management models.

Objective:It aims to discuss the impact of the competitive bidding access policy on the use of non-exclusive drugs in public hospitals.Methods:A national hospital sales data-based interrupted time series analysis was performed,using Q2 2023 as the intervention point,to evaluate the bidding policy's impact on non-exclusive drugs' price,utilization volume,sales revenue,and daily cost.Results:(1)With the adjustment of medical insurance payment standards,the prices of non-exclusive drugs have generally decreased.(2)Following the implementation of the bidding policy,the usage of most drugs increased significantly,with only a few experiencing a decline.Sales amounts showed a divergent trend,with some decreasing due to market competition or clinical substitutes,and others increasing due to expanded demand.The overall decrease in daily expenses effectively reduced the burden on patients.Conclusion:The bidding access policy has effectively lowered drug prices through competition,driving notable consumption growth for heavily discounted products,while those with strong substitutes showed limited uptake.Meanwhile,sales revenue and daily costs varied significantly across drug categories.