1.Pathways to regional coordination of medical insurance catalogs:The case of Zhejiang and Shanghai
Rui HUANG ; Li LUO ; Tian-tian ZHANG ; Cheng MAO
Chinese Journal of Health Policy 2025;18(10):19-23
Objective:Under the framework of regional coordinated development,this study aims to construct a generalizable pathway for the coordination of medical insurance catalogs,providing methodological support for dynamic adjustment and fund impact estimation,thereby promoting convergence among regional catalogs.Methods:The medical insurance catalogs of the insured and treatment regions were systematically compared to identify discrepant items.Based on the National Healthcare Security Administration(NHSA)service coding system,a"treatment region-national-insured region"mapping process was established to standardize item correspondence and accurately calculate interregional service volumes.A static scenario simulation was then conducted,using the number of interregional hospitalizations as the core indicator to design multi-threshold inclusion schemes and estimate the resulting impacts on insurance fund expenditures.Results:Using Zhejiang and Shanghai as a case study,344 discrepant items were identified,with therapeutic services being predominant.When the inclusion threshold for interregional hospitalizations increased from 0 to 500 cases,the number of included items decreased from 244 to 36,while the additional insurance expenditure declined from 892 million to 322 million CNY.Conclusion:The proposed coordination pathway demonstrates both scientific rigor and operational feasibility.It is recommended that regions establish a demand-oriented dynamic adjustment mechanism,prioritize the inclusion of high-frequency and high-demand therapeutic items,and improve multi-tier insurance systems to systematically advance the integration of regional medical insurance.
2.Analysis on the synergy degree between financing and payment of basic medical insurance for urban workers in China under the background of aging
Jin-xuan ZHENG ; Ruo-bin XING ; Jin-tao SONG ; Yan-tao MA ; Wan-yu YANG ; Yan-bing ZENG
Chinese Journal of Health Policy 2025;18(10):24-31
Objective:To analyze the synergistic relationship between financing and payment systems in China's urban employee basic medical insurance under the background of aging,providing decision-making basis for promoting coordinated development of these two systems.Methods:Based on statistical yearbook data from medical security systems,the Delphi method was employed to identify collaborative analysis indicators for urban employee medical insurance financing and payment under the aging population context.A collaborative theory-based model was constructed to measure the coordination degree of China's urban employee medical insurance financing and payment composite system,while simultaneously assessing the orderliness of the financing and payment system and the coordination degree of the composite system.Results:The order degree of the financing system ranged from 0.324 in 2019 to 0.517 in 2023;the order degree of the payment system ranged from 0.454 in 2019 to 0.517 in 2023;the synergy degree of both systems reached-0.084 in 2023.Conclusions:Influenced by aging,the development speed and scale of China's urban employee basic medical insurance financing system and payment system are asynchronous,with the payment system being more affected than the financing system,resulting in a non-coordinated and disordered development state of the composite financing-payment system.
3.Analysis of China's cross-regional medical insurance settlement policy based on policy tools
Shi-qiang WANG ; Hui WANG ; Shu ZHANG ; Zi-qi ZHANG ; Yi-jie LI ; Jia-yi LIU ; Guo-heng HU
Chinese Journal of Health Policy 2025;18(10):32-39
Objective:Systematically review the release status and characteristics of policies related to cross-regional medical insurance settlement policies in China,providing reference for promoting the convenience of medical insurance settlement services and improving management efficiency.Methods:Using content analysis,a two-dimensional framework of"policy objectives-policy tools"was constructed.A total of 127 policy documents were coded and analyzed.Results:Demand-based tools were applied most frequently(43.6%),followed by environmental and supply-based tools.Policy objectives mainly focused on improving service convenience,supported by expanding coverage and ensuring regulatory security.Conclusions:China's cross-regional medical insurance settlement policies have improved service accessibility and strengthened institutional supervision while gradually expanding coverage.However,deficiencies remain in assessment refinement and emergency mechanisms.Greater interdepartmental coordination is needed to enhance regulatory linkage and ensure the safe operation of medical insurance funds.
4.Mini Health Technology Assessment report standardizes:The optimization and selection of key items
Zi-yi WANG ; Ya-fang LI ; Wen-di LIU ; Jia-yi HUANG ; Fa-qiang ZHANG ; Jun-liang TAO ; Ye ZHU ; Ke-hu YANG ; Xiu-xia LI
Chinese Journal of Health Policy 2025;18(10):75-82
Objective:To construct a key item checklist for the Mini-HTA report specification,providing scientific guidance for drafting each section of Mini-HTA research reports,enhancing their standardization,scientific rigor,and completeness,thereby improving the efficiency and quality of health decision-making.Methods:Based on preliminary literature review and qualitative systematic review,a pool of problem items for the Mini-HTA report specification was formed.Delphi questionnaires were distributed,and the Delphi technique was employed through two rounds of expert consultation to optimize and select key items.Results:Through two rounds of Delphi expert consultation,the initial Mini-HTA report specification item checklist was screened,integrated,and supplemented.A finalized key item checklist was constructed,comprising 8 first-level items(Title,Abstract,Introduction,Methods,Results,Discussion,Conclusion,and Other Relevant Information)and 48 second-level items.Conclusion:The constructed key item checklist for the Mini-HTA report specification provides scientific guidance for drafting Mini-HTA research reports.It helps enhance the standardization and transparency of the assessment process and the reliability of results,thereby optimizing the efficiency and quality of health decision-making.
5.Research on primary healthcare medication continuity and security in China from the perspective of policy tools:A quantitative analysis based on provincial policy texts from 2020 to 2025
Qiang YAO ; Yue-fang JIAO ; Xiu-fang ZHANG ; Yan-ping HE ; Xiao-dan ZHANG ; Miao ZHANG ; Lan YAO
Chinese Journal of Health Policy 2025;18(10):1-8
Objective:To comprehensively analyze the current situation of the policy tools for primary healthcare medication continuity and security in China,and to provide advice for improving the policy system of primary healthcare medication continuity and security.Methods:Based on the theory of policy tools,a two-dimensional analysis framework of"policy tools-policy goals"was constructed.Results:A total of 407 policy text codes were generated from 58 policy texts included in the analysis.Among them,the supply-based policy tools were the most(41.03%),followed by environmental(37.59%)and demand-based(21.38%);the policy goals mainly focused on promoting the equipment and linkage of medication(21.84%),optimizing the types of medication(18.88%),and improving the centralized supply and distribution of medication(18.25%).Conclusions:Significant regional disparities exist in the design and implementation of China's primary healthcare medication continuity and security policies.Certain policy tools are absent,policy objectives lack comprehensive coverage,and coordination remains inadequate.It is suggested to optimize regional policy layouts through differentiated configuration and cross-regional coordination,enhance policy adaptability by refining policy tool combinations,strengthen weak segments and vertical coordination,promote the articulation of primary healthcare medication based on tight medical consortium,and finally build a systematic and dynamically adaptive primary healthcare medication continuity and security policy system.
6.The impact and enlightenment of market-driven price comparison mechanisms on the prices of commonly used retail drugs
Hong-yuan WU ; Rong JIANG ; Fan YANG
Chinese Journal of Health Policy 2025;18(10):9-18
Objective:To explore the impact of public price comparison of medical insurance drugs on the prices of commonly used retail drugs,and to provide empirical analysis and theoretical basis for optimizing the price governance of commonly used retail drugs.Methods:Based on the sales and settlement data of commonly used drugs in medical insurance designated retail pharmacies in Shenzhen,Guangdong Province from December 2023 to February 2025,the chain Fisher index and ARIMA model were used to analyze the price change trend of commonly used retail drugs.Results:During the study period,the price level of commonly used drugs decreased significantly twice.However,during the stable period after the decline and in the prediction of the price level,the price level would rebound at an average monthly rate of 1%.The price changes of different categories of drugs showed significant heterogeneity:drugs with fierce market competition and higher common use were more affected by public price comparison,with larger price drops.The market-led price comparison mechanism has a weaker impact on drug price reduction than centralized volume-based procurement.Suggestions:Optimize the design and publicity of price comparison mini-programs to give full play to the due price control effect of social supervision,use medical insurance settlement data to build a drug price early warning mechanism,and guide enterprises to obtain profits by replacing price competition with technological innovation and service upgrading.
7.The impact of internet use on the well-being of the elderly in China:A trajectory-based analysis
Jing GUO ; Pei WANG ; He LIU ; Yuan YAO ; Yan-xi HU ; Yao YANG
Chinese Journal of Health Policy 2025;18(10):40-48
Objective:To identify the developmental trajectories of internet use and well-being among the elderly in China,and to explore the dynamic relationship between these trajectories and the moderating role of intergenerational support from children.Methods:Group-Based Trajectory Modeling was employed to identify developmental trajectories,and moderated generalized logits models were used to analyze the relationship between trajectories and the moderating effect of intergenerational support from children.Results:Both internet use and well-being among the elderly exhibited differentiated developmental trajectories.Internet use trajectories had a significant positive impact on well-being trajectories.Compared with the low-level group,the elderly in the moderate internet use group being classified into the medium-and high-level well-being groups were 1.550 times(P<0.01)and 1.539 times(P<0.05)those of the offline group respectively,while those in the high-frequency internet use group were 9.560 times(P<0.01)and 9.030 times(P<0.01),respectively.Intergenerational support from children negatively moderated this relationship(medium-level well-being group:OR=0.768,P<0.05;high-level well-being group:OR=0.733,P<0.05).Conclusions:Internet use can sustainably enhance the well-being of the elderly over the long term,with this effect being more pronounced among those receiving less intergenerational support from children.It is recommended to establish a dual-track service system integrating online and offline channels,and to prioritize internet empowerment as a targeted social support strategy for the elderly with insufficient intergenerational support from children.
8.The health risks of flexible work and the buffering effect of medical security
Chinese Journal of Health Policy 2025;18(10):49-57
To investigate the impact of flexible work on the health of Chinese workers and its underlying mechanisms,as well as to examine the moderating role of basic medical insurance and minimum wage policies,this study uses two waves of panel data from the China Family Panel Studies(CFPS)in 2020 and 2022.It constructs a two-way fixed effects model to test the influence of flexible work on workers'physical and mental health.The results show that flexible work significantly reduces workers'physical health levels,while its impact on mental health fails to pass the significance test.Flexible work exerts negative effects on physical health mainly by blurring the work-family boundary and triggering the income penalty effect.Such negative impacts are more prominent among specific groups of workers,including males,middle-aged and elderly individuals,those with lower educational levels,formal employees,and workers with fixed workplaces.Urban Employee Medical Insurance,Urban-Rural Resident Basic Medical Insurance,and the minimum wage system can effectively mitigate the negative health impacts of flexible work.Therefore,efforts should be made to expand the coverage of medical insurance and set reasonable minimum wage standards,so as to build a more health-inclusive flexible work environment.
9.Promoting HPV vaccination coverage through configurational research:A fuzzy-set qualitative comparative analysis of 110 countries
Hong-rui WANG ; Che DENG ; Jiao ZHANG ; Hong HE
Chinese Journal of Health Policy 2025;18(10):58-65
Objective:To explore the configurational characteristics of conditions influencing HPV vaccination coverage across countries,identify typical models for achieving high vaccination coverage under different developmental contexts,and provide references for the formulation of HPV vaccination policies in China.Methods:Using 110 WHO member states as the analytical sample,this study employed fuzzy-set qualitative comparative analysis(fsQCA).Seven conditions were selected from two dimensions—macrosocial factors and policy elements—to examine their effects on improving HPV vaccination coverage.Results:No single antecedent condition constituted a necessary condition for promoting HPV vaccination coverage.The solution yielded five main condition configurations,which were further categorized into three representative patterns:"Resource-Saving""Economy-Driven"and"Target-Focused."Conclusion:The configurational conditions for improving HPV vaccination coverage exhibit multiple concurrent characteristics.School-based vaccination models play a generally facilitating role,while reducing the number of doses and adjusting target population restrictions are key driving factors under resource-limited conditions.Different patterns reflect the synergistic effects between socioeconomic environments and policy design,providing theoretical and practical references for optimizing HPV vaccination policies across diverse contexts.
10.Domestic and international experience and implications on development and utilization of health data
Ru WANG ; Jun FENG ; Lu-yi JIANG
Chinese Journal of Health Policy 2025;18(10):66-74
Data has become the fifth major factor of production in China.To accelerate the development and utilization of public data resources,China has established a"1+3"policy system framework.However,there remains considerable room for exploration in aspects such as data authorization pricing and authorization models.In particular,health data possesses both personal privacy and public data attributes,requiring multi-factor trade-offs between security protection and development benefits.The United Kingdom,the United States,and China's Hong Kong Special Administrative Region have accumulated certain prior experiences in the development and utilization of health data.This article systematically studied and sorted out the institutional design of the construction,organizational structure,and operation mechanism of health data open platforms in these three countries/regions.Combining with China's domestic realities,specific suggestions were put forward regarding the construction of health data platforms,data resource registration,ethical review and security management,as well as pricing mode,aiming to provide a reference basis for the formulation of relevant policies and systems.

Result Analysis
Print
Save
E-mail