Objective To explore the mechanism of participating in internet medical services(PIMS)on primary care utilization(PCU)and patient satisfaction,and to provide evidence and reference for promoting hierarchical medical treatment and improving patient experience through internet medical services.Methods A total of 24 primary health care(PHC)institutions in Y City were selected for questionnaire survey.Structural equation modeling and Bootstrap method were used to explore the mediating role of perceived quality and perceived value in the relationship between PIMS and PCU and patient satisfaction,as well as the moderating role of PHC institution type.Results PIMS is positively related to perceived quality and perceived value(β=0.184,0.172,P＜0.001).Perceived quality is positively related to patient satisfaction(β=0.804,P＜0.001),while perceived value is positively related to PCU and patient satisfaction(β=0.587,0.146,P＜0.05).PIMS at township health centers had higher perceived quality and perceived value than those at community health service centers.Conclusion Perceived quality and perceived value play a complete mediating role between PIMS and patient satisfaction and PCU respectively,and PHC institution type moderates the relationship between PIMS and perceived quality and perceived value.

Objective:To construct the evaluation indicator system of medical insurance capacity, healthcare service capacity, and pharmaceutical supply security capacity, and explore the process and law of medical-insurance-medicine linkage reform in the 12 years since the Sanming medical reform.Methods:Data from documents such as Development of Healthcare in Sanming City and Financial Performance Report of Public Medical Institutions in Sanming City were collected. The TOPSIS and coupled coordination models were used to measure the degree of medical-insurance-medicine linkage reform, and correlation analysis was employed to explore the relationship between medical insurance capacity, healthcare service capacity, pharmaceuticals supply securty capacity and the degree of medical-insurance-medicine linkage reform.Results:The degree of medical-insurance-medicine linkage reform in Sanming medical reform increased from 0.220 before the reform to the highest of 0.346, 0.642 and 0.831 in the stages of " governing chaos and blocking waste", " establishing rules and systems" and " treating diseases before they occur and promoting general health" respectively. The coupling coordination status advanced from moderate imbalance to sound coordination. The r-values of medical insurance capacity, healthcare service capacity, and pharmaceutical supply security capacity with the degree of medical-insurance-medicine linkage were 0.940, 0.926, and 0.789 respectively ( P<0.01), among which medical insurance had the highest correlation with the degree of medical-insurance-medicine linkage. Conclusions:Since the Sanming medical reform, the service security capacities in the fields of medical insurance, healthcare service, and pharmaceuticals, as well as the degree of medical-insurance-medicine linkage reform, have been continuously improved, showing the characteristics of differentiated development in different stages. Among them, medical insurance has played an engine role in the medical-insurance-medicine linkage reform of Sanming medical reform.

Objective:To explore whether the general hospital and primary healthcare institutions can achieve efficiency collaboration in tightly integrated medical alliances, with Sanming as a case study.Methods:The service data of 12 general hospitals and 129 primary healthcare institutions in Sanming city from 2021 to 2023 were collected, and data envelopment analysis was used to evaluate the comprehensive technical efficiency, pure technical efficiency and scale efficiency, and hierarchical linear modeling was used to explore the influence of the service efficiency of general hospitals on the service efficiency of primary healthcare institutions.Results:The comprehensive technical efficiency, pure technical efficiency and scale efficiency of the general hospitals were 0.966, 0.995 and 0.971, respectively higher than those of the primary healthcare institutions, which were 0.505, 0.670 and 0.745. The comprehensive technical efficiency of the general hospitals had a significant positive impact on the comprehensive technical efficiency of the primary healthcare institutions ( β=0.833). and the scale efficiency of the general hospitals could lead to the improvement of pure technical efficiency ( β=0.619) and scale efficiency ( β=0.705) of primary health care institutions ( P<0.05). Conclusions:Tightly integrated medical alliances could achieve efficiency collaboration between general hospitals and primary healthcare institutions. However, the service efficiency and development progress of general hospitals are superior to those of primary healthcare institutions, and the pure technical efficiency of general hospitals has not yet played a driving role.

Objective Based on the perspective of doctors and patients,it explores the impact of Internet medicine on primary medical and health service ability.Methods A survey was conducted with 331 physicians and 675 patients,t-test and structural equation modeling was employed to analyze the relationship between Internet healthcare services and primary healthcare services capacity.Results From the perspective of physicians,Internet healthcare services were positively correlated with comprehensiveness(service accessibility),family-centered care,comprehensiveness(service provision),coordination(information systems),community orientation,and coordination,but no correlation with first treatment accessibility and continuity.From the perspective of patients,Internet healthcare services were positively correlated with family-centered care,comprehensiveness(service accessibility),coordination(information systems),comprehensiveness(service provision),community orientation,first treatment utilization,coordination,continuity,and first treatment accessibility.Conclusion Internet healthcare services is an effective strategy for enhancing primary healthcare services capacity.It is crucial to consider the similarities and differences in the demands of both physicians and patients.Strengthen equipment renewal,medication security and talent construction from the perspective of doctors,optimize and improve the first diagnosis at the grassroots level from the perspective of patients,and integrate Internet medicine into the construction of healthy families by relying on the grassroots and communities from the perspective of doctors and patients.

Objective Based on the perspective of doctors and patients,it explores the impact of Internet medicine on primary medical and health service ability.Methods A survey was conducted with 331 physicians and 675 patients,t-test and structural equation modeling was employed to analyze the relationship between Internet healthcare services and primary healthcare services capacity.Results From the perspective of physicians,Internet healthcare services were positively correlated with comprehensiveness(service accessibility),family-centered care,comprehensiveness(service provision),coordination(information systems),community orientation,and coordination,but no correlation with first treatment accessibility and continuity.From the perspective of patients,Internet healthcare services were positively correlated with family-centered care,comprehensiveness(service accessibility),coordination(information systems),comprehensiveness(service provision),community orientation,first treatment utilization,coordination,continuity,and first treatment accessibility.Conclusion Internet healthcare services is an effective strategy for enhancing primary healthcare services capacity.It is crucial to consider the similarities and differences in the demands of both physicians and patients.Strengthen equipment renewal,medication security and talent construction from the perspective of doctors,optimize and improve the first diagnosis at the grassroots level from the perspective of patients,and integrate Internet medicine into the construction of healthy families by relying on the grassroots and communities from the perspective of doctors and patients.

Objective To explore the mechanism of participating in internet medical services(PIMS)on primary care utilization(PCU)and patient satisfaction,and to provide evidence and reference for promoting hierarchical medical treatment and improving patient experience through internet medical services.Methods A total of 24 primary health care(PHC)institutions in Y City were selected for questionnaire survey.Structural equation modeling and Bootstrap method were used to explore the mediating role of perceived quality and perceived value in the relationship between PIMS and PCU and patient satisfaction,as well as the moderating role of PHC institution type.Results PIMS is positively related to perceived quality and perceived value(β=0.184,0.172,P＜0.001).Perceived quality is positively related to patient satisfaction(β=0.804,P＜0.001),while perceived value is positively related to PCU and patient satisfaction(β=0.587,0.146,P＜0.05).PIMS at township health centers had higher perceived quality and perceived value than those at community health service centers.Conclusion Perceived quality and perceived value play a complete mediating role between PIMS and patient satisfaction and PCU respectively,and PHC institution type moderates the relationship between PIMS and perceived quality and perceived value.

Objective:To construct the evaluation indicator system of medical insurance capacity, healthcare service capacity, and pharmaceutical supply security capacity, and explore the process and law of medical-insurance-medicine linkage reform in the 12 years since the Sanming medical reform.Methods:Data from documents such as Development of Healthcare in Sanming City and Financial Performance Report of Public Medical Institutions in Sanming City were collected. The TOPSIS and coupled coordination models were used to measure the degree of medical-insurance-medicine linkage reform, and correlation analysis was employed to explore the relationship between medical insurance capacity, healthcare service capacity, pharmaceuticals supply securty capacity and the degree of medical-insurance-medicine linkage reform.Results:The degree of medical-insurance-medicine linkage reform in Sanming medical reform increased from 0.220 before the reform to the highest of 0.346, 0.642 and 0.831 in the stages of " governing chaos and blocking waste", " establishing rules and systems" and " treating diseases before they occur and promoting general health" respectively. The coupling coordination status advanced from moderate imbalance to sound coordination. The r-values of medical insurance capacity, healthcare service capacity, and pharmaceutical supply security capacity with the degree of medical-insurance-medicine linkage were 0.940, 0.926, and 0.789 respectively ( P<0.01), among which medical insurance had the highest correlation with the degree of medical-insurance-medicine linkage. Conclusions:Since the Sanming medical reform, the service security capacities in the fields of medical insurance, healthcare service, and pharmaceuticals, as well as the degree of medical-insurance-medicine linkage reform, have been continuously improved, showing the characteristics of differentiated development in different stages. Among them, medical insurance has played an engine role in the medical-insurance-medicine linkage reform of Sanming medical reform.

Objective:To explore whether the general hospital and primary healthcare institutions can achieve efficiency collaboration in tightly integrated medical alliances, with Sanming as a case study.Methods:The service data of 12 general hospitals and 129 primary healthcare institutions in Sanming city from 2021 to 2023 were collected, and data envelopment analysis was used to evaluate the comprehensive technical efficiency, pure technical efficiency and scale efficiency, and hierarchical linear modeling was used to explore the influence of the service efficiency of general hospitals on the service efficiency of primary healthcare institutions.Results:The comprehensive technical efficiency, pure technical efficiency and scale efficiency of the general hospitals were 0.966, 0.995 and 0.971, respectively higher than those of the primary healthcare institutions, which were 0.505, 0.670 and 0.745. The comprehensive technical efficiency of the general hospitals had a significant positive impact on the comprehensive technical efficiency of the primary healthcare institutions ( β=0.833). and the scale efficiency of the general hospitals could lead to the improvement of pure technical efficiency ( β=0.619) and scale efficiency ( β=0.705) of primary health care institutions ( P<0.05). Conclusions:Tightly integrated medical alliances could achieve efficiency collaboration between general hospitals and primary healthcare institutions. However, the service efficiency and development progress of general hospitals are superior to those of primary healthcare institutions, and the pure technical efficiency of general hospitals has not yet played a driving role.

Objective:To explore the perceived differences of medical staff in the hierarchical diagnosis and treatment effectiveness of telemedicine from the perspective of supply and demand, as well as the moderating effects in their respective regions, in order to provide reference for the integrated development of telemedicine services and hierarchical diagnosis and treatment.Methods:From June to September 2023, a survey was conducted on the current status and effectiveness of telemedicine services among medical staff from 245 hospitals in 27 provinces. Using non participants as the reference group, an ordered probit model was used to explore the differences in perception of the hierarchical diagnosis and treatment effectiveness of telemedicine services among medical staff who only served as suppliers, only as demanders, and simultaneously as suppliers/demanders; Using the region as a moderating variable, explore the perceived differences among medical staff in different regions.Results:A total of 997 valid questionnaires were obtained. Medical staff who only served as the demanders ( β=0.197, P<0.05) and simultaneously served as suppliers/demanders ( β=0.189, P<0.01) thought that the implementation of telemedicine could significantly improve the effectiveness of hierarchical diagnosis and treatment, while those who only served as the suppliers thought that the implementation of telemedicine did not significantly improve the effectiveness of hierarchical diagnosis and treatment ( β=-0.028, P>0.05). With the eastern region, medical staff in the central and western regions believed that providing telemedicine services simultaneously as suppliers/demanders could better improve the effectiveness of hierarchical diagnosis and treatment ( β=-0.324, P<0.05). Conclusions:The role and location of medical staff involved in telemedicine services could lead to differences in their perception of hierarchical diagnosis and treatment effectiveness.

Healthy Sanming is a new stage, a new goal and a new station of Sanming′s reform of medical and health system. Based on the rainbow model, the author summarized and analyzed the theoretical logic, content framework and practical effectiveness of the health protection system in new era, summarized the advanced experience and practices in the construction of Healthy Sanming, and systematically interpreted the Sanming practice in Healthy China. Vertically, the macro-level of institutional integration constructed a regional healthcare mechanism to improve the protection system, the meso-level of organizational integration promoted the four-tier referral mode to build a protection network, the micro-level of the professional integration carried out in-depth medical and preventive synergy and fusion to protect the key populations, and the service integration provided life-cycle health services to consolidate the health coverage. Horizontally, the instrumental level drived health performance through the innovation of the health insurance fund and payment method, and the value level standardized and balanced the layout of resources by enhancing the primary medical service capacity. Constructing the health protection system in new era is an important initiative for the construction of healthy Sanming, public hospitals have shifted their focus from treating diseases to treating diseases and health management, the service system has shifted from the program system of health care and health to the synergy and integration of medical and preventive care, and medical insurance payment has shifted from regulating the behavior of doctors′ practice to encouraging the development of health promotion. These health transformations have resulted in a series of experiences that can inform the articulation of the reform of medical and health system with the construction of Healthy China.