Objective: To explore a simple, effective, and safe method for excluding false positives and identifying infections by comprehensively evaluating blood donors with reactive HIV screening results, thereby providing a basis for developing management strategies for such donors. Methods: HIV testing data of blood donors from our laboratory from January 2022 to December 2024 were collected. The results of ELISA and nucleic acid testing (NAT) were combined with confirmatory results from the CDC and analyzed. Results: A total of 605 929 samples were tested for HIV over the three-year period, with 682 reactive samples (reactive rate: 11.25 per 10 000). All were sent to the CDC for Western blot (WB) confirmation, resulting in 53 confirmed positives ((confirmed positive rate: 7.77%). Among these, 619 samples showed isolated HIV Ag&Ab reactivity with non-reactive NAT (HIV Ag&Ab+-&HIV RNA or NAT NR), with a confirmed infection rate of 0%; 9 samples showed dual HIV Ag&Ab reactivity with non-reactive NAT (HIV Ag&Ab++&HIV RNA NR or NAT NR), also with 0% confirmed infection; 52 samples showed dual HIV Ag&Ab reactivity and reactive NAT (HIV Ag&Ab++&HIV RNA R or NAT R), all confirmed as positive (100% infection rate); and 2 HIV Ag&Ab dual-reactive samples without NAT detection were also confirmed infected (100%). For all four HIV Ag&Ab assays, the S/CO values in the true positive group with dual reactivity were significantly higher than those in the false-positive groups (P<0.05). The S/CO distributions for both single-reactive false positives and dual-reactive false positives were narrow, with the upper box (Q3, 75th percentile) below optimal cutoff values in all cases (The optimal cutoff values for the four reagents were 5.00, 11.67, 8.50, and 20.90, respectively). Conclusion: Blood donors with positive NAT results in HIV blood screening are permanently deferred. Donors with dual positive HIV Ag&Ab but negative NAT results are classified and managed based on the S/CO values of HIV Ag&Ab and the optimal screening thresholds. Donors with single positive HIV Ag&Ab but negative NAT results are placed under evaluation status and retain their eligibility to donate blood. Optimizing the management measures for blood donors and establishing a scientific stratified management and assessment mechanism can effectively maintain the stability of the blood donor team.

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 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.

As an important part of China′s multi-level medical insurance system, commercial health insurance has developed rapidly in recent years, but its guarantee level is still limited, and its role in the multi-level medical insurance system is not fully played. Huimin Insurance, as a new public private partnership health insurance, takes into account the dual characteristics of commercial operation and inclusive protection, and provides an important supplement to meet the needs of the masses for multi-level protection, alleviate the economic burden of serious diseases, and promote the innovation and development of the pharmaceutical industry. The author systematically analyzed the characteristics of social and commercial integration in the development of Huimin Insurance in China from the aspects of value-oriented mechanism, policy complementary mechanism and operation support mechanism, and analyzed the problems of in the current development process of Huimin Insurance based on the holistic governance framework of multi-level medical security system in three dimensions of " hierarchy-institutional-tool". It is suggested that the functional positioning of multiple subjects should be clarified, the ability of information integration should be enhanced, and the product design and serviceshould be optimized, so as to fully enlarge the supplementary security efficiency of Huimin Insurance, and explore a new path for the formation of a multi-level medical insurance system with Chinese characteristics.

With the explosive growth of " City-customized Medical Insurance" products, the voice of commercial health insurance needs medical insurance data support is increasing.The authors took " City-customized Medical Insurance" as the representative of commercial health insurance, analyzed the demands and motivations of stakeholders in medical insurance data sharing through the power-interest matrix model, and summarized the medical insurance data sharing path at the commercial insurance product design end and claim settlement end. It is suggested to strengthen the top-level design, build the implementation path of standardized sharing of medical insurance data and the operation mechanism of hospital data docking, to realize the value increment of all stakeholders.

By means of analysis of related national policies on medical alliances, and investigation of their current development in China, the authors summarized the conceptual category of existing medical alliances. Typical cases were selected for comparative analysis in terms of urban medical groups, medical communities, specialized alliances and telemedicine collaboration networks. In view of such setbacks found as lack of health services, ambiguity of power and duties of stakeholders, and low penetration rate of composite medical insurance payment, as well as lack of effective incentives and poor online diagnosis and treatment mechanism, the authors recommended on development of medical alliances in respect of framework improvement and mechanism optimization among others.

Objective:To analyze the filing mechanism for cross provincial immediate reimbursement of medical insurance in China, so as to provide reference for optimizing the filing mechanism and improving the filing accessibility of insured personnel.Methods:Taking the filing policy of cross provincial immediate reimbursement of medical insurance in 2019 as the research object, on the basis of a comprehensive understanding of the national filing policy background, 90 coordinating regions in Zhejiang Province, Hubei Province and Ningxia Hui Autonomous Region were taken as survey samples to evaluate the relevant policies and extract key parameters, including filing identification methods, filing-related settlement benefits and filing ways. The parameters were compared and analyzed by using descriptive statistical methods.Results:The results of the survey showed that in terms of identity recognition methods, the provision of various supporting materials(residence permit, work certificate, etc.)was still the main way to carry out identity recognition for medical insured persons in different places.Filing-related reimbursement benefits were mainly adjusted by limiting the area of medical insurance treatment and adjusting the benefits parameters(reimbursement ratio). In terms of filing channels, 51(56.7%)sample co-ordination areas had realized at least one remote filing mode.Conclusions:The inclusiveness of filing identity verification mechanism for the floating population needs to be further improved, the filing-related treatment policies need to be further improved, and the convenience and standardization of filing channels need to be strengthened.

After recent years′ development, China′s Internet medical service and medical insurance policy system has begun to take shape, but it still needs to be further improved. By combing the connotation and mode of Internet medical services, the evolution of medical insurance payment system and the content of medical insurance payment policy in the United States, the authors put forward that China could further improve the medical insurance payment policy system of Internet medical care, strengthen the multi-point practice management of licensed doctors on the Internet, give full play to the role of commercial insurance in promoting Internet medical care, and rely on information technology means to improve the medical insurance supervision of Internet medical services, then promote the development and management of Internet medical insurance services in China.

Objective:To provide a reference for establishing the evaluation system of the implementation effect of cross provincial direct settlement policy.Methods:By referring to the public policy evaluation model and using the expert consultation method, the authors built an evaluation index system for the implementation effect of cross provincial direct settlement policy for urban and rural residents. The multi-attribute group decision-making analytic hierarchy process, Matlab software and Yaahp software, combined with Spearman correlation coefficient method, were used to cluster the expert opinions and further determine the weight of each element at different levels.Results:The evaluation index system of the implementation effect of direct settlement policy for urban and rural residents′ cross provincial medical insurance was constructed, including 3 first-class indicators, 9 second-class indicators and 20 third-class indicators, and the weight of each index was calculated.Conclusions:The designed index system is suitable for grasping the implementation level of the cross provincial direct settlement policy from a macro perspective, and find out the problems in the implementation process. Efforts should be made to refine the evaluation criteria of the indicators in the index system.

The present use of artificial intelligence at primary health care institutions covers auxiliary treatment, voice electronic medical records, rational drug use, chronic disease management assistance, and auxiliary diagnosis of medical images. The authors analyzed the main factors restricting the development of primary medical artificial intelligence products, and put forward solutions from the perspectives of optimizing product functions, organizing expert resources from the national level. These efforts can assist in the examination and approval of medical artificial intelligence products, and improve the medical artificial intelligence system, so as to promote the healthy and sustainable development of artificial intelligence in primary medical and health institutions.