OBJECTIVE To investigate the factors influencing the changes in purchasing quantity in the procurement varieties of the first batch of volume-based drug centralized procurement （hereinafter referred to as centralized procurement）. METHODS Using 25 procurement varieties of the “4+7” policy as research objects， the changes in purchasing quantity of procurement varieties were analyzed before and after the implementation of the “4+7” pilot， renewal and expansion policies. The influential factors were determined from the three levels of drugs， medical institutions and regions； and the multiple linear regression model was used to analyze the influential factors for the changes in the purchasing quantity of procurement varieties. RESULTS Before and after the implementation of the “4+7” pilot， renewal and expansion policies， the purchasing quantity increased by 52.1， －0.2， 85.8 ten thousand DDDs on average， compared with base period. During pilot， renewal and expansion period， DDDc decrease in procurement varieties was positively correlated with the increase in purchasing quantity （P＜0.01）. During the pilot and renewal period， the number of absolutely alternative varieties was positively correlated with the increase in purchasing quantity （P＜0.1）. During the pilot and expansion period， the number of alternative varieties to a certain extent was negatively correlated with the increase in purchasing quantity （P＜0.05）. During the renewal period， the increment of purchasing quantity in tertiary hospitals was smaller than that of primary medical institutions （P＜0.05）. CONCLUSIONS There is a relationship between the decline of DDDc and the changes in the purchasing quantity， that is， the more the drug price dropped， the more the purchasing quantity increased. The number of alternative varieties for centralized procurement will affect the changes in their purchasing quantity， but it is not always stable. With the implementation of the policy， the volume of primary medical institutions gradually exceeds that of tertiary institutions， indicating that the consumption of centralized purchased varieties is transferred to the primary medical institutions， and centralized procurement has promoted the implementation of the hierarchical diagnosis and treatment system.

Health insurance fund regulation (HIFR) is a vital issue in the modernization of healthcare security governance, with its importance as a primary task of the healthcare security department continually reinforced in policy practice. This study focused on the 22 specialized policies issued by the National Healthcare Security Administration from its establishment in 2018 to March 2024, deeply analyzed their issue characteristics, and summarized the evolutionary trends of policy changes, as well as the knowledge production patterns that existed in the series of policy formulation, implementation, and feedback processes. Our analysis revealed that the diverse issue characteristics had led to heterogeneous directions in HIFR policies. The policy development process presented distinct composite evolutionary trends, mainly manifested in four aspects: the integration of regulatory system and content, the convergence of professional and societal forces, the parallelism of special governance and regular supervision, and the complementarity of conventional and emerging methods. Additionally, the study demonstrated that the knowledge production embedded in policy evolution encompassed four different dimensions: problem rectification, norm setting, pilot experience, and technical absorption. Together with issue characteristics and policy evolution, they formed an integrated, dynamic, and open system of knowledge production, continuously promoting the renewal and iteration of regulation policies.

OBJECTIVE To investigate t he attitude of endocrinology physicians to clinical conversion and substitution of insulin drugs ，and to provide basis for improving the centralized procurement program of insulin. METHODS The proportion of convertible and substitutable insulin recognized by endocrinology physicians was investigated by questionnaire from 4 dimensions： intergenerational level ，bargaining group level ，common name level and brand/specification level. The subjects were endocrinology physicians in the third grade class A general hospitals in Nanchang. RESULTS A total of 89 questionnaires were successfully distributed，accounting for 80.2％ of the on-the-job endocrinology physicians （111 in total ）in the third grade class A general hospitals in Nanchang. Eighty-nine questionnaires were collected ，one of which was invalid ，and the effective rate was 98.9％. At the intergenerational level ，93.2％ of endocrinology physicians preferred insulin analogues. At the bargaining group level ，the weighted average of the convertible ratio between group 3 and group 4 approved by physicians was 63.9％. At the levels of common name and brand/specification ，the weighted averages of convertible proportion of each group were more than 70％. CONCLUSIONS The method of insulin grouping in Wuhan is reasonable which can complete clinical conversion and substitution of insulin in the group safely. It is suggested to cancel long-acting human insulin group. The weighted average of the proportion of convertible and substitutable drugs in the group is high. It is suggested to increase the agreed purchase volume of insulin and conduct“volume price linked ”negotiations. When the surveyed physicians choose the initial treatment scheme of insulin ，they pay more attention to the factors such as efficacy and safety ，so the replacement of insulin should be based on the clinical efficacy and drug safety.

Objective To analyze the composition and influencing factors of the hospitalization expenses of patients with cardiovascular and cerebrovascular diseases who has participated in basic medical insurance, and to provide evidence for controlling excessive increase in the hospitalization expenses and reducing the financial burden of patients. Methods The hospitalization information of 14,271 insured patients with cardiovascular and cerebrovascular diseases from January 1, 2019 to December 31, 2019 in Xianning City, Hubei Province was retrospectively collected. The basic information of the patients and the composition of their hospitalization expenses were descriptively analyzed, and the influencing factors of hospitalization expenses of the patients were analyzed by univariate analysis and logistic regression analysis. Results Among the patients included in the study, coronary heart disease, cerebral infarction, cerebral hemorrhage and essential hypertension were the four main types of cardiovascular and cerebrovascular diseases with the largest proportion of hospitalization expenses, accounting for 26.18%, 20.29%, 11.82% and 9.94%, respectively. The largest proportion of hospitalization expenses was treatment expenses and drug expenses, accounting for 44.09% and 32.52%, respectively. Logistic regression analysis showed that age, length of stay, type of insurance, type of cardiovascular and cerebrovascular diseases, whether there were other comorbidities or complications, and whether they visited tertiary medical institutions were the influencing factors of hospitalization expenses for patients with cardiovascular and cerebrovascular diseases. Conclusion It is necessary to strengthen the disease prevention and control for the elderly and patients with cardiovascular and cerebrovascular diseases such as coronary heart disease, cerebral infarction, cerebral hemorrhage and essential hypertension, accelerate the integration of the basic medical insurance system, scientifically and reasonably shorten the length of hospital stay, and strengthen the promotion of the hierarchical medical system.

Objective To analyze the composition and influencing factors of hospitalization expenses for diabetic patients，and to provide reference for effective control of medical expenses. Methods The hospitalization cost data of diabetes patients in rural areas of Wugang from 2013 to 2017 were collected. Structural change analysis，non-parametric test and BP (Back Propagation)neural network model were used to analyze the hospitalization expenses and influencing factors. Results The top three components of hospitalization expenses were drug cost (50.02%), examination cost (15.35%) and laboratory cost (12.06%). The contribution rates of structural change of hospitalization expenses were the examination fee (41.00%), drug fee (34.92%) and treatment fee (13.41%), respectively. Factors affecting the total hospitalization cost of diabetic patients included length of stay, operation or not, hospital level, age, discharge year, complication or not and gender (P<0.05), among which length of stay had the greatest impact (sensitivity value was 0.669). Conclusion The hospitalization expenses of patients with diabetes is affected by a variety of factors. It is suggested to optimize the composition of hospitalization expenses by improving the price mechanism of medical services, and to control and reasonably reduce hospitalization expenses by implementing standardized management of clinical pathways, implementing two-way referral and strengthening tertiary prevention.

Health related behaviors are closely related to health outcomes. This paper reviews the studies on factors for health related behaviors worldwide published in recent 15 years, and systematically summarizes the current research status of the factors for health related behaviors. The factors influencing health related behaviors are individual social demographic factors, social cognitive factors of individuals, and social environmental factors. The individual social demographic factors mainly include gender, age, marital status, economic level and educational level. The social cognitive factors of individuals mainly include self-efficacy, health belief, social support and peer influence. The social environmental factors mainly include mass media, accessibility of facilities and level of urbanization, etc.

OBJECTIVE:To provide reference for promoting the rational use of essential medicines in primary medical institutions.METHODS:Twenty six rural primary medical institutions (13 township health centers,13 village clinics) were randomly selected from 2 poverty-stricken county (city) in Huanggang city of Hubei province.The utilization of essential medicine was investigated and analyzed statistically through exporting hospital information system data and on-site interviews.RESULTS:The utilization rate of essential medicine in sample township health centers was 76.9％,and the amount of essential medicine accounted for 93.0％;the utilization rate of essential medicine in sample village clinics was 89.7％.The utilization rate of variety from essential medicine list was 53.6％ in sample township health centers and 25.0％ in sample village clinics;the utilization rate of variety from National Essential Medicine List was higher than that of Provincial Essential Medicine List Supplement.The amount of 5 major categories as antimicrobial agents,cardiovascular agent in sample primary medical institutions accounted for 64.7％ of chemical agents.The top ten medicines in the list of amount were all essential medicine,9 of which were national essential medicines.There were 2.8 kinds of medicines in each outpatient prescription averagely in sample township health centers.The proportion of antibiotic prescription was 44.2％.CONCLUSIONS:The utilization rate of essential medicines in township health centers of this area is lower than WHO recommended value,and the ratio of amount meets the policy requirements.The utilization rate of variety from Provincial Essential Medicine List Supplement is in low level in primary medical institutions;the amount of anti-microbial drugs is in high level;the rationality of medicine use in prescriptions needs to be improved.It is suggested to adjust the type of provincial supplement list dynamically according to actual situation and control the price and amount of main categories strictly,the rationality of prescription.

OBJECTIVE:To provide reference for promoting the rational use of essential drugs in primary medical institutions. METHODS:Twenty-three rural primary medical institutions(8 township health centers,15 village clinics)were randomly selected from 2 poverty-stricken counties in Chongzuo city of Guangxi Zhuang Autonomous Region. The utilization of essential drugs was investigated and analyzed statistically through exporting hospital information system data and on-site interviews. RESULTS:The utilization rate of essential drugs in sample township health centers was 72.4％,and the amount of essential drugs accounted for 78.3％. The utilization rate of variety from National List of Essential Drug was 36.9％,which in the Autonomous Regions Essential Drug List Supplement was 47.2％(utilization rate of chemical drugs was 53.9％,and that of Chinese patent drugs was 39.7％). The utilization rate of essential drugs in sample village clinics was 64.4％;utilization rate of variety from National List of Essential Drug was 18.3％, which in the Autonomous Regions Essential Drug List Supplement was 10.5％. The amount of 5 major categories accounted for 47.9％ of total amount of chemical agents,among which that of antimicrobial agents took up the highest proportion,being 35.9％. Among top 10 drugs in the list of amount,there were 8 national essential drugs and 4 antimicrobial agents. There were 2.90 kinds of drugs in each outpatient prescription averagely in sample township health centers;the average proportion of antibiotic prescription was 43.0％;the cost of each prescription was 33.12 yuan in average. CONCLUSIONS:The utilization rate of essential drugs in primary medical institutions is lower than the requirements of policy. There are great difference in utilization rate between chemical agents and Chinese patent drugs of township hospital in Autonomous Regions Essential Drug List Supplement. The cost proportion of antimicrobial agents is high. The rationality of prescription drug use still needs to be improved. It is suggested to guarantee essential drugs supply,adjust Autonomous Regions Essential Drug List Supplement in time,control the price of main categories and strengthen antimicrobial agent use monitoring so as to further promote rational drug use.

OBJECTIVE:To analyze the current status and problems of medicine purchase and distribution of county,township public medical institutions in Hubei province,and to propose targeted policy recommendations. METHODS:By stratified typical sampling,medicine data of 3 county medical institutions and 40 township medical institutions in 3 counties of Hubei province were collected from medicine bidding and purchasing platform of county health and family planning bureau and hospital information system (HIS). Medicine purchase and distribution,distribution rate,purchase and distribution of essential medicine,Chinese patent medicine and injection,general information of top 10 medicines in the list of purchase amount were analyzed in different levels of medical institutions. RESULTS:The medicine purchase and distribution amount of the township medical institutions were lower than those of county medical institutions, but the total amount and distribution rate were higher than county medical institutions. The purchase amount of essential medicine accounted for nearly 3/4 of the total amount (90.6％ of the township medical institutions,and 48.4％ of the county medical institutions);the purchase amount of Chinese patent medicine accounted for about 1/4 of the total amount (35.4％ of the township medical institutions,15.4％ of the county medical institutions);purchase amount of injection accounted for nearly half (34.6％ of the township medical institutions,and 59.3％ of the county medical institutions). The distribution rates of essential medicine,Chinese patent medicine and injection were 93.0％,93.3％,and 93.2％in township medical institutions,and 81.8％,78.6％ and 79.6％ in county medical institutions,respectively. The rate of medicine distribution of township medical institutions was higher than that of the county medical institutions. The top 10 medicines in the list of purchase amount included 6 kinds of antibiotics,and the top 5 medicines included 2 kinds of injection. CONCLUSIONS:The policy of essential medicine purchase is well implemented in Hubei province,and purchase rate of essential medicine meet the policy requirements(40％-50％);but the proportion of injection purchase can partly reflect the high usage of injection,which may indicate the abuse of injection, and Chinese patent medicine has become an integral part of medicine purchase. Moreover, medicines still have the status of distribution untimely,and medicine distribution of the township medical institutions is better than that of county medical institutions.

This paper summarizes the kinds of long term care facilities, service delivery organization, service model, service role and experience of long-term service system in the United States. It provides referral implications for China to explore and establish its own long-term care service system. . There is a variety of long-term care services such as short and long-term stay, adult day care, and home care services, with a gradual change from institutional services to home and community ones. Long-term care services are provided by paid both formal and mostly unpaid informal caregivers. Informal family caregivers are most frequently daughters (29. 3%), followed by spouses with (21. 2%). With the increased availability of the family and community-based services, the family caregivers are more likely to share long term care services with the paid formal ones. The United States has a well-structured long-term care service system whose access mechanism is rigorous and systematic, emphasizing the evaluation of service quality and effectiveness. Moreover, the U. S. long term care service system pays more attention on elders' wishes, respecting their preferences and rights of choice on the services. Based on the experience of the United States, China should primarily focuses on establishing a family and community-based long term care service system with a variety of service delivery facilities, give a full play to the community health facilities, social partners, and families. The Chi-nese government should not only give a focus to the service institutions and content diversification, but should as well establish a sound and detailed assessment and evaluation standard system to access the services and assure the effec-tiveness of service quality with a humanized concern.