The construction of compact urban medical groups has been carried out in 81 pilot cities,and whether the pilot work can form useful experiences that can be replicated depends on the grasp of key elements and develop-ment trends.It proposes that the key elements in the construction of a compact urban medical group include the le-gal status of the compact urban medical group,the distribution of rights and responsibilities between the compact medical group and local health administrative departments,the structure and integrated operation mechanism of the compact urban medical group,the demarcation between the city medical group and one hospital and multiple dis-tricts,and the evaluation of health benefits.Under the background of the superposition of healthy China and digital China construction,China's urban medical group has five significant development trends including new development models led by the digital revolution,diversifying development models oriented to demand,emphasizing the coopera-tion mechanism based on value inclusion and benefit sharing,and promoting the further strengthening of medical and prevention integration and the effectiveness evaluation shifts to results-oriented indicators.

The construction of urban medical groups is an important supply-side reform and exploration of Chinese urban health service system.It analyzes and discusses the interest generation mechanism,the dialectical relationship between public interests and economic interests and the balancing strategy of urban medical group construction,and proposes that the construction of urban medical groups mainly generates new value through comprehensive medical care,large-scale development,homogeneous services,digital construction and technology innovation,which can bring about optimizing the allocation of medical treatment resources,improving the homogeneity level and innovation ability of regional medical services,and strengthening regional primary medical services and other public interests.It can also bring about improvements in service efficiency,capacity and volume,which in turn generate economic benefits.The pursuit of public and economic interests in the construction of urban medical groups has potential value conflicts in terms of service positioning,cost and accessibility,effectiveness and rationality,and at the same time,there is a synergy mechanism in fulfilling social responsibilities,optimizing the utilization of medical resources,and promoting medical innovation and high-quality development.In the pilot construction of urban medical groups,public interests and economic interests should be viewed dialectically,the role of local governments in policy guidance,supervision and incentives should be explored,a focus on resource optimization,innovation-driven or high-quality development to promote the synergy of public interests and economic interests should be emphasized,and public participation should be strengthened and a performance evaluation mechanism should be established.

In order to adapt to the development of market economy, the original medical institutions run by state-owned enterprises have undergone restructuring reform, but these medical institutions have not fully played their role. Through the sampling survey and research interviews of several medical institutions run by state-owned enterprises, it was found that many problems such as unclear functional positioning, imperfect regional health planning, unclear responsible subjects and inadequate financial support hindered the development of medical institutions run by state-owned enterprises. In order to develop healthily, medical institutions run by state-owned enterprises need to cooperate with various parties to improve supporting policies, optimize their business environment, and build and improve the health service system.

The " 13th five-year Plan" period is a critical period for the modern hospital management system in China. The basic framework of the combination of the macro-external management system and the micro-internal management system has been preliminarily constructed, and new progress has been made in the new hospital operation mechanism that is guided by the needs of patients, high-quality development and guaranteed sustainable. In 2021, China has entered the " 14th five-year Plan" period, and the modern hospital management system will enter the comprehensive implementation stage. In view of the problems existing in the modern hospital management system at the macro, medium and micro levels, the authors put forward relevant approaches from three aspects: reforming the management system to promote the modernization of hospital governance system, creating a good policy environment to promote the scientific and standardized hospital management, and deepening the reform of internal management system to realize the modernization of governance ability.For example, according to the constitution of the hospital, the internal governance system should be established, the reform and innovation of personnel establishment should be promoted, the emergency management capacity of the hospital should be improved, the ability evaluation system of clinicians should be rebuilt, the discipline construction and talent construction should be strengthened, etc., which can provide reference for the implementation of the modern hospital management system during the " 14th five-year Plan" period

Objective To make a cost-effectiveness analysis for stereotactic radiotherapy and intensity-modulated radiotherapy using linear accelerators against malignant tumors, then to provide references for choosing a more cost-effective radiotherapy for the patient. Methods Basic information of patients subject to radiotherapy(gender, age, date of admission, days of hospital stay), hospitalization cost, admission diagnosis, clinical outcomes among others of 320 patients with malignant tumors(lung tumor, head and neck tumor, bone metastases, liver tumor) were collected from Hubei, Guangxi and Fujian provinces. The cost of hospitalized radiotherapy and treatment effect of these patients were compared to identify the more cost effective of the two methods. Results The effective rates of stereotactic radiotherapy and intensity-modulated radiotherapy were 99.1% (108/109) and 97.2% (205/211) respectively, and the difference was not significant( P>0.05). The average hospitalization cost of treatment of the two groups was 37 545.56 yuan and 48 159.05 yuan respectively; the cost-effectiveness ratio was 37 886.54 and 49 546.35 respectively. Conclusions The short-term effects of stereotactic and intensity-modulated radiotherapy are similar, but the cost of intensity-modulated radiotherapy is higher. The minimum cost analysis shows that stereotactic radiotherapy is more cost effective.

At present,the functional positioning,service capabilities and resource allocation of various medical institutions differs in China,the tertiary public hospitals,which are rich in high-quality resources,are playing a significant role in integrating medical resources,improving the accessibility and affordability of services and achieving the Chinese national health goal.Through the analysis of the importance and key problems of leading hospitals in a variety of medical alliance,the paper explores the basic ideas and pathways of public hospitals' leading role in various forms of medical alliances.

Medical alliance refers to a medical consortium innovating the existing medical and health service model ( alliance as below ) , which is key to improving the unbalanced distribution of medical resources and promoting the hierarchical diagnosis and treatment in our country .This article analyzed the practice of alliances development in China and pointed out existing problems including insufficient inter -agency collaboration , poor progress of the hierarchical diagnosis and treatment system , and shortage of general practitioners and supporting policies .In the end, a series of measures is proposed namely building a compact alliance , creating a model integrating hierarchical diagnosis and treatment-prevention-rehabilitation-aging care , strengthening general practitioner training , and improving relevant supporting measures .