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.

To analyze the interest distribution relationship and symbiotic mode in the construction of urban medi-cal groups,based on the symbiotic theory,a framework for analyzing the interest distribution relationship of urban medical groups is constructed.Based on actual cases,urban medical groups are summarized and divided into four types:one-way supply type,partial benefit symbiosis type,asymmetric reciprocity symbiosis type,and symmetric reciprocity symbiosis type.The focus of a one-way supply oriented urban medical group is on reshaping the profit distribution mechanism,a partial benefit symbiotic urban medical group is on establishing a profit compensation mechanism for benefit medical institutions,and an asymmetric and mutually beneficial symbiotic urban medical group is on building a long-term benefit balance mechanism.

At present,there is a series of difficulties in the development of TCM medical cluster.By sorting out the connotation and characters of TCM medical cluster and clarifying the development status and problems of TCM medical cluster,from the perspective of interest appeal of internal stakeholders of TCM medical cluster,it analyzes the interests of stakeholders such as core hospitals,member units,medical staff,government,patients and their families.It presupposes the interests appeal of stakeholders of TCM medical cluster,suggests to build up a balanced and sustainable medical consumption linkage,in order to provide a reference for guarantee the long range sustainable development of TCM medical cluster.

Objective To analyze the competition status and spatial autocorrelation of Beijing medical market from 2015 to 2019.Methods The Herfindahl-Hirschman Index(HHI)was used to calculate the degree of market competi-tion in 16 districts of Beijing,and the Moran index was used to calculate the spatial autocorrelation of market compe-tition.Results Except for the number of discharged patients,the average HHI of the number of health technicians,the number of beds and the total number of medical visits in 16 medical markets in Beijing from 2015 to 2019 showed a downward trend between 0.2 and 0.4,and the spatial global Moran index of the HHI index was all less than 0,showing a spatial negative correlation with the degree of competition in the medical market.Conclusion The medical market competition in Beijing is strengthened,the competition gap between urban and rural areas is large,and the competition in adjacent markets is mutually exclusive.It is suggested to strengthen the differentiated develop-ment of hospitals,strengthen the balanced layout between regions,and promote the low-competitive market with cross-regional medical association,forming a positive spillover effect.

Objective To analyze the spatio-temporal characteristics and influencing factors of local hospitalization proportion in 57 counties of Guangdong Province.Methods Using local hospitalization proportion and related indicators in 57 counties of Guangdong Province from 2016 to 2019,temporal trend analysis and spatial autocorrelation analy-sis were used to analyze the spatiotemporal characteristics.Bayesian spatio-temporal model was used to explore in-fluencing factors of local hospitalization proportion.Results The local hospitalization proportion in Guangdong Province rose from 79.8%in 2016 to 84.1%in 2019,showing an increasing trend and the overall characteristics of"high in the west and low in the east".The global and local spatial autocorrelation results show that there is a spatial correla-tion in the local hospitalization proportion within the counties of Guangdong Province,and spatial aggregation has formed in some areas.There is a"high"aggregation in western Guangdong,and a"low"aggregation in eastern Guangdong Province.The Bayesian spatio-temporal model shows that the number of people with a bachelor's de-gree or above per 1 000 population and the CMI of county hospitals had an effect on the local hospitalization propor-tion(P＜0.05).Conclusion Guangdong Province can improve the medical service capacity of county hospitals sub-stantially and introduce or train high-quality talents through multiple measures,and continue to improve the local hospitalization proportion.

The reform of medical insurance payment method,as an important measure in the health system re-form,should handle with the connection with the comprehensive management policies of medical services,such as medical services price adjustment,public hospitals salary performance reform,cost accounting optimization,health information construction and medical service quality supervision,etc.so as to give full play to the synergy and form the joint force of policies,so as to give full play to the role of the reform of payment mechanism.

Objective By studying the changes in the institutional distribution of curative care expenditure(CCE)of the elderly population before and after the comprehensive reform medical-pharmaceutical separation and linkage of medical consumption,it provided data reference for the next step of accurately optimizing the elderly patients flow.Methods A multi-stage stratified whole-group sampling survey was used to select the sample.A System of Health Accounts 2011 was used to calculate the CCE of elderly patients in medical institutions.Results The CCE of medical institutions for the elderly population in Beijing increased from 60.457 billion yuan to 797.54 billion yuan,with an average annual growth rate of 6.83%,the fastest growth rate of 24.04%for community-based health treat-ment center.The percentage of CCE in the community increased from 11.31%to 17.71%,while the percentage of CCE in tertiary hospitals decreased by 4.39 percentage points.The flow of CCE for outpatient patients was obviously opti-mized.Younger elderly outpatient patients are more willing to seek treatment in the community,but the flow di-rection of outpatient treatment for elderly patients is more optimized.The CCE fpr elderly outpatient patients with chronic diseases such as endocrine,nutritional and metabolic diseases and nervous system diseases have been substantially transferred to the community-based health center.Conclusion The reform has different impacts on the treatment of elderly patients with different genders,ages and diseases.It is necessary to strengthen the service capacity building of primary medical institutions,highlight the development characteristics of secondary hospitals,and accurately improve the hierarchical diagnosis and treatment system for elderly patients.

Objective To analyze the changes of the cost and structure of coronary intervention patients before and after the centralized procurement of coronary stents in Zhejiang Province.Methods It was conducted on the medical expenses of patients in the FM1 group(percutaneous coronary stent implantation)of a Class A tertiary hospital in Zhejiang Province from February to December in each 2020 and 2021.The number of cases was 1 403 and 1 698,re-spectively.A nonparametric test was conducted on the patient expenses before and after the reform.Results There are significant differences in total medical expenses,material expenses,treatment expenses,operation expenses and drug expenses before and after centralized purchase(P＜0.01);After the implementation of centralized procure-ment,material cost of patients decreased significantly,while the treatment cost increased;At the same time,the more coronary stents were placed,the greater the decrease in the total medical expenses and material expenses.Conclusion The centralized procurement of coronary stents can reduce the medical burden of patients,improve the structure of medical expenses,enhance the value of technical labor services of medical personnel,and promote DRG cost control.

Objective To evaluate the effect of centralized procurement of artificial joint consumables on total arthro-plasty placement surgery.Methods Through a retrospective study,t-test was conducted on the medical quality and effi-ciency,hospitalization cost per time structure through July-December,2021 to July-December,2022 centralized pro-curement of joint replacement surgery in a tertiary hospital in Shanghai.Results After centralized procurement,the amount of knee arthroplasty surgery decreased,and the time of hip replacement surgery was increased,and the difference was statistically significant(P＜0.05).The total cost,cost of consumables,arthrotomy fee of the two types of arthroplasty surgery were significantly decreased,and the difference was statistically significant(P＜0.05).In addition,the average cost of other consumables hospitalization of knee joint surgery patient increased,and the difference was statistically significant(P＜0.05).Conclusion After centralized procurement of artificial joint consumables,the cost of total knee arthroplasty and total hip arthroplasty has decreased significantly,and the quality and efficiency of medical care have not changed significantly.At the same time,hospital managers should pay more attention to the rational use of consumables after centralized procurement.In addition,it calls for increasing the price of surgery to reflect the value of physician services.