Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

Objective:To analyze the effect of the implementation of diagnosis-intervention packet (DIP) on the doctors′ diagnosis and treatment behavior of chronic diseases, so as to provide reference for further improving medical insurance payment related policies.Methods:The first page information of chronic disease patients admitted to hospitals with diabetes, hypertension and coronary atherosclerotic heart disease as the main conditions in 103 hospitals at all levels and township health centers in a city from 2016 to 2020 was collected, and the patients were divided into non-DIP group and DIP group according to the implementation time of DIP. After 1∶1 propensity score matching to balance the general conditions of the 2 groups, the diagnosis and treatment behaviors were analyzed from two dimensions: diagnostic behavior and treatment behavior. The grade A rate of medical record writing, admission and discharge diagnosis coincidence rate, and the average length of stay were used to evaluate the diagnostic behavior; the proportion of drugs and the degree of change in the cost structure were used as the evaluation indicators of treatment behavior.Results:After matching, 41 050 patients were included in both the non-DIP group and the DIP group.From the perspective of diagnostic behavior, the grade A rate of medical record writing in the non-DIP group and the DIP group was 99.40% and 99.83%, the coincidence rate of admission and discharge diagnosis was 58.42% and 61.79%, the average hospital stay was 8.03 days and 7.04 days respectively, and the difference between the groups was significant ( P<0.05). From the view of treatment behavior, the proportion of drugs decreased from 33.00% in the non-DIP group to 27.59% in the DIP group, with a significant difference ( P<0.05); the drug cost represented by Western medicine changed negatively, while the diagnostic cost showed a positive change. Conclusions:DIP has played a certain role in regulating doctors′ diagnosis and treatment behavior for chronic diseases. Among them, doctors have significantly improved their diagnostic behavior for chronic diseases, and the proportion of drugs in treatment behavior has been well controlled.

BACKGROUND: Current guidelines recommend hepatocellular carcinoma (HCC) screening in high-risk populations. However, the ideal HCC screening interval and screening modality have not been determined. This study aimed to compare the screening efficacy among different modalities with various intervals. METHODS: PubMed and other nine databases were searched through June 30, 2021. Binary outcomes were pooled using risk ratio (RR) with 95% confidence intervals (CIs). Survival rates were also pooled using RR with 95% CIs because most eligible studies only provided the number of survival patients instead of hazard ratio. RESULTS: In all, 13 studies were included. Two random controlled trials (RCTs) and six cohort studies compared screening intervals for ultrasonography (US) screening and found no significant differences between shorter (3- or 4-month) and longer (6- or 12-month) screening intervals in terms of early HCC proportion, HCC significant mortality, 1-year survival rate; screening at 6-month interval significantly increased the proportion of early HCC (RR = 1.17, 95% confidence interval [CI]: 1.08-1.26) and prolonged the 5-year survival rate (RR = 1.39, 95% CI: 1.07-1.82) relative to the 12-month interval results. Three other RCTs and two cohort studies compared different screening modalities in cirrhosis or chronic hepatitis B, which indicated no statistical differences in the proportion of early HCC (RR = 0.89, 95% CI: 0.40-1.96) and HCC mortality (RR = 0.69, 95% CI: 0.23-2.09) between the biannual US and annual computed tomography (CT screening). Biannual US screening showed a lower proportion of early HCC than biannual magnetic resonance imaging (MRI) (RR = 0.60, 95% CI: 0.37-0.97) and biannual US combined with annual CT (RR = 1.31, 95% CI: 1.13-1.51) screening. The proportion of early HCC in the contrast-enhanced US group was slightly higher than that in the B-mode US (RR = 1.08, 95% CI: 1.00-1.23) group. CONCLUSIONS: The evidence suggests that 6 months may be the best HCC screening interval for US screening. The effectiveness of CT and MRI is better than US during same screening intervals. However, MRI and CT are more expensive than US, and CT also can increase the risk of radiation exposure. The selection of CT or MRI instead of US should be carefully considered. REGISTRATION No. CRD42020148258 at PROSPERO website ( https://www.crd.york.ac.uk/PROSPERO/ ).
Humans ; Carcinoma, Hepatocellular/pathology* ; Liver Neoplasms/pathology* ; Liver Cirrhosis/complications* ; Risk Factors ; Cohort Studies