Objective:To evaluate the impact of the reform of the county medical community on the expenditure of medical insurance funds, and to provide references for maintaining the stability of the medical insurance fund and deepening the reform of the medical community.Methods:Medical insurance data of urban and rural residents in M County, Yunnan province from 2016 to 2019 were collected, and a discontinuous time series model was used to analyze the impact of county medical community reform on medical insurance fund expenditures.Results:Since the reform, the number of patients discharged from county-level hospitals has shown a downward trend, averaging a decrease of 25.996 people per month; yet increases have emerged with the average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure, averaging a monthly increase of 90.931 yuan, 50.014 yuan and 1.528 yuan respectively. The average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure of the township hospitals all showed an upward trend, averaging a monthly increase of 31.191 yuan, 38.678 yuan and 0.085 yuan respectively. The flow of external medical insurance funds of the medical community has shown a continuous upward trend, averaging a monthly increase of hospitalization fund expenditures of 33.005 yuan, and a monthly increase of outpatient overall fund expenditures of 4.896 yuan overall.Conclusions:The M County medical community should further strengthen the top-level design, explore the reform of medical insurance payment methods, improve the regional information platform, standardize the referral system, and strengthen supervision to deepen the construction of the medical community to ensure the sustainable operation of medical insurance funds.

The construction of Health Hospital will become an important opportunity to promote the strategy of Healthy China. The authors analyzed the connotation of Health Hospital, and the feasibility of building Health Hospital from four aspects, including integrating health policy, building healthy environment, implementing health actions and optimizing health services. Then, six essential factors of building Health Hospital were put forward, namely, establishing a green environment, improving the operation mechanism, disseminating health culture, developing information technology, creating intelligent health care and strengthening top-level design.

Based on the needs of healthcare system reform, Australia has implemented activity based funding(ABF) payment mode nationwide, and established the Independent Hospital Pricing Authority as the specific implementation agency in 2011. The main responsibilities and functions of the ABF payment mode covers pricing of medical services, classification of healthcare services, collection of clinical data and cost accounting of healthcare services. ABF payment mode presents outstanding advantages in promoting the capacity of healthcare service, maintaining fairness of healthcare service supplies and carrying out cooperation across different institutions. These efforts provide important references for China in its top-level design of payment method, pilot project of classification system, medical service items and price dynamic adjustment, informationization and information standardization construction among public hospitals.

Objective:To explore the usage of system dynamics analyzing the influencing factors of total health expenditure(THE),forecast the trends of total health expenditure based on the method of System Dynamics and put forward relative countermeasures.Methods:According to the literature and expert consultation,the population,elderly,GDP,government health expenditures,drug costs and the number of health workers per thousand population were the important factors for THE.These factors were incorporated into system dynamics model for total health expenditure and conducted the simulation.Results:Based on the examination,the simulation results highly corresponded to historical data (2002-2014) and the official forecast (2015-2020),which showed that the model had good stability and reliability.The simulation results showed that steadily increasing total health expenditure would reach 7 457.12 billion yuan in 2025.Conclusion:The system dynamics approach had superior characteristics to other projection methods in terms of stability and reliability.In order to control the irrational growth of total health expenditure,it needed to increase the prevention investment,decrease the incidence of chronic diseases;sustainably improve the reform of public hospitals,implement the basic drug system;change the income-oriented performance appraisal to realize the labor value of medical staffs.

Objective Exploring theoretical teaching model of chronic diseases management of preventive medicine undergraduates,to provide feasible suggestions to improve the theoretical teaching of the chronic disease management ability of preventive medicine specialty in China so that graduates can better adapt to chronic diseases management work.Methods On the basis of reading a large number of relevant literature both at home and abroad,the research team designed questionnaires,and conducted a questionnaire survey on 190 respondents who engaged in chronic diseases management or teaching in central China.The content includes the understanding of the importance of training chronic disease management ability in undergraduate education of preventive medicine and the constitution and training mode of undergraduates' chronic disease management ability.EpiData 3.1 software was used to input survey data,SPSS 23.0 software was used for statistical description analysis,and the usage ratio and component ratio were used for statistical description analysis.Results The survey found that more than 50％ of the respondents believed that training students with chronic disease management should focus on prevention,intervention services and health promotion ability,and chronic disease modules need to be added to undergraduate courses in preventive medicine.Conclusions preventive medicine undergraduates need to be improved,and medical colleges should change teaching model to increase undergraduates' ability of chronic diseases management.

Objective:To analyze the system of first contact in community health institutions for migrant workers in Shenzhen city with the stakeholder theory. Methods:The report forms of the Social Insurance Fund Administration Bureau and the health bureau of Shenzhen city were used to analyze. All stakeholders of this policy were interviewed. Results:The system of first contact in community health institutions was good for all stakeholders. The number of in-sured migrant workers grew steadily, the business volume of community health service centers increased significantly, and the fund ran smoothly. Conclusions:The effects of the system of first contact in community health institutions for migrant workers in Shenzhen city were obvious. All the stakeholders felt satisfied with the policy.

The system of first contact in community health institutions, as the core element of hierarchical di-agnosis and treatment system, is of great importance for reforming successfully China’ health service system. The sys-tem of first contact in community health institutions implemented among labor workers in Shenzhen City plays an im-portant role in patients ’ distribution and the interested parties can accept this mandatory system. Campared with Shenzhen City, the level of services is enough to meet patients’ primary health demands in some cities which the com-munity health service develops well, and it should be thought highly of the mandatory in the process of policy imple-mentation in order to ensure the implementation effect.

Objective:To explore the utilization of and satisfaction at community health service between migrant and non-migrant workers in Shenzhen city. Methods: Random sampling was used and 8000 community residents in Shenzhen city were investigated, and the data was analyzed with SPSS 18. 0. Results:There was statistically signifi-cant difference on the times of seeking community health services last year between migrant workers and non-migrant workers ( P<0. 0001 ) , and the proportion of more than three times service utilization of migrant workers were greater than that of non-migrant workers. The top three elements inpluencing satisfaction at community health service between migrant and non-migrant workers were service attitude ( 73. 29% vs. 73. 46%) , technical level ( 65. 29% vs. 67. 50%), and its convenience of seeking a doctor (63. 16% vs. 64. 98%). 73. 47% of users (migrant workers:74. 16%, non-migrant workers:69. 71%) were willing to accept the system of first contact in community health in-stitutions. Conclusions:The utilization of community health service has increased since implementing the system of first contact in community health institutions. Both migrant workers and non-migrant workers were very satisfied with the community health services, and the differences on satisfaction between the two groups were not significant. It is feasible to gradually promote the system of first contact in community health institutions over China.

Objective To measure the costs of primary health services in the community for developing government compensation standard and prediction of budget in 201 5.Methods Literature review and panel discussions were used to build the index database.A two-round Delphi expert consultation determined the work to do and steps for community healthcare standards.60 community health centers were sampled by stratified random sampling for survey,and the work hours,workload and service volume of respective services in 2013 were measured according to the service standards of primary care.Results The community primary care consists of the categories of outpatient services,nursing care, laboratory tests and drug management,totaling 20 services and 88 working procedures.The total work hours of primary healthcare service at 60 community health centers were 2 557 187.9 hours,which is adjusted to 2 959 21 5.1 hours based on workload coefficients.Based on the income standards of employees at the community health centers investigated,and the human cost price which was recommended by the experts,the total costs of primary healthcare of the 60 centers were 245 million,248 million and 318 million respectively,and the average cost was 71.0 yuan,71.8 yuan and 92.1 yuan per visit respectively.By such standards,the government should subsidize 38.9 ~ 60.0 yuan per visit to the centers.The total expenditure of primary healthcare of all communities in Shenzhen in 201 5 was predicted to be 314 to 407 million,for which the government is expected to subsidize 1.68~2.58 billion.Conclusion The subsidies for community primary healthcare fall short as the cost per visit runs up in 2013 to 71.0 yuan per visit or more,far above the current subsidy of 32.1 yuan per person.The subsidy per visit should be made 50.0 yuan in 201 5.

Objective Understanding current situation of pharmaceutical service before and since the ongoing health reform in community health institutions of China,and providing practical evidences to the government.Methods Adopting some indicators to comparative study the pharmaceutical care in 2008 and 201 1 in community health service institutions of China.Results From 2008 to 201 1, pharmaceutical service quality in general has greatly improved in community health institutions of China. For example,average number of drugs per prescription descended from 2.5 1 to 2.23.Percentage of prescriptions with an antibiotic descended from 43.98 to 32.08.Percentage of prescriptions with a hormone descended from 7.13 to 4.67.Percentage of prescriptions with two or more antibiotics descended from 1 1.24 to 7.31.These four indicators before and since the reform have statistical significance (P values are:0.003,0.001,0.003,0.004 respectively).But there are still inadequacies:from 2008 to 201 1,the average prescription cost descended from 59.63 to 5 1.18 yuan.Percentage of prescriptions with an IV drip descended from 34.84 to 30.41.These two indicators have not statistical significance(P values are 0.182,0.236 ).Conclusion To improve the quality of pharmaceutical service in community health institutions,the government should increase financial input to the community health institutions.