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With the changing spectrum of human diseases and people′s pursuit of high-quality life, the scope of medical services required of nurses keep expanding. However, the current legislation in China has not yet granted nurses the right to prescribe, and there was no specific law to regulate related issues, which will inevitably limit the development of nursing work in the extended field. Therefore, the authors explored the concept definition and legal attributes of nurses′ prescription rights from a legal perspective, and proposed to regulate them from the legislative, law enforcement, and relevant supporting institutional levels to ensure the standardized exercise of nurses′ prescription rights.
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It is already an inevitable choice for the innovative development of the global healthcare system to grant nurse practitioners the prescription rights, in an effort to improve the access to primary care services and clinical outcome of patients. The contradiction between supply and demand of health service in China is becoming increasingly prominent, making it urgent for nurses with prescription rights to join the primary healthcare team. On the basis of clarifying the connotation and characteristics of nurses′ prescription rights, the authors demonstrated and analyzed the demands, realistic basis and challenges of nurses′ prescription right granting, and put forward their thoughts on the feasible paths from the aspects of national system construction and local pilot exploration, aiming to provide reference for promoting the reform of nurses′ prescription right granting in China.
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Deep integration of healthcare and prevention in public hospitals is not only a basic function played by hospitals in their public health services, but also an inevitable choice to meet the health needs of the people in their life span. The authors analyzed the current situation in healthcare and prevention integration in Wuhan in recent years, focusing on such problems existing in the construction of healthcare and prevention integration in public hospitals, as unclear functional positioning of medical prevention integration in public hospitals, insufficient refinement of healthcare and prevention integration policies, delay in the construction of public health informatization, and poor public health awareness of medical personnel. In view of the above problems, the authors put forward the following improvement suggestions: optimizing the policy environment of healthcare and prevention integration, strengthening the leading role of the hospital management, building a hospital public health big data platform, mobilizing the initiative of clinical technicians, and improving the work identity of hospital public health workers.
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In order to give full play to the social functions of state-owned enterprises running medical institutions, find out the functional orientation, and maximize their role in the context of regional health planning, the author made a comprehensive analysis of the functional orientation of state-owned enterprises running medical institutions. It is suggested that governments at all levels should integrate the state-owned enterprise-run medical institutions into the regional medical and health service system for overall planning, provide reasonable support and compensation for the public welfare responsibilities and tasks undertaken by state-owned enterprise hospitals, provide policy space for their exploration and innovation, and support the collectivization development of state-owned enterprise-run hospitals.
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With the deepening reform of state-owned enterprise-run medical institutions, a large number of medical institutions have entered the state-owned enterprises dominated by the health industry through resource integration. The research team conducted in-depth research on six medical institutions run by state-owned enterprises and analyzed the effect of resource integration. The research found that the investment of the holding enterprises in hospitals was significantly increased, the talent team tended to be stable, and the scope and volume of medical services were improved, but there were still problems such as insufficient participation in market competition and large differences in hospital operation, which needed to be further explored in practice.
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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.
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With the continuous development of Internet related technology in recent years and the improvement of infrastructure such as software and hardware, Internet plus medical service has developed rapidly under the dual development dividends of market demand and national policy incentives. The authors analyzed the current situation and problems in the development of public hospitals′ Internet plus medical services, and explored how public hospitals combine the opportunity of " the 14th five-year plan" to achieve the optimization of Internet plus medical treatment through 4 aspects: system construction, information construction, hierarchical diagnosis and treatment, and new technology application.
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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
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Objective:To explore the influencing factors of telemedicine system operation and identify the relationship among them, so as to provide policy suggestions for promoting the healthy operation of telemedicine service system.Methods:The published literatures from January 2009 to December 2019 were searched, and the factors influencing the operation of telemedicine service system were preliminarily screened out. The influencing factors were evaluated and scored by expert consultation method(0-5 points). Then the influencing factors and their relationship were analyzed by decision-making trial and evaluation laboratory method.Results:A total of 16 influencing factors, including 6 cause factors and 10 result factors, were selected. In the cause factors, leadership support, supervision mechanism and incentive compatibility mechanism were in the top three; among the outcome factors, disease information communication, patient participation and medical service quality were more susceptible to other factors.Conclusions:It is helpful to promote the healthy and sustainable operation of telemedicine service system by enhancing the attention of the leaders of medical institutions, building a perfect regulatory mechanism and incentive compatible mechanism, ensuring the effective communication of disease information by doctors of upper and lower medical institutions, and improving the participation of patients and the quality of medical services.
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Objective:To evaluate the sense of gain of health technical personnel of public hospitals for the healthcare reform, and to put forward relevant policy recommendations.Methods:Taking a province in central China as an example, a questionnaire survey was conducted from August to September 2018, on the health technical personnel in 12 public hospitals. 900 questionnaires were distributed, among which 886 were effective. According to the indexes of the questionnaire, this paper constructed the framework of analysis and evaluation of the sense of gain for the healthcare reform by these personnel. The sense of gain of health technical personnel in different institutions and specialties was descriptively analyzed using Mann-Whitney U test and chi square test. Two-class multivariate logistic regression was used to analyze the influencing factors of health technical personnel′s recognition for the healthcare reform. Results:Compared with the public hospitals at prefecture level, the health technical personnel in county-level cities shoulder heavier work burden, and their satisfaction evaluation of work, compensation system and management was relatively lower( P<0.05). Medical staff had a heavier workload and their income was affected by the policy to a greater extent. Nursing staff′s job satisfaction and their recognition of the healthcare reform was higher. The satisfaction of the management was the most important factor that affects the recognition of the healthcare reform. Conclusions:Health technical personnel in public hospitals had a higher sense of gain for the healthcare reform, while that of county-level public hospitals was lower. It was suggested that the reform should prioritize personnel management system, emphasize the compensation system, and ensure the improvement of medical service environment so as to further promote the reform process.
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The innovative healthcare plus elderly care model is a major move for China to combat population aging. Given its initial success, there still exist challenges in the systems and economic conditions, for which family doctors can play a key role as population health " gatekeepers" . From the perspective of supply-side reform, this paper analyzed the current progress and challenges in this regard, and proposed a win-win mode. This mode combined the advantages of the family doctor system to optimize the community-based healthcare and elderly care as well as aging care resources.Family doctors are centered to build a community elderly care supply mode, to promote mutual development of primary medical institutions and the elderly-healthcare sector in China.
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Objective@#To understand the healthcare and elderly care needs of the elderlies.@*Methods@#From July to December 2018, a questionnaire survey was conducted to investigate the healthcare and elderly care status and characteristics of the elderly under different modes of combination of medical care and elderly care, and to analyze their objective needs for both cares.@*Results@#There was an outstanding need for daily life care for the elderlies in the healthcare plus elderly care mode. 71.8% of them were senior elderlies, and 61.1% had obvious disabilities. It was found that elderly-adaptive transformation was required for their living environment in the home care mode, as 41.7% of them live in elevator-free buildings, and 48.2% use squat-type toilets. The elderlies need in general cultural services, and widowhood and solitary living were common. The home care mode required disease prevention services, as 43.6% of them had weight problems, and smoking and drinking rates were very high(9.4%, 13.7%). The elderly care in medical mode required medical services, because the proportion of two or more chronic diseases was very high(27.2%).@*Conclusions@#The healthcare and elderly care modes vary in terms of needs, thus it is necessary to adapt to specific conditions.
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Objective@#To learn the job experience and cognition of the staff working in elderly-healthcare institutions by means of the psychological contract theory and the questionnaire so developed, for probing into the factors affecting the work recognition.@*Methods@#The psychological contract questionnaire was used to conduct on-site questionnaires on 232 staff of such institutions in Hubei province between July 2018 and February 2019. The study covered their job experience and organizational contract, responsibility cognition. The data collected were analyzed statistically by methods such as variance analysis, descriptive statistics and related analysis.@*Results@#It was found that personal responsibility scoring(76.0±11.8) was generally higher than organizational responsibility scoring(60.9±10.0). 46.1%(107/232) of the employees had the intention of resignation. The respondents′ resignation intention was correlated with the performance of the organization, and there was a strong correlation between employees′ career development and their resignation intention(Gamma coefficient G≥0.5).@*Conclusions@#Organizational performance needs further enhancement, and institutions should better the income distribution and incentive mechanism, and raise the income level of the staff. At the same time, the managers should optimize the institutional environment, improve the social status of the staff, strengthen career planning, training, and provide them with a more promising career development path.
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In order to fully understand the status quo of the healthcare plus elderly care mode development in China, this paper comprehensively analyzed the progress of China in this respect, from four aspects as follows. These include the policy making, service mode development, number of elderly care beds and long-term care insurance. In view of the current shortage of resources in China, namely that of talents, poor teambuilding, imbalance between supply and demand of medical institutions, and the lack of coordination among healthcare and elderly care institutions, this paper suggests that China should focus on strengthening the construction of diversified elderly care system and professional elderly care personnel. In addition, it suggests to establish and improve the long-term care system with Chinese characteristics and promote the introduction of hospice care services for elderly care institutions, hence encouraging a high level healthcare plus elderly care career in China.
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Objective To identify current research hotspots, research trends and future trends of family physician research by means of literature review. Methods " Family physician" and " general practitioner" were used as the search words, to retrieve in CNKI database the literature on family physicians published during 2011 - 2018 using the method of subject retrieval, with related literature citations downloaded. The citespace software was used to analyze and generate the research institutions and their cooperative network, the keyword co-occurrence network and emergent word analysis. Information visualization was used to analyze the current research status of family physicians in China. Results A total of 1616 papers were retrieved, and 773 literatures were finalized as research samples with exclusion of those obviously irrelevant. The study found that studies in China focused on talent cultivation, service contract signature of family physicians, pattern of such contracts, and the construction of primary medical institutions. In terms of future research trends, the hotspots fell on " performance evaluation" , " incentive mechanism" , " talent cultivation" , " health management" , and " chronic disease management" by such physicians. Conclusions This paper used citespace software in a visual analysis of the research on family physicians in the recent eight years, so as to explore the research hotspots, research trends and future trends of such study in China.
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Objective To analyze the deployment of medical linear accelerators at 26 hospitals in China, and suggest on the deployment of such accelerators. Methods From June 2017 to November 2018, a total of 26 hospitals were surveyed by stratified random sampling. Descriptive analysis of the deployment and staffing of medical linear accelerators at 26 hospitals, and the deployment appropriateness of the medical linear accelerator was evaluated using the TOPSIS method. Results The number of medical linear accelerators in different types of hospitals was significantly different. The proportion of imported equipment at tertiary hospitals was 80% (12/15) and the proportion of imported equipment at secondary hospitals was 9% (1/11). The professional staff was deployed basically reasonable, and there was a shortage of physicists at some hospitals. The suitability of medical linear accelerators at tertiary hospitals was better than that of secondary hospitals, 80% (12/15) of tertiary hospitals received " good" and above ratings, while 91% (10/11) of the secondary hospitals received " general" and below ratings. Conclusions Hospitals should carry out the allocation of large-scale medical equipment based on their own situations and requirements. Efforts should be paid on training of professional technicians for radiotherapy. It is important to strengthen the management of planning, access and supervision of medical equipment.
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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.
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Objective To explore the utilization of the basic medical insurance and the influence of age factors on the medical expenses of the retirees. Methods Descriptive statistics and variance analysis were used to analysis the 265 426 medical service use records of the retirees in Y city in 2016. Results Increase of age pushes up the utilization rate of retirees for hospitalization services and reduces the service utilization of chronic disease outpatient clinics. In total, the medical expenses are concentrated in the age of 60-70, and the total medical cost of the population decreases with age. The per-capita medical expenses of different age groups were different, the greater the age the higher the average.Conclusions The change of the disease spectrum such as higher incidence of chronic diseases poses a new challenge to the medical service system. Aging will continue to pressurize the medical security system. It is urgent to establish a healthcare system centering on the elderly and a sound medical insurance system.
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As a recognized and effective decision-making assessment tool, health technology assessment can provide scientific support for scientific decision-making such as medical devices deployment and management. This study highlighted the necessity of medical device health technology assessment by studying the development history of health technology assessment at home and abroad. On this basis, the authors pointed out the necessity of medical device health technology assessment from the perspective of laws and decrees of the country, deepening of the healthcare reform, medical insurance directory, as well as enhancement of medical quality and patient safety. Also analyzed are such problems as development of health technology assessors, system construction, and policy transformation capability.
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Objective@#To study the socioeconomic burden of bacterial resistance incurred by taking carbapenem-resistant Klebsiella pneumoniae and cefotaxime-resistant Escherichia coli as examples.@*Methods@#Such indexes as disability-adjusted life years and health utility values were used to conduct a socioeconomic analysis of drug resistance.@*Results@#The economic burden caused by Klebsiella pneumoniae and Escherichia coli resistance among inpatients of 187 members of the national antiseptic drug clinical application monitoring network in 2015 was as high as 260.498 9 million yuan and 352.325 8 million yuan respectively. The years of healthy life lost due to disability were 4 658.02 years and 6 346.97 years respectively.@*Conclusions@#This study introduced indexes such as disability-adjusted life years and health utility values, to scientifically innovate the measurement of the economic burden of drug resistance from the perspective of economic burden of diseases.