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This paper analyzed the problems existing in China’s basic medical and health services from the perspective of fairness and efficiency, and the main restricting factors of balanced developmen. The main factors were: the far-reaching influence of "dual economic structure" between urban and rural areas, the government’s low-efficiency intervention in the allocation of health resources, the efficiency of hierarchical diagnosis and treatment system has not been fully released, the level of basic medical security needs to be improved, and the reform of the management and operation mechanism of medical institutions is lagging. It is proposed to adhere to the value concept of appropriate balance between fairness and efficiency, give full play to the functions of the government and the market, and take concrete measures to improve the financing mode, optimize the allocation of resources and improve the service system.
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Objective To understand the health-related quality of life (HRQOL) of migrant workers with pneumoconiosis who received basic medical treatment in Hunan Province. Methods A total of 613 migrant workers with pneumoconiosis who received basic medical treatment and assistance in Hunan Province was selected as the study subjects using stratified random sampling method. The European Quality of Life-5 Dimensions (EQ-5D) questionnaire was used to assess their HRQOL. Results The abnormality of the five dimensions of the EQ-5D health description system, from high to low, were as follows： daily activities, mobility, pain/discomfort, anxiety/depression, and self-care, with the abnormal rates of 50.9%, 46.8%, 41.1%, 21.0%, and 14.5%, respectively. The visual analogue scale (VAS) score of EQ-5D was (63.5±18.6) points. Patients with stage Ⅲ pneumoconiosis had high abnormality in mobility, daily activities, and pain/discomfort compared with those with stage Ⅰ and Ⅱ disease (all P<0.02). Patients in stage Ⅱ and Ⅲ of pneumoconiosis had higher incidence of anxiety/depression compared with those with stage I disease (all P<0.02). Patients with complications in addition to pneumoconiosis had higher abnormality in mobility, self-care, and pain/discomfort compared to those with simple pneumoconiosis or those eligible for lung lavage treatment (all P<0.02). Patients with simple pneumoconiosis had a higher incidence of anxiety/depression compared with those eligible for lung lavage treatment (P<0.02). Patients with stage Ⅲ pneumoconiosis had lower average VAS scores compared with stage Ⅰ and Ⅱ patients (all P<0.02). Patients with simple pneumoconiosis or those with complications had lower average VAS scores compared with those eligible for lung lavage treatment (all P<0.05). Conclusion The HRQOL of pneumoconiosis patients among migrant workers needs improvement, especially for patients with stage Ⅲ disease and those with complications. This study indicates the need of optimizing policies, raising the hospitalization expense limit for critically ill patients with stage Ⅲ pneumoconiosis or with complications, and improving their HRQOL.
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As the major means of outpatient payment for basic medical insurance (the insurance for short) relies on fee-for-service, it tends to encourage unreasonable growth of medical expenses. Based on the principal-agent theory, this paper analyzed the principal-agent relationship between the insurance handling agencies and the hospitals designated by the insurance, and constructed a benefit game model of outpatient payment methods and the supporting supervision game model. This practice aims to explore the optimal and balanced benefit of the insurance payment methods and supporting supervision mechanism, and provide decision support for promoting the reform of medical insurance outpatient payment in China. The analysis results of the benefit game model of payment methods showed that a system mixing the post-payment and pre-payment could optimize and maximize the total benefits and interests of all the stakeholders within the system. Specifically, the practice recommended was a mixed payment integrating ambulatory-payment-classification, fee-for-service and global-budget-payment. The analysis of the supporting regulatory game model found that the factors that must be considered to ensure the expected utility of the above mixed payment mode as follows: the gap between the unreasonable income obtained by the hospital by out-of-control charging and the reward obtained by under-control charging, the size of the penalty after the unreasonable income of the hospital was discovered, the size of the regulatory cost and the loss of benefits of the government and the insured group. It is suggested to adopt the mixed payment method mainly based on the ambulatory-payment-classification supported by fee-for-service and global-budget. At the same time, medical insurance agencies can improve their supervision mechanism from such aspects as perfecting penalties, reducing supervision costs, leveraging government administrative power and advocating public supervision.
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Basic medicine is the starting point to contact medicine for students, and also the key period for the formation of professional ethics and core qualities. While imparting basic professional knowledge, it is necessary and effective to integrate ability training and value guidance into the whole person education and carry out the fundamental task of building moral principle and cultivating students. Based on the high-quality resources of national online first-class courses, the teaching team combined the advantages of O-PIRTAS flipped classroom and TBL teaching, and explored the molecular mechanism of cell signal transduction in practice. Through introducing rich and diversified materials and cases, such as Nobel Prize research process, major research achievements of Chinese scholars, frontier progress of disciplines, mechanism of action of targeted drugs, clinical diseases, etc, students were guided to gain knowledge, exercise ability and improve quality via discussion and cooperation. Through the interactive links of online and offline, in-class and out-of-class, individual and team, listening and speaking, learning and practice, basic theory and extension and exploration, students’ abilities in autonomous learning, team cooperation, communication and expression had been significantly improved and they had a deeper understanding of scientific spirit and humanistic spirit. At the same time, students have been trained with preliminary dialectical thinking and innovation consciousness, enhanced sense of mission and national confidence, and strong professional concept of serving people’ s health. The teaching team believes that the high-quality resources and the control of exploration activities are important steps to improve the teaching effect of O-PIRTAS flipped classroom combined with TBL.
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Medical microbiology is one of the compulsory courses of basic medical sciences, which lays an important theoretical foundation for the follow-up study of infectious diseases, contagions, tumors, and so on. The course of medical microbiology in our college adhered to the concept of student-centered, diversified teaching, scientific evaluation, and continuous improvement. Teaching design was a cross-link of general theories, specific chapters, clinical cases, theory and practice, and the ideological and political education throughout the curriculum. Lectures adopted the mode of offline teaching (such as flipped classroom, case analysis, and comprehensive experimental design), online assistance (such as classroom test, stage test, extracurricular homework, and questionnaire survey), and combined process evaluation. This teaching mode also reflected the deep integration of information technology and classroom teaching. With the development and construction in these years, medical microbiology has completed the renewal of curriculum resources, the construction of online question bank, the construction and design of ideological and political case bank, and process evaluation (10 points of usual score + 10 points of case study + 10 points of experimental performance + 100 points of final examination multiplied by 70%). There was no significant difference in the results of qustionnaire survey in terms of the improvement of independent learning ability, curriculum evaluation system and satisfaction feedback. Students in Batch 2019 were most satisfied with the teaching of keeping pace with the times and the guidance of positive outlook on life and values.
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Multiple factors such as traditional history evolution, resource allocation and management mechanism all restrict the discipline development of basic medical sciences and the enhancement of postgraduate education quality. Guangzhou Medical University starts from top-level design, focuses on joint efforts of discipline construction and adopts a series of reform measures to promote first-class basic medical sciences discipline construction and enhance the postgraduate education quality, such as transforming the architecture of scientific institutions, grasping the discipline direction, setting double-tutor system, optimizing the tutor team, promoting curriculum reform, strengthening communication between domestic and overseas and selecting excellent students. Practice shows that positioning properly and developing with unique features based on joint efforts of discipline are effective approaches to build high-level teaching-research medical universities.
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Objective To analyze the composition and influencing factors of the hospitalization expenses of patients with cardiovascular and cerebrovascular diseases who has participated in basic medical insurance, and to provide evidence for controlling excessive increase in the hospitalization expenses and reducing the financial burden of patients. Methods The hospitalization information of 14,271 insured patients with cardiovascular and cerebrovascular diseases from January 1, 2019 to December 31, 2019 in Xianning City, Hubei Province was retrospectively collected. The basic information of the patients and the composition of their hospitalization expenses were descriptively analyzed, and the influencing factors of hospitalization expenses of the patients were analyzed by univariate analysis and logistic regression analysis. Results Among the patients included in the study, coronary heart disease, cerebral infarction, cerebral hemorrhage and essential hypertension were the four main types of cardiovascular and cerebrovascular diseases with the largest proportion of hospitalization expenses, accounting for 26.18%, 20.29%, 11.82% and 9.94%, respectively. The largest proportion of hospitalization expenses was treatment expenses and drug expenses, accounting for 44.09% and 32.52%, respectively. Logistic regression analysis showed that age, length of stay, type of insurance, type of cardiovascular and cerebrovascular diseases, whether there were other comorbidities or complications, and whether they visited tertiary medical institutions were the influencing factors of hospitalization expenses for patients with cardiovascular and cerebrovascular diseases. Conclusion It is necessary to strengthen the disease prevention and control for the elderly and patients with cardiovascular and cerebrovascular diseases such as coronary heart disease, cerebral infarction, cerebral hemorrhage and essential hypertension, accelerate the integration of the basic medical insurance system, scientifically and reasonably shorten the length of hospital stay, and strengthen the promotion of the hierarchical medical system.
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As a powerful attempt by government to promote the construction of the multi-level healthcare security system and social and commercial integration in China, " City-customized Medical Insurance" still has many problems to be solved at the beginning of its development, such as unclear boundary between government and enterprises, limited coverage and strength of security. On the basis of clarifying the current situation of " City-customized Medical Insurance", and combing the management experience of social and commercial integration in Medicare Part C plan of the United States, the authors put forward that China should make full use of the advantages of the combination of promising government and efficient market, guide differentiated product design, and establish market access and evaluation mechanism, so as to promote the effective connection between China′s commercial health insurance and basic healthcare insurance, and further reduce the people′s medical burden.
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Objective:To investigate the current status and influencing factors of outpatient institution choice for hypertensive patients with basic medical insurance in Beijing, for reference to promote the implementation of the hierarchical medical system and guiding hypertensive patients to seek healthcare in primary care.Methods:Based on data of hypertensive outpatients from the basic medical insurance database of Beijing from April 2019 to January 2020, we analyzed major demographic characteristics of hypertensive patients, the selection of outpatient institutions and its influencing factors. The chi square test was used for comparison between groups, and the multivariate logistic regression model was used to analyze influencing factors.Results:2.842 1 million outpatients with hypertension were enrolled. 39.03% of them chose primary healthcare institutions, 5.16% chose secondary healthcare institutions, and 17.34% chose tertiary healthcare institutions, while the rest 38.47% chose two or more types of healthcare institutions. Gender, age, type of medical insurance, place of residence, utilization of Chinese herbal drugs, utilization of Chinese patent drugs, polypharmacy, needs of outpatient tests and examinations were the influencing factors for their selection of primary healthcare institutions for hypertensive outpatients under Beijing basic medical insurance.Conclusions:At present, the primary institutions have become the first choice for the majority of hypertensive patients with medical insurance in Beijing, but there are still many influencing factors on their choice of institutions. In the future, we should optimize the allocation of medical resources, promote the reform of medical insurance payment methods, strengthen the construction of primary medical institutions, expand the coverage of contracted services of family doctors, and reasonably guide the patients to seek healthcare in primary healthcare institutions.
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Objective:To analyze the filing mechanism for cross provincial immediate reimbursement of medical insurance in China, so as to provide reference for optimizing the filing mechanism and improving the filing accessibility of insured personnel.Methods:Taking the filing policy of cross provincial immediate reimbursement of medical insurance in 2019 as the research object, on the basis of a comprehensive understanding of the national filing policy background, 90 coordinating regions in Zhejiang Province, Hubei Province and Ningxia Hui Autonomous Region were taken as survey samples to evaluate the relevant policies and extract key parameters, including filing identification methods, filing-related settlement benefits and filing ways. The parameters were compared and analyzed by using descriptive statistical methods.Results:The results of the survey showed that in terms of identity recognition methods, the provision of various supporting materials(residence permit, work certificate, etc.)was still the main way to carry out identity recognition for medical insured persons in different places.Filing-related reimbursement benefits were mainly adjusted by limiting the area of medical insurance treatment and adjusting the benefits parameters(reimbursement ratio). In terms of filing channels, 51(56.7%)sample co-ordination areas had realized at least one remote filing mode.Conclusions:The inclusiveness of filing identity verification mechanism for the floating population needs to be further improved, the filing-related treatment policies need to be further improved, and the convenience and standardization of filing channels need to be strengthened.
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Objective:To explore the effect of flipped classroom combined with scenario simulation in the teaching reform on four basic medical puncture techniques of clinical skills training.Methods:A total of 1 275 students majoring in five-year clinical medicine in Guangzhou Medical University were enrolled in the study. The control group (647 cases from Batch 2015) were given the traditional teaching pattern and the experimental group (628 cases from Batch 2016) adopted flipped classroom combined with scenario simulation. At the end of the course, the performance in the tests of four basic medical puncture techniques in the objective structured clinical examination (OSCE) of the two groups were compared. The feedback and evaluation of this teaching mode in the experimental group were investigated by questionnaires. SPSS 19.0 was used for independent samples t test. Results:All the scores of the tests of four basic medical puncture techniques in the experimental group were significantly higher than those in the control group: abdominocentesis [(87.89±7.13) vs. (82.60±10.74) points], thoracocentesis [(85.20±7.39) vs. (81.96±7.76) points], bone marrow aspiration [(88.13±6.00) vs. (83.50±9.63) points], and lumbar puncture [(91.91±7.19) vs. (80.74±12.20) points], with significant differences ( P<0.001). The results about the feedback and evaluation in the experimental group showed that the students gave an average score of 8.4 points to their satisfaction with the new teaching mode. The approval rates of the teaching effect evaluation items such as teaching arrangement, improving learning ability, improving clinical practice ability and school promotion were higher than 90.0%. Conclusion:Flipped classroom combined with scenario simulation, which is worthy to be popularized, can not only improve the students' performance in the tests of four basic medical puncture techniques in the OCSE, but also improve teaching satisfaction and teaching effect.
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OBJECTIVE：To provi de reference for classification ，selection and management of antibacterial drugs in medical institutions. METHODS ：The adjustment of antibacterial drug list in 2019 edition of National Basic Medical Insurance ，Work Injury Insurance and Maternity Insurance （called“New List ”for short ）was introduced. The politic reference of selection and adjustment of antibacterial drugs and the principle of classification selection in medical institutions were sort out. The challenges which may bring to pharmaceutical administration and clinical use in medical institutions were investigated. RESULTS & CONCLUSIONS： Three new varieties of the antibacterial drugs in the New List have been added ，including Doxycycline injection，Faropenem granules and Metronidazole oral regular-release preparations. Nine product specifications were excluded ，such as Tetracycline oral regular-release preparations ，Dirithromycin oral regular-release preparations ，etc. The limitation of indications and/or indications of 19 regulations was modified ，and some antibacterial requirements were limited to patients with clear evidence of drug sensitivity test or severe infection. When classifying and selecting antibacterial drugs ，medical institutions should take the existing policy documents as the basis ，strictly implement the relevant provisions of antibacterial drug management ，give priority to meeting various national prescription sets and drug list varieties ，select drugs with sufficient evidence-based treatment basis ，drug quality and safety ，and take into account the convenience and economy of drug use ，supply guarantee service capacity of drug production and circulation enterprises and local situation of pathogenic bacteria resistance. The adjustment of New List also brings challenges to use and management of antibacterial drugs in medical institutions. For example ，New List emphasizes“limited drug sensitivity evidence ”for many antibacterial specifications. But if the clinicians choose drugs mechanically according to the drug sensitivity results and ignores the experience treatment in anti-infection treatment ，another type of “abuse”may be abused ；in addition，the indications of myxomycetin B and colistin （sulfate myxomycetin ）are completely different ，which also deserves further study.
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OBJECTIVES@#To verify the applicability and extensibility of the satisfaction index of basic medical insurance for rural and urban residents, and to explore the mechanism responsible for the satisfaction index in Kunming and Changsha City, and provide references for effective management and policy making.@*METHODS@#A stratified cluster sampling method was conducted. A total of 560 familial decision makers were randomly selected in 24 classes of 14 schools of Kunming and Changsha City. Model reliability was tested by SPSS18.0. In addition, Smart PLS 3.0 was applied to conduct model validity test, calculate the satisfaction index, and to compare the model path coefficients of Kunming and Changsha by multi-group analysis.@*RESULTS@#In the application of the satisfaction index of basic medical insurance for rural and urban residents in Kunming, Cronbach's α of the model was 0.93, split-half reliability coefficient was 0.90, and the latent variable composite reliability coefficient values were more than 0.86; the latent variable average variance extraction (AVE) values were greater than 0.66, and the square root of the AVE of each latent variable (all greater than 0.66) was larger than the correlation coefficient with other latent variables. The factor loading values were greater than 0.70, with statistical significance. The basic health insurance satisfaction index of Kunming and Changsha was 60.40 and 52.05, respectively. The difference between the path coefficient of Kunming and Changsha was not statistically significant except the path from public satisfaction to public loyalty. Perceived value had the largest direct and total effect on public satisfaction latent variable in Kunming City. While the perceived value had the largest direct effect on public satisfaction, and the perceived quality had the largest total effect on public satisfaction in Changsha City.@*CONCLUSIONS@#The satisfaction index model reflects the satisfaction of pupils' basic medical insurance for urban and rural residents, and it also shows good reliability and validity in Changsha and Kunming. What's more the model can be extended to the national level to evaluate the satisfaction of basic medical insurance for urban and rural residents for primary school students. The basic health insurance satisfaction index of familial decision makers in Kunming is higher than that of Changsha. There are differences between Kunming and Changsha in the influential mechanism of the satisfaction index of for Chinese pupils with basic medical insurance for rural and urban residents, and the measures taken by the government and relevant departments to improve the satisfaction of basic medical insurance should be based on local conditions.
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Humans , China , Decision Making , Personal Satisfaction , Reproducibility of Results , Rural Population , Urban PopulationABSTRACT
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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This paper defined the main stakeholders of basic medical insurance mobile payment using the stakeholder theory, namely the government ( medical insurance bureaus, human resources and social insurance authorities, and healthcare regulators ), medical insurance agencies, pilot hospitals, medical workers, patients, and third-party social resources ( third-party payment entities, commercial insurers, web-based medical enterprises, and state-own financial institutions). SWOT analysis is used in analysis of stakeholders, to uncover the strength, weakness, opportunity and threats in advancing basic medical insurance mobile payment, thereby proposing how to guarantee the healthy and sustainable development of such mobile payment.
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Objective To understand the basic medical literacy status of Chongqing residents in 2016 and it’s influencing factors. Methods From August to December of 2016, multi-stage stratified cluster random sampling and PPS method were used to extract 15-69 years permanent residents from 34 counties in Chongqing to investigate residents' status and influencing factors of basic medical literacy by paper questionnaire survey, and SPSS 21.0 software was adopted for data analysis, and multi-factor logistic regression analysis was used for main result. Results The basic medical literacy level of Chongqing residents was 10.59% in 2016. 8 217 people were surveyed and 8 214 valid questionnaires for this analysis were completed. The ratio of urban and rural population was 0.43:1 and sex ratio was 1.02:1. Multi-factor logistic regression analysis showed that education level was an important factor affecting the basic medical literacy of residents. Conclusion The basic medical literacy level of Chongqing residents in 2016 is still at a low level, and the education and region are the main influencing factors, so it is necessary to carry out targeted health educational and health promotion activities.
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Western medicine was first introduced to Korea by Christian missionaries and then by the Japanese in the late 19th century without its historical, philosophical, cultural, social, political, and economic values being communicated. Specifically, during the Japanese colonial era, only ideologically ‘degenerated’ medicine was taught to Koreans and the main orthodox stream of medicine was inaccessible. Hence, Korean medical education not only focuses on basic and clinical medicine, but also inherited hierarchical discrimination and structural violence. After Korea's liberation from Japan and the Korean war, the Korean medical education system was predominantly influenced by Americans and the Western medical education system was adopted by Korea beginning in the 1980s. During this time, ethical problems arose in Korean medical society and highlighted a need for medical humanities education to address them. For Korean medical students who are notably lacking humanistic and social culture, medical humanities education should be emphasized in the curriculum. In the Fourth Industrial Revolution, human physicians may only be distinguishable from robot physicians by ethical consciousness; consequentially, the Korean government should invest more of its public funds to develop and establish a medical humanities program in medical colleges. Such an improved medical education system in Korea is expected to foster talented physicians who are also respectable people.
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Humans , Aptitude , Asian People , Clinical Medicine , Consciousness , Curriculum , Discrimination, Psychological , Education , Education, Medical , Ethics, Medical , Financial Management , Humanities , Japan , Korea , Korean War , Missionaries , Rivers , Societies, Medical , Students, Medical , ViolenceABSTRACT
Objective To find out research progress for remote medical treatment of basic medical insurance in China,in order to provide evidences for further research and policy-making.Methods Doing literature research.Results Research progress is summarized from five aspects,such as concepts and theoretical basis,causes of remote medical treatment and different social problems caused by it,the observation of domestic and foreign experiences,shift and continuity of basic medical insurance for rural residents,as well as instant reimbursement.Conclusion The enlightenment from the existing research is put forward,that is to solve the related problems of remote medical treatment.The most important thing is to classify the people who need remote medical treatment,and then to give solutions acording to different categories.
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Objective: To compare the differences and caused of patients' utilization of Traditional Chinese Medicine service under three basic medical insurance systems.Methods: Using self-developed questionnaire,random sample survey was conducted among the basic medical insurance outpatients in five hospitals in Nanjing and Lanzhou.The survey content included the basic information of the patients,the utilization of Traditional Chinese Medicine outpatient clinics,the utilization of Traditional Chinese Medicine service items,and the suggestions for the Traditional Chinese Medicine service.Results:①The utilization rate of the Traditional Chinese Medicine out-patient clinics in new rural cooperative medical system patients was much lower than that in urban basic medical in-surance patients.②The utilization rate of Traditional Chinese Medicine service projects in patients under basic medical insurance for urban employees was higher than those under medical insurance for urban residents and new rural cooperative medical system patients.In all Traditional Chinese Medicine service projects,the utilization rate of cupping project was the highest(48.3％).③ The gap between urban and rural areas made the utilization rate of Traditional Chinese Medicine service projects different among patients participating in basic medical insurances.④ The most expected suggestion of patients was the improvement of the efficacy of Traditional Chinese Medicine(68.5％),followed by the improvement of medical insurance-related reimbursement ratio(65.2％)and the in-crease of reimbursement items(64.3％).Conclusion: The government should increase the financial input in new rural cooperative medical system and improve the basic medical insurance system.Traditional Chinese Medicine medical institutions should improve the quality of services in order to achieve the fairness in the provision of health services.
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Medical philosophy has important guiding significance for the development of medicine. Ancient Greek medical philosophy has rich connotation and strong vitality. In the study of ancient Greek medical philosophy and combined with"the positioning of basic medicine"and"doctor-patient relationship"and other outstanding is-sues in the current development of medicine, we found that the rational examination of medical theory and medical treatment in ancient Greek medical philosophy, ways of thinking and analytical methods of medical philosophy and the character that physician should have had an important value in the development of modern medicine. We should pay attention to basic medical research,pursue innovative thinking, be good at using critical thinking and pay atten-tion to the training of humanistic spirit among medical workers.