The influence of Beijing medical care reform on crowded Emergency Department in the tertiary hospital / 中华急诊医学杂志

Objective To explore the influence of medical care reform on crowded emergency department in the tertiary hospital.Methods The 8 April 2017 was considered as turning point when Beijing began to implement medical care reform.The research subgroups consisted of pre-medical reform group,intra-medical reform group and post-medical reform group,according to the date 20 days before the medical reform,20 days after the medical reform and 21-40 days after the medical reform.During this period,The NEDOCS scores(The National Emergency Department Overcrowding Scale) were calculated at 10:00,14:00,18:00 in the Emergency Department of Peking University Third Hospital every day,the mean of which assessed the degree of crowding.The key indicators in the NEDOCS scoring formula were compared to find the reasons for the change of emergency crowding.All statistical analyses were performed using SPSS version 25.0.Continuous data presented as means ± standard deviation (normal distribution),analyzed by t-tests or median ± quartile(abnormal distribution),analyzed by Mann-Whitney U test.Results The NEDOCS scores in the intra-medical reform group were statistically higher than that in the pre-medical reform group (401.69 vs 339.68,P＜0.05).The NEDOCS scores in the post-medical reform group were higher than that in the pre-medical reform group,but the difference was not statistically significant (380.83 vs 339.68,P＞0.05).The number of ventilated patients (Rn) significantly increased after the reform (P＜0.05).Conclusions The degree of emergency department crowding in the tertiary hospital has increased after the Beijing medical care reform in 2017.The increase in the number of critically ill patients may be the reason for the increased overcrowding in the emergency department.

Training the applicable medical talents for adapting medical care reform / 中华医学教育探索杂志

The medical care reform is at the stage of rapid development of economic,science and technology in China. Facing the problems and the reform trend of focusing on the hospitals at basic level for medical services,medical schools should play the role in training medical personnel for community and township. The pathways for cultivating the applicable medical talents include the scale enlargement and structure adjustment,quality control,curriculum reform,postgraduate education and training program on post.

Ethical Analysis of All-Free Health Care in Shenmu County / 中国医学伦理学

The "all-free health care" system is being implemented in Shenmu County in Shaanxi Province,whose ethical orientation is during the transitional process from "basic medical insurance" to "meeting residents′ actual healthcare demand".The "all-free health care" system safeguards human health rights,embodies the principle of giving priority to social benefits,and is in accordance with the principle of effectiveness.However,due to the lack of scientific management,the capital flows violate the principle of prevention in the system.