Iodine nutritional status of population before and after system reform of salt industry in Gansu Province / 公共卫生与预防医学

Objective To understand the impact of system reform of salt industry on iodine nutrition of people in Gansu Province, and to provide a scientific basis for policy adjustment of relevant departments. Methods The investigation period (2014-2021) was divided into two sub-periods: before system reform of salt industry (2014-2016) and after system reform of salt industry (2017-2021). Thirty counties were selected according to the method of “population proportional probability sampling (PPS)” in 2014. According to the iodine deficiency disease monitoring program of Gansu Province, from 2016 to 2021, children aged 8-10 years and pregnant women were taken as research objects to collect urine samples for urine iodine detection. Children in 2014 and 2018 were selected to measure thyroid volume. Results A total of 90 989 children urine iodine samples were investigated, and the median urinary iodine (MUI) of children was 194.70µg/L; 7 663 and 83,326 children's urinary iodine samples were investigated in the two periods, the MUI was 180.73 µg/L and 196.00 µg/L, respectively, and the difference was statistically significant (P<0.05). A total of 44 741 pregnant women's urinary iodine samples were investigated, and the MUI of pregnant women was 176.50 µg/L; 4 480 and 40 261 pregnant women's urinary iodine samples were investigated in the two periods, the MUI was 160.61 µg/L and 178.10 µg/L, respectively, and the difference was statistically significant (P<0.05). The thyroid volume of 1 555 children and 8 509 children was investigated in the two periods, the median thyroid volume was 2.70 mL and 2.55 mL , respectively, and the difference was statistically significant (P<0.05). The rates of goiter in children were 3.15% and 1.26%, respectively, and the difference was statistically significant (P<0.05). Conclusion The iodine nutrition of people in Gansu Province has not fluctuated significantly after the reform of salt industry system and has maintained an appropriate level. It is necessary to pay attention to the potential risk of insufficient iodine nutrition level and thyroid health of key populations such as children and pregnant women and strengthen health education of scientific iodine supplementation.

Analysis of typical experiences of public hospital salary system reform in Sichuan province / 中华医院管理杂志

Objective:To analyze the experiences and practice in the reform of public hospital salary system in Sichuan province, summarize the typical modes of such reform in the province, and provide references for further reform.Methods:As of October 29, 2021, the research group received 77 sets of typical experience materials submitted by the health commissions and public hospitals in Sichuan province on enforcing the reform of the public hospital salary system. The analysis framework was based on the five main elements proposed in the Guidance to Deepening the Reform of the Salary System of Public Hospitals for the purpose of furthering the reform. These five elements refer to " reasonably determining the level of salary in public hospitals" " fully implementing the autonomy of internal distribution in public hospitals " " establishing and improving the incentive and restraint mechanism for the remuneration of public hospital leaders" " improving the assessment and evaluation mechanism oriented to public welfare" and " funding sources ". A quantitative analysis was made on the typical experience materials using the social network analysis method, while a qualitative analysis was made on the typical experience materials using the content analysis method. Results:The results of social network analysis showed that the network density was 0.272; the highest point centrality was " fully implement the autonomy of internal distribution in public hospitals" (0.935), and the highest intermediary centrality was " improving the assessment and evaluation mechanism oriented to public welfare" (0.870), while the closeness to centrality of " establishing and improving the incentive and constraint mechanism for the salary of public hospital leaders" (0.434) and " funding sources" (0.421) were relatively low. The results of content analysis showed that the ones with higher frequency among all the typical experience materials were " fully implementing the autonomy of internal distribution of hospitals" (72 times) and " improving the assessment and evaluation mechanism oriented to public welfare" (67 times), while the ones with lower frequency were " establishing and improving the salary incentive and constraint mechanism for public hospital leaders" (17 times) and " funding sources" (14 times). In terms of unity and synergy, the typical models of public hospital salary system reform in the province could be categorized as the fine standard mode, the fair value mode, the autonomous synergy mode and the circular symbiosis mode.Conclusions:Deepening the reform of the salary system of public hospitals should unify the standards and improve the fair and refined assessment and evaluation mechanism; explore various forms of distribution and build an internal autonomous and synergistic incentive mechanism; pay attention to the weak remuneration incentive mechanism for hospital leaders and the problem of a relatively single source of funding.

Analysis on the staff salary status in traditional Chinese medicine hospitals of Sichuan province in 2020 / 中华医院管理杂志

Objective:To analyze the staff salary status and the influencing factors in traditional Chinese medicine(TCM) hospitals implementing the salary system reform in Sichuan province in 2020, for reference in optimizing the salary system reform of such hospitals.Methods:Cluster sampling and institutional survey were used to collect the salary information of 26 TCM hospitals in 21 cities(prefectures)of Sichuan province implementing the salary system reform in 2020. Such information was then subject to descriptive analysis, while the influencing factors of salary were subject to one-way analysis of variance and generalized linear model multifactor analysis.Results:15 428 staff from 26 TCM hospitals were included as the research objects. In 2020, personnel expenditure accounted for 40.23% of the total expenditure, and 24.34% of which came from financial subsidy in 26 TCM hospitals. The average annual payable income per person was(149 312±74 288)yuan, 67.82% of which being performance pay. Analysis of variance showed that there were significant differences among the salary levels of staff in different economic regions, hospital grades, hospital levels, gender, educational background, position, seniority, performance pay ratio, employment in the government system and other natures, senior and other professional titles, doctors and other positions( P<0.05), and the differences were still statistically significant after adjustment by generalized linear model( P<0.05). Conclusions:The reform of the salary system of Sichuan TCM Hospitals has basically achieved equal pay for equal work, and the income of low-level personnel has been improved. However, the salary level was not very motivated and the salary structure was not guaranteed. It is necessary to strengthen financial precision subsidies, increase the proportion of personnel expenditure, so as to support the increase of the absolute value of salary in non-core economic areas, improve the salary structure, reasonably widen the salary gap among different educational backgrounds and positions, further optimize internal distribution, and ensure the sustainable development of Chinese medicine talents.

Analysis of salary characteristics and influencing factors of personnel expenditure in medical institutions in Sichuan province / 中华医院管理杂志

Objective:To analyze the salary characteristics of medical institutions and the influencing factors of personnel expenditure as found in the salary system reform of public hospitals in Sichuan province, for reference in furthering such reform in public hospitals.Methods:The data of personnel expenditure, business operation and medical services came from 96 medical institutions in 21 cities(prefectures)of Sichuan province from 2017 to 2020 by means of institutional survey. The average salary level and salary structure of medical staff were used to describe the salary characteristics, and the total salary was presented by the level of personnel expenditure. The measurement data was represented by M(IQR), the counting data was described by frequency and constituent ratio, and the influencing factors of personnel expenditure were analyzed by generalized linear mixed model. Results:From 2017 to 2020, the personnel expenditure of medical institutions increased by 13.04% annually. In 2020, the per capita salary level of medical staff was 151 900 yuan, while the basic salary and performance salary accounted for 16.20% and 54.60% of personnel expenditure respectively. The analysis results of the generalized linear mixed model showed that the average cost of patients per visit( β=0.596), the level of drugs and sanitary materials consumed per 100 yuan medical income( β=0.286), the number of medical visits( β=0.328), and the years [(2018, 2019, 2020) β=0.025, 0.052, 0.066] were positively correlated to personnel expenditure, while the average length of stay( β=-0.693), the proportion of medical service income( β=-0.392), and the balance rate of income and expenditure( β=-0.062)were negatively correlated to personnel expenditure( P<0.05). The proportion of fiscal subsidy revenue, regional GDP and asset-liability ratio were not the influencing factors of personnel expenditure( P> 0.05). Conclusions:In the reform of the salary system of the province, its salary level of medical institutions has surpassed the current wage ceiling of these institutions. As the salary distribution was mainly made based on the workload, the " baton" role of the salary system reform has begun to pay off. However, the basic guarantee role of compensation has not yet been fully leveraged.Further reform is needed in upgrading refined management, and timely dynamic adjustment of personnel expenditure in combination with the hospital's financial performance and cost analysis, and reasonably optimizing the level of medical staff compensation.

Exploration of clinicians′ practice competency evaluation based on medical record homepage data / 中华医院管理杂志

The professional title evaluation of health professionals needs to highlight the clinical performance and actual contribution, and make full use of the information system of medical and health institutions to collect relevant data as an important basis for such evaluation.Based on this, the project team innovatively developed a " clinical work data extraction system" , to extract and calculate the performance indexes of clinicians using data from homepages of medical records. Meanwhile, the team established a reference scale based on the data in the hospital quality monitoring system; developed a " health workers evaluation data platform" , visually presenting the comparison results between the clinical work performance evaluation data of a clinician, and the reference scale and the data of other applicants. In the 2021 annual evaluation of senior professional titles among some medical institutions directly under the National Health Commission and such provinces as Sichuan, Shandong and Chongqing, this method was used to extract homepage data of medical records of 7 833 applicants from 39 medical specialties in 1 416 medical institutions, and finally 6 093 people (77.79%) completed the calculation of clinical work evaluation index data. The initial application results showed that the evaluation of senior clinicians′ professional competence based on homepage data of the medical record was feasible in the senior professional title evaluation of various medical institutions at all levels equipped with the electronic medical record database system, and could effectively present the performance level and actual contribution of the applicant.

Investigation on salt sales and salt iodine content in Guizhou Province three years after the system reform of salt industry / 中华地方病学杂志

Objective:To understand the salt sales situation and salt iodine content in the market of Guizhou Province 3 years after the system reform of salt industry.Methods:From August to October 2020, in 9 cities (prefectures) of Guizhou Province, 2 counties (cities and districts) were selected from each city (prefecture), 1 urban area and 1 township were selected from each county (city and district), 1 large supermarket and 1 farmers' market were selected in the urban area, and 1 small supermarkets or convenience stores were selected in the township, to check the varieties, place of origin and iodine content label on the package of salt sold, and different brands of salt were collected and sent to the provincial and county salt iodine laboratories. The iodine content was determined and analyzed.Results:A total of 18 large supermarkets, 18 farmers' markets and 18 small supermarkets or convenience stores were investigated, and 70 salt samples of 23 brands, 3 types and origin from 11 provinces were collected. Among them, there were 56 samples with iodine content of 21 - 39 mg/kg on the package. The iodine content range of provincial detection was 19.23 - 37.41 mg/kg (two of them were lower than 21.0 mg/kg), and the median was 25.75 mg/kg. There were 12 samples of two iodine contents (18 - 33 and 21 - 39 mg/kg) marked on the package, and the salt iodine range of provincial detection was 23.52 - 32.90 mg/kg, with a median of 26.55 mg/kg. One sample was marked with 18 - 33 mg/kg, and the iodine content of provincial detection was 25.20 mg/kg; the iodine content of 1 sample of non-iodized salt was not detected. According to the actual test value, iodine contents of 68 samples were within the range of packaging marks, accounting for 97.14% of the total. Taking the provincial test results as a standard, the absolute value of the relative deviation of the provincial and county test results was 0 - 27.45%, the average deviation was 7.65%, and the coincidence rate was 91.43% (66/70). The county test results were acceptable.Conclusions:After the system reform of salt industry, there are many kinds of salt which come from many provinces, and more than 97% of the salt iodine content which is within the standard range of salt concentration in Guizhou Province.

Study on the influence of Beijing Medical Reform on the hospitalization expenses of medical and surgical patients in a hospital / 中华医院管理杂志

Objective:To analyze the impact of Beijing Medical Reform on inpatient costs of medical and surgical patients in a hospital, and to provide reference for the hospital to explore the path of patient cost control.Methods:Based on the data of medical and surgical inpatients′ expenses from June 2016 to December 2019 in a hospital in Beijing, breakpoint regression method was used to analyze the impact of the two reforms(namely the comprehensive reform of separation of medicine and pharmacy and the comprehensive reform of medical consumption linkage)on the level of medical and surgical inpatients′ expenses and the cost structure of drugs and consumables.Results:The two reforms controlled the rapid rise of hospitalization expenses and reduced the proportion of drugs and medical consumption. The effect of the reforms on the total cost control of internal medical patients was better than that of surgical patients.For internal medical patients, the reform of separation of medicine and pharmacy played a greater role in the proportion of medicine; For surgical patients, the two reforms had effectively reduced the proportion of consumables, and the proportion of drugs had gradually decreased.Conclusions:The two reforms have effectively controlled the growth trend of hospitalization expenses, and changed the cost structure of drugs and consumables.

A preliminary study on the development of grassroots disease prevention and control institutions in post-epidemic era / 公共卫生与预防医学

Now China vigorously promoted the reform of the disease prevention and control system and the construction of the public health system. In the context of the reform of the disease prevention and control system, grassroots disease prevention and control institutions have been greatly improved in terms of the number and structure of personnel, the configuration of facilities and equipment, the construction of information technology, and the ability of laboratory testing. However, it is still a challenge for grassroots disease prevention and control institutions to achieve long-term development under the supportive development policy of “one type of protection and two types of management”. Paper in Wuhan district of institution of disease prevention and control, for example, by analyzing its current working train of thought, puts forward the basic institution of disease prevention and control should be in the internal management level, social level and system level under the three-dimensional development ideas, fully show the technical characteristics, improve the ability of the business, to provide more diversified public health services to the public, may be able to get long-term, stable and continued development.

Thoughts on the strategy and mechanism for the regular prevention and control of COVID-19 / 公共卫生与预防医学

Since the outbreak of the COVID-19 at the end of December 2019, Hubei province has actively adopted a series of prevention and control measures such as “quarantine, treatment, testing, and containment”, and have basically blocked the spread of COVID-19. However, with the development of overseas epidemics and the occurrence of case clusters in local areas, we not only face the threat of imported cases, but also face the urgent need to resume normal work and daily life. This puts forward higher requirements for regular prevention and control of COVID-19. Therefore, we should more deeply understand the significance of regular prevention and control as well as the epidemic situation in our province, summarize experience and lessons, and adhere to the prevention and control strategy of “government-led, group-specialist combination, and specialized-oriented”. Meanwhile, it is necessary to implement the working requirement that combines regular prevention and control surveillance with rapid emergency response to local COVID-19 outbreaks. Furthermore, we should establish a regular multi-point trigger early warning mechanism for COVID-19, strengthen the reserve of emergency supplies and carry out training and drills on epidemic prevention and control across the province to make full preparations for the coming autumn and winter epidemics. The most important is to reform the system of disease prevention and control and public health, comprehensively improve the ability of prevention and treatment, and promote the modernization of public health governance.

Medical insurance model based on the national big data platform for medical and healthcare management / 国际生物医学工程杂志

The fundamental goal of China's medical insurance is to build a multi-level social security system covering the whole people, urban and rural planning, clear rights and responsibilities, moderate protection, and sustainable development. It is required to unify the medical insurance system, achieve fairness in medical insurance, improve the degree of protection, and increase the protection project, so as to effectively meet the needs of the basic health care services of the national diversification and to comprehensively improve the national health level. It is help to reduce the incidence of diseases, improve the quality of life, reduce the expenditure on medical expenses, and regulate the health habits of the people by emphasizing the importance of active prevention in the medical insurance sector. That is consistent with the ultimate goal of the health system reform. Active health insurance based on the national big data platform for medical and healthcare management can implement effective health interventions through various medical and economic means, helping to block risk factors before disease formation, thereby extending the individual health cycle and achieving the purpose of maintaining health. It can be foreseen that with the implementation of active medical insurance, the awareness rate of major chronic diseases will increase, and theincidence of major chronic diseases and the number of patients will gradually decrease. Therefore, the economic burden of the national medical and health system will gradually be reduced, so as to meet the growing needs of people for health care.

Design and practice of deepening the healthcare system reform in Hangzhou / 中华医院管理杂志

Further healthcare system reform calls for desirable pathway design. This paper introduced the logical framework of the new healthcare system reform pathway design and typical practical experience in Hangzhou.Known for " Internet+Smart healthcare" forerunner, Hangzhou has pioneered the reform of public hospitals and the construction of smart handy service for the public.With the aim of fully protecting the health rights and interests of urban and rural residents, comprehensive policy has been taken to deepen the reform of public hospitals; with the comprehensive promotion of contracted services and the primary level sharing of resources as a carrier, we will build a hierarchical medical service system of vertical linkage.We will also innovate and practice the governing philosophy of " Medicine has its limitations but we have the courage to overcome, service is boundaryless and we must pursue excellence".Promotion of party building in the industry also ranks high.Deepening the reform of " one visit for all" in the field of medical and health services as a measure to enhance people′s sense of gain; The " public-private partnership" to encourage the development of the social governance system and legalization in healthcare proves successful at this stage. However, there are still many challenges in the information security maintenance of smart healthcare, the balance of stakeholder interests in public hospitals, the all-round advancement of hierarchical medical service, standardizing and streamlining the reform of " one visit for all".

Discussion on capitation payment system reform based on case analysis / 中华医院管理杂志

Pilot areas have achieved initial success in capitation reform. On the other hand, challenges remain unsolved in terms of practical pathways, change of national medical insurance management system, related measures, incentives and allocative mechanism for implement of the reform. With the concerning on progress, practice, effects and challenges of typical areas, this article established an institutional framework. On such basis, we propose to design and refine a scheme in terms of 5 aspects, namely strengthening the basic medical care packages′financing, setting contents and standard of the basic medical care packages rationally, establishing effective evaluation system and formulating supporting measures.

Case analysis and enlightenment of capitation payment system reform / 中华医院管理杂志

Objective To analyze the main practices of capitation payment system reform in the case areas and put forward enlightenments and suggestions in this regard. Methods The implementation practices of the case areas were summarized, and descriptive statistical analysis was carried out on the implementation effects. Results By analyzing the effectiveness of the case areas′reform, it was found that the case areas are curbing the excessive growth of medical expenses (for example, outpatient fees per visit of Dingyuan county-level hospitals decreased from 245.11 yuan in 2015 to 218.40 yuan in 2017), increasing the actual compensation ratio of residents ( for example, the actual compensation ratio of Funan increased from 59.80% in 2015 to 63.28% in 2017), forming a medical treatment pattern within the county (for example, out-of-county compensation ratio in Dingyuan decreased from 37.38% in 2015 to 31.13% in 2017), achieving double-way referrals (for example, the number of referrals to superior hospitals of Jimo increased from 98 in 2015 to 328 in 2017), improving the subsidence of quality services, and controlling the risks of medical insurance funds. Conclusions At present, the reform of the case areas has been implemented steadily and achieved results. It is recommended to further improve such aspects as reform coordination, insurance standard setting, incentive mechanism establishment, and leadership to ensure the reform progress.

La donación de órganos y el veto familiar. Razones bioéticas para un cambio / Organ donation and family refusal. Bioethical reasons for a change

Cases of next-of-kin veto, i.e., a family refusal to allow organs harvest contrary to donor wishes or when the law presumes consent, is a widespread practice that seriously harms thousands of people. This is a practice settled in many countries Family refusal to donate reduces an already shallow donor pool by approximately 43% in the Americas, 25% in Europe (37,3% in United Kingdom) and 54% in Asia. Some countries, such Argentina, France, Colombia and Wales, current reversed its policy on organ donations to a system that prevents next of kin to dishonoring the donor's wishes restricting the confirm donor status only with the National Donor Registry and unless evidence of their objection is produced. In part I we review the latest amended transplant legislation of those countries that are trying to change this scenario. In part II we question the most frequently cited arguments to uphold the next-of-kin veto right and the countries that successfully changed their legislation banning this practice to encourage organ donation. We conclude that it is imperative to change this practice because the harm caused by promoting the family veto is greater and more serious than the potential harm of not allowing it

Los casos de veto familiar a la donación de órganos es una práctica generalizada que perjudica seriamente a miles de personas. Esta es una práctica establecida en muchos países. La negativa de la familia a donar reduce en un 43% las donaciones bajas de los donantes en las Américas, un 25% en Europa (37,3% en el Reino Unido) y un 54% en Asia. Algunos países como Argentina, Francia, Colombia y Gales han intentado revertir su política de donación de órganos de modo de impedir que los parientes revoquen los deseos del donante. En la primera parte, revisamos las más recientes reformas legislativas de aquellos países que están tratando de cambiar este escenario. En la segunda parte cuestionamos los argumentos más citados para defender el derecho de veto de la familia. Concluimos que es imperativo cambiar esta práctica porque el daño causado por el veto familiar es mayor y más grave que el daño potencial de no permitirlo

How does the world's most efficient healthcare system respond to the challenge? Hong Kong's health governance system, healthcare system reform and implications for mainland China / 中国卫生政策研究

Mainland China's healthcare system reform has achieved remarkable results. As the reform progresses ,more efforts could be made in policy-learning from other Chinese societies with more successful experiences. Hong Kong Special Administrative Region has an internationally renowned healthcare system, ranked at the top in the world's most efficient health systems. This paper reviews Hong Kong's health governance system, the challenges it has faced, its reform initiatives in the recent years, and discusses their implications for the mainland China. Heath governance in Hong Kong has fully realized the separation of regulationswith operation, thus overcoming major institutional barriers. The Hospital Authority of Hong Kong has demonstrated very high efficiency and managerial professionalism. However, Hong Kong's healthcare system is also facing various daunting challenges, and the government has introduced a series of reform initiatives, including the Voluntary Health Insurance Scheme, Public-Private Partnership, and Elderly Health Care Voucher. Many reform ideas and policy instruments can be of reference value for healthcare system reforms in the mainland.

Analysis on labor dispatch management at institutions of healthcare and public health / 中华医院管理杂志

Objective To understand the basics and existing problems of labor dispatchers at institutions of healthcare and public health, and to provide reference for its improvement. Methods In October 2017, 3548 dispatchers from 29 such institutions in Beijing were investigated to find out the basic salary and welfare, career development and labor disputes of their dispatchers. Descriptive statistics was used to analyze the data. Results Among those dispatched of 29 institutions surveyed, 51. 2％ were employed upon staffing quota, 31. 1％ were dispatched and 17. 7％ were employed in other forms. Labor dispatchers had higher educational level as a whole, mainly college and undergraduate education, accounting for 79. 6％;their social security was well assured, and there were few cases of labor disputes. Conclusions It is necessary to further improve the management of labor dispatch personnel, highlight post management, improve salary and welfare mechanism, smooth career development channels, and strengthen the awareness of risk prevention and control.

Study on the doctor-patient interest demands satisfaction of the payment system reform in China's new rural cooperative medical care scheme / 中华医院管理杂志

Objective To study doctor-patient interest demands satisfaction and its influencing factors of the payment system reform of the new rural cooperative medical care scheme to provide reference for the reform. Methods Cross-sectional survey was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was used in six counties of three provinces in the eastern, middle and western regions of China, and mathematical statistics was applied to analyze the data. Results The doctor-patient overall interest demands satisfaction was high, but the satisfaction was lower both with the income and ability improvement of medical staff and with the benefits of farmers. The influencing factors of the satisfaction of managers in medical institutions included the type of payment, educational level and work unit (P＜0.05). The influencing factors of medical staff's satisfaction included the type of payment, work unit, and working years among others(P＜0.05). The influencing factors of farmers'satisfaction included the type of payment and the average annual income, etc(P＜0.05). Conclusions The core interest demands of both doctors and patients should be valued to enhance their satisfaction. Diseases related groups should be promoted and applied scientifically, and appropriately integrated with other methods of payment. Both doctors and patients'understanding of the payment reform should be improved by propaganda and training, to get their support and cooperation.

Study on the participating farmers'interest demands for the payment system reform in China's new rural cooperative medical care scheme / 中华医院管理杂志

Objective To study the participating farmers'interest demands for NRCMs in order to provide basis for the payment system reform based on the demand side perspective. Methods A cross-sectional study was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was conducted in six counties of three provinces in the eastern, middle and western regions of China. Mathematical statistics analysis was conducted to clarify the interest demands and influencing factors of the participating farmers. Results The interests claims of the 1 452 participating farmers were to improve service quality, to reduce the economic burden of disease, and to standardize the management. The medians found were 4.00, 4.00 and 3.63 respectively. Relative to the flat rate, the DRGs raised higher requirements for standardized medical behaviors offered by the medical workers. Furthermore, it called for effective medical quality supervision, rigorous control of medical costs and highly scientific and standardized management. The differences were statistically significant ( P ＜0.05 ). Conclusions The diversity of participating farmers'interest demands deserves due attention, the payment methods combination should fit local needs, the interests demands expression channel of the participants should be expanded, and the demand side deserves a due role in supervision of the funds.

A study on the effect of the Luohu healthcare group reform:An analysis based on the employees'perspective / 中国卫生政策研究

Objective: The study aimed to explore the initial effect of the Luohu Healthcare Group Reform in Shenzhen based on the employee’s perspective. Methods: The questionnaire survey was conducted to investigate the views of employees in 3 hospitals and 23 community health centers in Luohu district. Results: A total of 480 ques-tionnaires were distributed and only 412 valid questionnaires were collected and analyzed. The valid response rate was 85. 83% . 37. 21% of doctors responded that they had motive power to work in community health centers; 75. 38 per-cent of employees stated that their healthcare organization changed a lot; Employees’average work satisfaction scores, interpersonal relationship and healthcare organization development were all above 4. 20, and the consistency of em-ployee evaluation was high. Conclusions: Most of the surveyed employees evaluated the initial stage of the Luohu health reform positively. Since the hospital group started to operate two years ago, the development of the affiliated health facilities has been on an upward trend. The formation of vertical alliance within the hospital group has e-merged; and physicians of secondary and higher-grade hospitals have had increasing willingness of working at the community health centers, especially in the departments of internal medicine and traditional Chinese medicine. The hospital group has been guiding all affiliated facilities to develop its unique signature specialty so that facilities can col-laborate with each other and evolve as a whole. Group employees have expectations that the hospital group will coordi-nate and incorporate interests of all stakeholders, fulfill the commitments, and develop a better future for the group.

Policy analysis of health system reform in Luohu district of Shenzhen City / 中国卫生政策研究

Health system reform at district-level is an important but often neglected component in health system reform of China. According with the national policy-strategy guidance and the local health needs and problems within its jurisdiction,Luohu District has taken a series of effective reform measures for promoting a comprehensive reform since 2015,in which the crucial part was the establishment of"LuoHu Hospital Group". The reform in Luohu was initiated by the district-level government under the favorable policy and external conditions. The district government departments explored and innovated,and developed a featured district-level health system reform road. This experi-ence shows that district-level government should be an active actor in the local health system reform in China. The re-form in Luohu is still on the way,and more effect is yet to emerge, but the experience is of important reference for the health system reform in other regions/cities of China.