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Objective It analyzes the characteristics of the policy text of Sanming City on the basis of two dimen-sions,policy tools and policy objectives,to accumulate the experience of abolishing the increase in the price of tradi-tional Chinese medicine tablets in Sanming City,and puts forward some reflections.Methods Using literature re-search combined with content analysis,a two-dimensional analysis framework of policy tools and objectives was constructed to code 26 policy documents published publicly in Sanming City from January 2013-April 2023 regarding the policy of abolishing the markup on Chinese medicine tablets.Results A total of 87 articles were coded,with de-mand-type,supply-type and environment-type accounting for 16.09 per cent,34.49 per cent and 49.42 per cent respectively,with the overall distribution of policy tools favouring the use of supply-type and environment-type;and there was a certain tendency towards a certain policy objective,"ensuring the quality of Chinese medicine tablet","improving the price mechanism of Chinese medicine tablets","standardising the use of Chinese medicine tablets","strengthening the organisation and implementation,and implement the government's responsibility to invest"ac-counted for 11.49%per cent,39.08 per cent,18.39 per cent and 31.03 per cent respectively.Conclusion Innovative use of demand-based tools,such as market shaping,to promote the development of the beverage production chain in a high quality manner;taking into account the level of the regional economy,returning the price initiative to the market,optimising the market structure of the traditional Chinese medicine beverage industry,and cooperating with publicity measures to promote the implementation of the policy;and reforming the personnel and remuneration system of the pharmacy staff and regulating medical practices.
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Male sterility is an important trait in rice for hybrid rice (Oryza sativa) breeding. However, the factors involved in dominant male sterility are largely unknown. Here, we identified a gene from Sanming dominant genic male sterile rice, named Sanming dominant male sterility (SMS), and reported that an epi-allele of this locus contributes to male sterility. Segregation analysis attributed dominant male sterility to a single locus, SMS, which we characterized using a male-sterile near isogenic line (NIL) of rice cultivar 93-11. The SMS locus was heterozygous in the male-sterile 93-11 NIL, containing an epi-allele identical to that in 93-11, and an epi-allele identical to that in rice cultivar Nipponbare, which we refer to as SMS9 and SMSN, respectively. SMS9 is silent and hyper-methylated, whereas SMSN is expressed and hypo-methylated in the 93-11 NIL. Overexpressing SMSN led to male sterility. Mutations in SMS rescued the male sterility of the 93-11 NIL. Interestingly, we observed the duplication of SMSN in Nipponbare, but did not observe the duplication of SMS9 in 93-11. Together, these findings suggest that the reduced methylation and enhanced expression of the SMSN epi-allele in the 93-11 NIL is responsible for its role in conferring dominant male sterility.
Subject(s)
Oryza , Plant Infertility , Alleles , Oryza/genetics , Phenotype , Plant Breeding/methods , Plant Infertility/geneticsABSTRACT
Introduction: China is promoting integrated care. However, incomplete payment methods led to medical insurance overspending and intensified service fragmentation. Sanming implemented Integrated Medicare Payment Methods (IMPM) in October 2017, which integrates multi-level payment policies. Sanming's IMPM works well and has been promoted by the Chinese government. Therefore, in this paper, we aim to systematically analyze Sanming's IMPM, and conduct preliminary evaluations of Sanming's IMPM. Policy Description: IMPM integrates two levels of policy that are implemented simultaneously: (1) The payment policy for healthcare providers refers to how to calculate the global budget (GB) of the medical insurance fund paid to the healthcare providers and the policy guidance for the healthcare providers on how to use GB. (2) The payment policy for medical personnel refers to the adjustment of the evaluation index of the annual salary system (ASS) according to the IMPM's purpose and the payment policy that adjust pay levels based on performance. Discussion and lessons learned: After the IMPM reform, county hospitals (CHs) may reduce over-providing dispensable healthcare, and cooperation between hospitals may increase. The policy guidance (Determining GB according to population; Medical insurance balance can be used for doctors' salary, cooperation between hospitals, and promotion of residents' health; Adjusting ASS assessment indicators according to IMPM purposes) increases CHs' motivation to promote balances of medical insurance fund by cooperating with primary healthcare and increasing health promotion actions. Conclusion: As a model promoted by the Chinese government, the specific policies of Sanming's IMPM are better matched with policy goals, which may be more conducive to promoting medical and health service providers to pay more attention to cooperation among medical institutions and population health.
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Objective:To analyze the research hotspots and change trends of Sanming medical reform theory in China from 2013 to 2019, so as to provide reference for the relevant research of medical reform in China.Methods:The theoretical and empirical studies on Sanming medical reform from 2013 to 2019 in relevant databases at home and abroad were screened. The literature metrology method was used to analyze the overall trend of domestic literature. The keyword cloud method was used to analyze the research hotspots and main problems.Results:After screening, a total of 59 literatures were obtained. It was found that the reform of public hospitals was the hotspot of current research. Three medical linkage, governance system, annual salary system and medical insurance integration were the core contents of researches.Conclusions:The research of Sanming medical reform is in the initial stage of development. In the future, the research on medical reform can be further deepened around the relevant basic theories, normative and specific research, and so on.
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Objective To evaluate the outcomes of the payment reform at public hospitals in Sanming city.Methods Interrupted time series analysis was used to compare changes of the average days of stay,per capita hospitalization expense,outpatient expense per visit,proportion of medical expense and that of drugs during hospitalization at 21 public hospitals at or above county level before and after the DRGs reform.Results Comparisons before and after the reform found the average days of stay at the original momentum,poor control in curbing the proportion of medical expense and that of drugs during hospitalization,adropping followed by rising trend in the outpatient expense per visit,and minimal drop of the abovementioned proportions.Conclusions The rapid growth of outpatient and hospitalization costs at tertiary hospitals may be incurred by unreasonable cost transfer,structural trend of hospitalization expense makeup,and rationality pending scrutiny.
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Annual salary system reform at public hospitals in Sanming was cited as an example,to touch upon the five components of equity in such a reform,namely external equity,internal equity,individual equity,procedural equity and interactive equality.The significance,roadblocks and essential conditions were then analyzed,to come up with such recommendations as development of a mechanism for remuneration survey and dynamic adjustment,and a system for better posts grading and evaluation,as well as better performance appraisal tools,and a competent performance appraisal system.
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Tripartite-sector reform (a synergistic reform in public health services,medical insurance and medicine production-circulation) in Sanming city was described in the paper which centers on medical insurance.Tapping full potentials of the medical insurance,the city achieved efficient synergy among healthcare,medical insurance and medication systems.This reform has trimmed out inflated drug pricing to some extent for rooms of maneuver of medical service pricing changes,thus curbing excessive growth of medical costs successfully.The authors proposed areas of further improvements including the relationship between achieving such objective as curbing medical expenditure,and advancement of technical/medical service capacity;that between integrative control of medical insurance expenditure and protection of people's health;the equilibrium of interests between medical insurance,healthcare and medication.All these will contribute to the goal of healthy patients flow and a hierarchical medical system.
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Objective To evaluate the performance and efficiency of public hospitals in Sanming city,for suggestions on bettering their medical resources deployment efficiency and operational efficiency.Methods Descriptive analysis was used to longitudinally describe the general performances of such hospitals,leveraging the operating data of 21 public hospitals of the city.Meanwhile,appropriate indexes were selected to construct data envelopment analysis models for analysis of hospital operational efficiency and variations.Results Longitudinal analysis showed the operation process as stable,the efficiency as improved,and the structure as optimized thanks to the reform.Horizontal analysis found three hospitals (14％ of all) as efficient in general,and seven (33％) as efficient technically.Those hospitals found as inefficient technically suffer from overinvestment or output deficiency to varying extents.Three hospitals (14％) were found with scale efficiency,while those found without scale efficiency were regarded as diminishing returns on scale.Conclusions Reforms measures must be adhered to consolidate outcomes of the ongoing reform;Regional healthcare resources planning must be consolidated to improve the efficiency of resource allocation;Delicacy management must be made to enhance service delivery capabilities.
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The paper centered on the background,objectives,key actions of the policy and the relationships between policy objectives and key policy actions.Further analysis went on to the three phases of policy implementation and phased achievements,as well as the opportunities and challenges of the policy.These efforts aim at supporting sustainable development of the drug supply support model and hospital reform stage of greater risks and challenges with policy recommendations in Sanming city.
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Centering on the reform practice in Sanming featuring a synergistic reform in public health services,medical insurance and medicine production-circulation (Tripartite-sector reform below),this paper focused on the top-level design of the management system in such a reform and its synergistic operation mechanism.The authors probed into the main reasons for its grounding-breaking success and challenges,to pave way for their discussions on the reproducibility and sustainability of the reform.
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OBJECTIVE:To provide the scientific evidence and reference for improving medical reform. METHODS:Based on background ofSanming Medical Reform,self-designed questionnaires were used to investigate the cognition and satisfaction of local patients. The results of investigation were analyzed statistically. RESULTS:A total of 275 paper questionnaires were sent out and all were collected;345 electronic questionnaires were sent out by Wechat and all collected. Among 620 questionnaires,372 valid questionnaires were collected with effective rate of 60.00%. More patients(31.45%)thought the cost of treatment decreased, and less (22.31%) thought the cost increased. The proportion of high-income people who thought cost reduced was significantly higher than the proportion of low-income people (P=0.018). 27.42% of patients believed shortage of drugs,and tertiary hospi-tals were more prone to drug shortage than other medical institutions(P=0.062). The patients'satisfaction with medical staff and healthcare reform were both high(86.56% and 79.03%),but the satisfaction of rural patients was lower than that of urban patients (P=0.051). Understanding of patients onSanming Medical Reformwas in low level. Only 20.70% of the patients fully under-stood or generally understood ofSanming Medical Reform. The patients who thought the skills of medical staff were improved (40.32%)were more than those who thought the skills of medical staff were reduced(5.91%). CONCLUSIONS:Most patients are satisfied withSanming Medical Reform,and agree the achievements;but some problems are not solved,such as the shortage of some drugs,lack of grass-roots medical personnel,not understand medical policy.
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Success of Sanming's heahhcare reform relies heavily on the government's dominant role.Based on this inspiration,the paper discussed the responsibilities expected of the government in health protection of the people as required by national strategy,public interests and market demands,and presented the corresponding responsibilities of the government in the protection,leadership,scrutiny and management for the sake of public health.In addition the paper recommended on policies to make up for the absence and dislocation of governmental responsibilities,including all-out efforts for legislations in health protection,greater government subsidy for health protection,development of a comprehensive supervision system,and establishment of entities accountable for people's health in general.
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Government departments,pharmaceutical enterprises,health providers and patients were the four main stakeholders who involved in drug supply support reform in Sanming City.The paper centered on stakeholders' role and basic appeal,their influence on the reform or the influence of reform on them and the probable problems of reform,to make the motivation and resistance of the reform clearly and provide evidence for the sustainability and reproducibility of the reform.
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Objective To evaluate the medical efficiency of sample hospitals in Sanming city before and after Sanming health care reform.Methods One tertiary hospital,two general county hospitals and two TCM county hospitals in Sanming were sampled for the study.Two dimensions(the intensity index of medical work and work efficiency index)were selected.In addition,six indexes were identified,namely the number of discharged patients,number of outpatients and emergency diagnostics,doctor′s daily workload per capita for inpatients,bed turnover times,bed utilization rate and average days of stay.Descriptive trend analysis and comprehensive index method were applied in turn to evaluate the longitudinal changes in medical efficiency at the sample hospitals before and after the medical reform.Results The five sample hospitals in Sanming were found with less days of stay in average,and three were found with year-by-year rise of medical efficiency index,with one of them rising from 1.57 to 2.42.Conclusions Sanming′s health care reform has effectively improved internal operational efficiency at the sample hospitals,and has well addressed the relationship of medical service efficiency and scale expansion.On the other hand,the relationship between work intensity and medical efficiency needs to be further balanced,resource allocation to be further optimized,and more priority to be put in the development of TCM hospitals.