Basic Medical Research Articles

MODERATE EXERCISE AND ANTIOXIDANT DYNAMICS: UNRAVELLING THE INFLUENCE OF FAMILY HISTORY IN PREDIABETES

Objectives: This study investigates the effects of moderate-intensity physical activity on glycemic control and antioxidant capacity in prediabetics, regardless of whether they have a family history of diabetes. Methods: It was conducted at the Physiology Department of the Institute of Basic Medical Sciences in Peshawar, Pakistan. The study included a cohort of 50 adult participants who were diagnosed with prediabetes. Out of the total, 25 individuals had a positive family history of diabetes (PFHG), and the other 25 had a negative family history (NFHG). The group consisted of 22 females and 28 males, whose ages ranged from 18 to 35 years. The diagnosis of prediabetes was made based on glycated hemoglobin values falling between 5.7-6.4% and impaired fasting glucose levels ranging from 100-125 mg/dL. Anthropometric measurements and biochemical testing were conducted before and after the exercise session. The Participants engaged in moderate exercise for 30 minutes, with a maximum heart rate of 70% ± 5%, five days a week for eight weeks. Their exercise was tracked using a pedometer. An enzyme-linked immunosorbent test (ELISA) was conducted to measure both individual and total antioxidants. Results: Anthropometric measurements, fasting blood glucose (P<0.001), and glycated hemoglobin (P<0.001) showed significant changes at post-intervention. A slight rise in uric acid levels (P<0.005) and a substantial increase in total antioxidant concentration (P<0.001) was observed. Peroxidase, vitamin C, and nitric oxide significantly dropped (P<0.001). Conclusion: Engaging in moderate physical activity for 8 weeks, there was a notable decrease in the levels of individual antioxidants. Additionally, there was a slight increase in overall antioxidant capacity and uric acid. Both groups experienced an apparent fall in their anthropometric measurements and diabetes profile.

Effect of Vitamin D on Fasting Blood Sugar and HbA1c in Type 2 Diabetes Mellitus Patients

ABSTRACT:Objective: To evaluate the impact of vitamin D supplementation on fasting blood sugar & HbA1c in Type-2 diabetes mellitus patients.Methodology: This was an analytical case control study and was carried out by the Pharmacology Department at the Basic Medical Sciences Institute (BMSI, JPMC) with the collaboration of Diabetic OPD, JPMC, Karachi for the duration of 6 months. In this study 80 patients were selected by non-probability purposive sampling method and open EPI 3.01 version was used to estimate the sample size.Results: The study revealed that pre and post plasma vitamin D proportions in the intervention group were significant (P<0.001) as compared to the group labeled as control which did not show any difference at the end of study (P=0.16). However, there was an insignificant relationship between Vit D and HbA1c with no improvement observed in glycemic control (P=0.74) or HbA1c levels (P=0.20) in the intervention group.Conclusion: According to the study's findings, vitamin D addition has improved plasma vitamin D3 levels and improved insulin sensitivity in patients with T2DM. The current analysis did not find a significant contribution to reducing HbA1c or enhancing glycemic control in individuals with T2DM.

The Impact of Monetary Policy on Healthcare Affordability: A Case Study of China's Urban and Rural Basic Medical Insurance

Longer life expectancy and improved health are key indicators of economic growth. As such, strategies to bolster the medical security system are priorities in government budgeting. The government is dedicating all available resources to better healthcare in rural and underdeveloped areas, narrowing the urban-rural healthcare gap, and achieving equitable healthcare resource distribution. This study examines the effect of monetary policy on healthcare affordability, focusing on China's Urban and Rural Basic Medical Insurance (URRBMI). It investigates how macroeconomic policies, such as interest rates and inflation control, affect healthcare costs and shape URRBMI's financial protection. Using an integrated methodology, including a literature review, theoretical framework, and econometric analysis, the research uncovers how monetary policy impacts healthcare costs and URRBMI's effectiveness. The findings highlight the importance of monetary policy in healthcare affordability. The study recommends collaboration between monetary authorities and healthcare policymakers to improve China's healthcare system's sustainability and effectiveness. Furthermore, these insights are crucial for refining URRBMI and provide new understandings of optimizing macroeconomic policy interactions with social welfare programs.

Do Social Assistance Programs Alleviate Rural Households’ Energy Poverty? Evidence from China’s Basic Medical Insurance Scheme

Government social assistance programs have significantly alleviated poverty. However, to our knowledge, few studies have analyzed their effectiveness in mitigating energy poverty. This paper applies the Multidimensional Energy Poverty Index (MEPI) to measure the extent of rural households’ energy poverty in China. Using a two-way fixed effects model and quantile regression analysis, this study explores the long-term impact of China’s basic medical insurance system on rural households’ energy poverty. The findings indicate that basic medical insurance significantly reduces rural households’ energy poverty, with heterogeneous effects observed across different levels of energy poverty, household incomes, population sizes, and age distributions of household members. Enhancing farmers’ health conditions and reducing medical expenditure are key mechanisms through which basic medical insurance alleviates rural households’ energy poverty. Overall, these findings underscore the crucial role of social assistance programs in enhancing the quality of life for rural residents and contributing to global sustainable poverty governance.

Vitamin-D deficiency as a potential indicator of defective placentation in preeclampsia.

To determine the association of serum Vitamin-D levels and placental laminin expression in pre-eclamptic and normotensive women. This cross-sectional study was conducted from July 2018 to February 2021, in the Department of Anatomy, Basic Medical Sciences Institute (BMSI) in collaboration with the Department of Gynecology and Obstetrics after the approval from Institutional Review Board (IRB), Jinnah Postgraduate Medical Centre JPMC, Karachi. The placentae were collected from 120 women, segregated into two cohorts as normotensive (NT) (n=60) and pre-eclamptic (PE) (n=60) and serum Vitamin-D levels measured. All placentae were examined for histological changes by Hematoxylin & Eosin stain and the expression of Laminin (LN) was calculated by the optical density using ImageJ. The serum Vitamin-D levels (ng/ml) in normotensive were significantly higher as compared to pre-ecclamptics (p-value = 0.001). The Syncytial knots, cytotrophoblast proliferation and basement membrane thickness were also significantly different among normotensive and pre-eclamptics (p-value= 0.001)When compared with normal placenta the optical density (expression) of LNs was significantly lower (p-value 0.001) in preeclampsia placentae. The association between serum Vitamin-D and laminin expression was highly positively significant. NT (r=0.811, p-value 0.001) and PE group (r=0.79, p-value 0.001). Our results show a strongly positive association between serum Vitamin-D levels, LN expression and severity of histopathological changes between normotensive and pre-eclamptic women.

Outpatient coordination reform improves the sustainability of China's Urban Employee Basic Medical Insurance Fund.

This study aims to examine the impact of outpatient coordination reform (OCR) on the sustainability of the Urban Employee Basic Medical Insurance (UEBMI) pooling fund. Using an employee medical insurance pooling fund model, we found that, without OCR, the fund will face current deficits by 2024 and cumulative deficits by 2033. However, with the "partial outpatient coordination reform," offering 50 or 75.6% reimbursement rates, the onset of cumulative deficits is delayed by 11 and 8 years, respectively. In contrast, implementing the "complete outpatient coordination reform" with 50 or 75.6% reimbursement rates ensures a positive cumulative balance until 2050. In conclusion, OCR not only strengthens the mutual assistance function of medical insurance but also ensures the sustainability of the insurance fund. Therefore, it is advisable to implement and refine these policies promptly to reduce the financial burden on the UEBMI pooling fund.

Exploring Perspectives of Basic and Clinical Sciences Medical Students on Research

Objective: To identify and compare motivating factors and obstacles towards research among undergraduate medical students of basic and clinical sciences. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital, Kharian medical college, Pakistan Jun to Aug 2021. Methodology: This study involved 205 undergraduate medical students divided into two groups: basic sciences (1st, 2nd, and 3rd year) and clinical sciences (4th year). Data collection was done using a self-structured questionnaire based on a 5-point Likert scale. Ethical approval was obtained from the institutional review board (CKMC/IERB/AC-00119). Results: Out of the participants, 84(40.9%) were male and 151(59%) were female. 183(89.2%) were aged 18-22, and 22(10.7%) were aged 23-27. Distribution by year was as follows: 1st year 17%, 2nd year 20.9%, 3rd year 15.6%, and 4th year 46.3%. Approximately 40-50% of clinical sciences students supported making research mandatory from the first to the final year and introducing weightage in the final assessment, foster critical thinking and teamwork, compared to only 2-17% of basic sciences students. This significant difference highlights the need for early integration of research activities in the medical curriculum (p-value<0.001). 40-50% of undergraduate students in both clinical and basic sciences agreed that there is a lack of research culture, infrastructure, training funds, and time. The barriers did not show significant differences between the groups. Conclusion: Clinical students’ perception of research is much better than basic sciences.

Detection of BRCA-1 gene mutations in epithelial ovarian tumors at tertiary care hospital Karachi

ABSTRACT Background: Ovarian cancer is the most common and lethal gynecological malignancy. Ovarian malignancy is the 3rd most common cancer in Pakistan. More than 90% ovarian cancers are of epithelial cell origin, about 24-40% such cancers have hereditary or sporadic mutation in the BRCA-1 or BRCA-2 genes. The present study was designed to detect BRCA-1 gene mutations in different histological sub-types of epithelial origin of benign, borderline and malignant ovarian tumors. Methods: This cross-sectional study was based on the analysis of BRCA-1 gene mutations in the epithelial origin of benign, borderline and malignant ovarian tumors received at the department of Pathology, Basic Medical Sciences Institute, Jinnah Post graduate Medical Centre, from 01-01-2011 to 31-12-2015. A total of 80 diagnosed cases were selected and analyzed for PCR. Results: BRCA-1 gene mutations were detected in 22 (27.5%) cases out of the 80 randomly selected epithelial ovarian tumors. Serous cyst adenocarcinoma was the commonest including 63% cases. BRCA-1 gene mutations were also positive in other epithelial ovarian tumors, including Mucinous cyst adenocarcinoma (13.6%), Endometroid adenocarcinoma and Mixed Mullerian tumor (4.5% each). In addition mutations were also detected in borderline tumors including Mucinous borderline tumor (9.09%) and Seromucinous borderline tumors (4.5%).The observations and results of the study were elaborated with the assistance of tables, figures and photomicrographs. Conclusion: BRCA-1 gene mutations manifestations were identified in a large number of serous malignant ovarian tumor cases. Small percentages of borderline and malignant mucinous tumors, endometroid adenocarcinoma and mixed mullerian tumor were also positive for BRCA-1 gene mutations.

Effect of different treatment strategies on modified Glasgow Prognostic Score (mGPS) in patients with breast cancer

BackgroundThere are various treatment options for breast cancer, but a delayed diagnosis at an advanced stage negatively affects overall survival. Our objective is to investigate the prognostic significance of the modified Glasgow Prognostic Score (mGPS) with different treatment modalities.Materials and methodsThe study was a longitudinal cohort conducted in the Biochemistry laboratory of the Institute of Basic Medical Sciences at Khyber Medical University. Enrolling 121 patients with invasive breast carcinoma from November 2018 to February 2021, blood samples were collected at various stages. Data analysis utilized SPSS® version 22, employing the Kaplan–Meier method for overall survival (OS) calculation. The log-rank test assessed P-values for OS, and the chi-square test analyzed the association of modified Glasgow Prognostic Score (mGPS) with different treatments. Statistical significance was considered for results with a P-value (p < 0.05).ResultsThe study results indicated that mGPS 2 was linked to lower overall survival, while mGPS 0 and 1 were associated with good overall survival. Chemo-endocrine therapy exhibited the highest median survival of 40.9 months compared to other treatment options. Conversely, chemoradiotherapy combined with targeted therapy demonstrated the lowest overall median survival of 22.5 months.ConclusionThe findings of the current research suggested that mGPS could be used as a prognostic screening tool in patients with breast cancers receiving different therapeutic modalities.

Impact of Family Mutual Aid System for Personal Medical Insurance Accounts on Paediatric Patients' Outpatient Utilisation Patterns and Costs: a difference-in-differences analysis.

This study explores the effect of the transformation of paediatric healthcare through the implementation of the Family Mutual Aid System (FMAS) for personal medical insurance accounts, among paediatric patients at a children's hospital (Hospital A in Shanghai, China). We conducted a cohort study in the endocrinology department of Hospital A from August 2021 to July 2023 to assess the impact of the FMAS enrolment on patients' annual outpatient visits, annual outpatient expenditures, and the allocation of these costs among the Basic Medical Insurance Pooling Fund and patients' out-of-pocket (OOP) expenses, with a further subdivision into online and offline consultations. Analysis employed a weighted Difference-in-Differences approach within a fixed-effects model following Propensity Score Matching. The study encompassed 10,975 paediatric patients, divided into those enrolled in the FMAS (observation group) and those not (control group). Enrolment in FMAS was associated with a statistically significant increase in annual outpatient visits by an average of 1.107, predominantly attributed to an uptick in offline consultations. Additionally, there was a substantial 38.9% rise in annual outpatient costs. Detailed analysis revealed a 52.5% increase in costs covered by the medical insurance pooling fund, while patients' OOP expenses decreased by an average of 69.2%. These findings highlight the beneficial effects of FMAS enrolment on healthcare service utilization and risk-sharing mechanisms of medical insurance.

Solving the issue of staffing shortage of medical staff using remote technologies and 3‑d interaction between students and the teacher at the RSBHI «Kirensk district hospital»

The topic of personnel shortage is close to all hospitals, relevant in all regions, both in central healthcare institutions and in the periphery. In September 2023, the RSBHI «Kirensk District Hospital» together with the RSBEI «Irkutsk Basic Medical College» launched a pilot project for distance learning in-person and part-time of mid-level medical personnel at the hospital. Target. Closing the personnel shortage. Formation of a personnel reserve in the institution. Results. Successful mastery of the curriculum by all students. Transfer of all students to the second year. Conclusion. Using our example, we would like to show the advantages of distance learning in-person and part-time of mid-level medical personnel, we are open to sharing experiences.

Corrigendum to: Neuropeptide Network of Polycystic Ovary Syndrome - A Review.

An error was found in the affiliations of the author in the article titled 'Neuropeptide Network of Polycystic Ovary Syndrome - A Review'', published in Protein and Peptide Letters, 2024, 31(9), 667-680 [1]. Details of the error and a correction are provided here. Original: *Address correspondence Department of Physiology, Dr. ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, India; E-mail: drgsathyanarayanan@gmail.com Corrected: *Address correspondence to this author at the Department of Physiology, Dr. ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, India; E-mail: drgsathyanarayanan@gmail.com We regret the error and apologize to readers. The original article can be found online at: http://dx.doi.org/10.2174/0109298665309949240822105900 PMID: 39313871.

The Influence of Basic Medical Insurance for Urban and Rural Residents on Farmers’ Entrepreneurship —— Based on the Quasi-natural Experiment of Medical Insurance for Urban and Rural Residents

With the economic development of China entering the transition period, mass entrepreneurship and innovation has become an important way to promote economic growth, but at the same time, the downward pressure on the economy is increasing, and farmers’ entrepreneurship is facing increasing challenges. In January 2016, the State Council issued the Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents and established the basic medical insurance for urban and rural residents as a whole. As an important social security system in China, medical insurance for urban and rural residents is not only a vivid embodiment of rural good governance leading to rural revitalization but also may have a positive impact on farmers’ entrepreneurship. Therefore, based on the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, this paper investigates the influence of urban and rural residents’ basic medical insurance on farmers’ entrepreneurial behaviour by using the method of Difference-in-Differences (DID). It is found that the implementation of basic medical insurance for urban and rural residents has significantly improved the entrepreneurial willingness of rural residents. When the cluster level is set to individual, its entrepreneurial probability has increased by about 4%. When the cluster level is changed to household and community, there is also a significant promotion effect. Secondly, this paper analyzes the influence mechanism of urban and rural residents’ medical insurance on entrepreneurship by using expected utility theory, life cycle theory and precautionary saving theory: urban and rural residents’ medical insurance enhances farmers’ economic security by reducing risk exposure level and medical burden, and then improves their entrepreneurial willingness. Furthermore, this paper analyzes the heterogeneity of different groups and finds that medical insurance for urban and rural residents has a more significant role in promoting entrepreneurship for male, people aged 60 or below, people with good health, people with bachelor’s degrees or below and married people. Based on this, this paper holds that basic medical insurance for urban and rural residents not only reduces the economic risks caused by diseases but also plays an active role in encouraging farmers to start businesses and increase their income, promoting medical equity and improving social welfare. Therefore, relevant departments should continue to implement the policy of merging the two insurances into one, popularize entrepreneurship knowledge, strengthen rural entrepreneurship publicity and help work, so as to give full play to the promoting effect of medical insurance on rural residents’ entrepreneurship and help realize rural revitalization in China.

Metabolomics in Cardiovascular Diseases

Review Metabolomics in Cardiovascular Diseases Shan Lu 1,†, Zisheng Huang 2,†, Baitao Liu 3, and Yan Zhang 1,* 1 Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, School of Basic Medical Sciences, Ministry of Education, Peking University Health Science Center, Beijing 100871, China 2 School of Basic Medical Sciences, Peking University, Beijing 100871, China 3 Aerospace School of Clinical Medicine, Peking University, Beijing 100871, China † These authors contributed equally to this work. * Correspondence: zhangyan9876@pku.edu.cn Received: 10 July 2023; Revised: 25 September 2024; Accepted: 26 September 2024; Published: 25 October 2024 Abstract: Cardiovascular diseases (CVDs) are the leading cause of death worldwide, and disorders of cardiac energy metabolism are the main contributors to many cardiovascular pathologies. Metabolomics is a science that examines the types and amounts of metabolites and the patterns of change in biological systems after stimulation or perturbation. Metabolites are widely distributed in the body and have universal regulatory effects on a wide range of physiological activities. Metabolism is at the end of the regulation of life activities, so metabolomics is closer to phenotypes than genomics and transcriptom-ics, and can reflect the state of biological systems more accurately. Metabolomics, a cross-cutting dis-cipline emerging in the post-genomics era, has rapidly penetrated into many fields of medicine, im-proves understanding of complex diseases and generates more new discoveries and hypotheses. Therefore, metabolomics helps detect metabolic changes in the course of CVDs, search for biomarkers, and further study the pathogenesis of CVDs. In this review, we intend to comprehensively summarize the principles, classification and applications in CVDs of metabolomics.

Eliciting medication preferences of patients with type 2 diabetes under different insurance coverages in China.

To understand the medication preference of type 2 diabetes mellitus (T2DM) patients with different insurance coverages, and to provide reference for improving the patient-centered clinical treatment decision. This study used Discrete Choice Experiment (DCE) to elicit preferences of T2DM patients with different insurance coverages in China. A multistage stratified cluster-sampling procedure for data collection and a total of 1,409 valid respondent were conducted. Seven attributes have significant influence on the preference of T2DM patients with Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI) (p < 0.05). T2DM patients with UEBMI pay the most attention to Gastrointestinal adverse events, while T2DM patients with URRBMI pay the most attention to the Treatment efficacy/reduction in HbA1c. Patients with different medical insurance have different willingness to pay for Cardiovascular benefits, Mode of administration and Weight change. When Gastrointestinal adverse events is changed from higher (40%) to none (0%), patients with UEBMI are willing to pay ¥523.49 more per month, while patients with URRBMI are only willing to pay ¥266.62; When the Treatment efficacy/reduction in HbA1c changes from poor (0.5%) to Highest (2.5%), patients with UEBMI are willing to pay ¥518.44 more per month, while patients with URRBMI are willing to pay ¥328.33 more per month. The Gastrointestinal adverse events and the Treatment efficacy/reduction in HbA1c are the primary factors for T2DM patients with UEBMI and URRBMI, followed by the Hypoglycemic risk. Physicians should consider patients' medication preferences in clinical medication treatment of T2DM patients with different insurance coverages, make targeted treatment decisions, and improve patients' medication compliance to achieve better treatment results.

Long-term effects of establishing outpatient pooling funds on financial protection: Empirical evidence from a quasi-natural experiment in China.

A limited benefit package for outpatient care in Chinese universal health coverage led to high out-of-pocket outpatient payments, and even medical impoverishment. The outpatient pooling fund model was introduced in China's Urban Employee Basic Medical Insurance to reduce cost-sharing for outpatient care. This study attempts to examine the dynamic effects of the outpatient pooling scheme on financial risk protection for its enrollees. A total of 18,097 individual-level observations covering 52 prefectures were extracted from six waves of China Health and Nutrition Survey (2000-2015). The difference-in-differences model with multiple periods and event study were employed to investigate the dynamic effects of reform on catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) and potential mechanisms. Our results showed outpatient pooling scheme generated a significant effect on reducing the probability of incurring CHE (β=-0.004, 95% CI=-0.009 to -0.006) and IHE (β=-0.007, 95% CI=-0.012 to -0.001), especially for elderly people over 60years old. The realization of this effect may depend on the reduction of outpatient cost-sharing, increased outpatient care utilization, as well as decreased inpatient care utilization after reform. However, event study found the effectiveness of outpatient pooling reducing CHE and IHE occurrences appeared to be weak even insignificant in more recent years relative to the initial years of policy implementation. Establishing an outpatient pooling system iseffective to alleviate the financial risk caused by healthexpenditures in China. Optimising health service deliveryaimed at enhancing health insurance purchasing efficiencyare deemed imperative for sustaining the policy effectiveness.

Sensing DNA as danger: The discovery of cGAS

Insight into how the immune system recognizes and responds to pathogens had led to landmark advances in biology and medicine in the last decades. This year's Albert Lasker Award for Basic Medical Research honors Zhijian "James" Chen for the discovery of cGAS, the enzyme that senses foreign and "pathogenic" self-DNA-self-DNA aberrantly located in intracellular compartments. The definition of the cGAS-STING pathway opens new horizons for the understanding and treatment of human disease.

Discovery of cGAS as a DNA-Sensing Enzyme That Triggers Inflammation

In this Viewpoint, 2024 Albert Lasker Basic Medical Research Award winner Zhijian J. Chen describes his discovery of cyclic guanosine monophosphate–adenosine monophosphate synthase (cGAS), a DNA-sensing enzyme that triggers inflammation.

Hunting down the elusive cytosolic-DNA sensor

The 2024 Albert Lasker Basic Medical Research Award was attributed to Zhijian (James) Chen for “the discovery of the cGAS enzyme that senses foreign and self DNA, solving the mystery of how DNA stimulates immune and inflammatory responses.” Bringing to bear an ingenious in vitro complementation system, an astute insight, and superlative biochemistry, Chen and colleagues identified cGAS (cGAMP synthase) as both the molecule that perceives cytosolic DNA in infected, stressed, or dying cells and the enzyme that catalyzes the synthesis of cGAMP (cyclic GMP-AMP), a critical second messenger along the route to inflammatory cytokine production. These findings cleared up the reigning confusion surrounding a major mechanism of inciting the innate immune system, with therapeutic implications for fighting infections, containing tumors, and extinguishing autoimmune and inflammatory diseases.

Forecasting health financing sustainability under the unified pool reform: evidence from China’s Urban Employee Basic Medical Insurance

ObjectiveThe integration of the health insurance fund pool may threaten the sustainability of the fund by increasing its expenditures through the exacerbation of the moral hazard of participations. The purpose of this paper is to assess and predict the impact of the single pool reform of China’s Urban Employee Basic Medical Insurance (UEBMI) on the expenditure and sustainability of the health insurance fund.MethodsIn this paper, we consider the pilot implementation of the single pool reform in some provinces of China as a quasi-natural experiment, and develop a staggered DID model to assess the impact of the single pool reform on medical reimbursement expenditure. Based on the results, an actuarial model is developed to predict the impact on the accumulated balance of China’s health insurance fund if the single pool reform is continued.ResultsWe found that the medical reimbursement expenditure would increase by 66.4% per insured person after the unified provincial-level pool reform. There is individual heterogeneity in the effects of the unified single pool reform on medical reimbursement expenditure, and the reimbursement expenditure of retired elderly has the largest increase. If the unified single pool reform is gradually promoted, the current and accumulated balance of the UEBMI pooling fund would have gaps in 2031 and 2042, respectively.ConclusionWe verified that a larger fund pool will bring unreasonable growth of fund expenditures, which will threaten the sustainable development of health insurance. To minimize the impact of the unified single pool reform on the sustainability of the health insurance fund, we suggest strengthening the monitoring of moral hazard behavior, promoting the delayed retirement system, and encouraging childbearing.