Levels Of Medical Institutions Research Articles

Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China

BackgroundThe construction of the ordered health delivery system in China aims to enhance equity and optimize the efficient use of medical resources by rationally allocating patients to different levels of medical institutions based on the severity of their condition. However, superior hospitals have been overcrowded, and primary healthcare facilities have been underutilized in recent years. China has developed a new case-based payment method called “Diagnostic Intervention Package” (DIP). The government is trying to use this economic lever to encourage medical institutions to actively assume treatment tasks consistent with their functional positioning and service capabilities.MethodsThis study takes Tai’an, a DIP pilot city, as a case study and uses an interrupted time series analysis to analyze the impact of DIP reform on the case severity and service scope of medical institutions at different levels.ResultsThe results show that after the DIP reform, the proportion of patients receiving complicated procedures (tertiary hospitals: β3 = 0.197, P < 0.001; secondary hospitals: β3 = 0.132, P = 0.020) and the case mix index (tertiary hospitals: β3 = 0.022, P < 0.001; secondary hospitals: β3 = 0.008, P < 0.001) in tertiary and secondary hospitals increased, and the proportion of primary-DIP-groups cases decreased (tertiary hospitals: β3 = -0.290, P < 0.001; secondary hospitals: β3 = -1.200, P < 0.001), aligning with the anticipated policy objectives. However, the proportion of patients receiving complicated procedures (β3 = 0.186, P = 0.002) and the case mix index (β3 = 0.002, P < 0.001) in primary healthcare facilities increased after the reform, while the proportion of primary-DIP-groups cases (β3 = -0.515, P = 0.005) and primary-DIP-groups coverage (β3 = -2.011, P < 0.001) decreased, which will reduce the utilization efficiency of medical resources and increase inequity.ConclusionThe DIP reform did not effectively promote the construction of the ordered health delivery system. Policymakers need to adjust economic incentives and implement restraint mechanisms to regulate the behavior of medical institutions.

Analysis of the current status and influencing factors of cross-regional hospitalization services utilization by basic medical insurance participants in China - taking a central province as an example.

The geographically uneven distribution of healthcare resources has resulted in a dramatic increase of cross-regional hospitalization services in China. The over-use of cross-regional hospitalization services may hinder the utilization and improvement of local hospitalization services. It is of great practical significance to study the utilization of cross-regional hospitalization services and its influencing factors in order to effectively allocate medical resources and guide patients to seek medical treatment rationally. Therefore, this study aims to analyze the current situation and influencing factors of the utilization of cross-regional hospitalization services by patients insured by basic medical insurance in China. A total of 3,291 cross-provincial inpatients were randomly selected in a central province of China in 2020. The level of medical institutions, hospitalization expenses and actual reimbursement rate were selected as indicators of hospitalization service utilization. Exploratory factor analysis was used to assess the dimensionality of influencing factors and reduce the number of variables, and binomial logistic regression analysis and multiple linear regression analysis to explore the influencing factors of the utilization of cross-regional hospitalization services. The proportion of cross-provincial inpatients choosing tertiary hospitals was the highest with average hospitalization expenses of 24,662 yuan and an actual reimbursement rate of 51.0% on average. Patients insured by Urban Employees' Basic Medical Insurance (UEBMI) were more frequently (92.9% vs. 88.5%) to choose tertiary hospitals than those insured by Urban and Rural Residents' Basic Medical Insurance (URRBMI), and their average hospitalization expenses (30,727 yuan) and actual reimbursement rate (68.2%) were relatively higher (p < 0.001). The factor "income and security," "convenience of medical treatment" and "disease severity" had significant effects on inpatients' selection of medical institution level, hospitalization expenses and actual reimbursement rate, while the factor "demographic characteristics" only had significant effects on hospitalization expenses and actual reimbursement rate. Cross-provincial inpatients choose tertiary hospitals more frequently, and their financial burdens of medical treatment are heavy. A variety of factors jointly affect the utilization of cross-provincial hospitalization services for insured patients. It is necessary to narrow down the gap of medical treatment between UEBMI and URRBMI patients, and make full use of high-quality medical resources across regions.

Guidelines of integrated Chinese and western medicine for diagnosis and treatment of chronic obstructive pulmonary disease (2022).

Chronic obstructive pulmonary disease (COPD), with high prevalence rate, mortality, disability rate, and heavy disease burden, has become a critical chronic disease seriously threatening public health worldwide. Traditional Chinese medicine and Western medicine both have shown advantages in diagnosing and treating COPD, which has been widely applied in the clinics. In order to improve the diagnostic and treatment level for COPD with integrated traditional Chinese and Western medicine, the Guidelines of Integrated Chinese and Western Medicine for Diagnosis and Treatment of COPD were developed by the Internal Medicine Committee of the World Federation of Chinese Medicine Societies. First, a multidisciplinary working group was established. Development methods and processes of international clinical practice guidelines were adopted in the whole research. In final, a total of 13 recommendations for the diagnosis and treatment of COPD were established based on available evidence with the best quality. Meanwhile, characteristics of integrated traditional Chinese and Western medicine in treating COPD were taken into account with pros and cons of each intervention. The guidelines could be used as a reference for physicians in respiratory medicine departments (traditional Chinese medicine, integrated traditional Chinese and Western medicine, and Western medicine) at various levels of medical institutions in their diagnosis and treatment.

Construction and effect evaluation of a hierarchical training system for nosocomial infection based on hospitals at all levels

INTRODUCTION: Nosocomial infection is a critical global public health issue. The education of medical personnel can effectively enhance compliance with nosocomial infection protocols and reduce the incidence of such infections. However, the current training provided to third-party staff is inadequate, necessitating an urgent enhancement of their knowledge on nosocomial infection through effective and tailored training programs.&#x0D; OBJECTIVES: The objective is to establish a hierarchical training system for nosocomial infection, customized to meet the specific requirements of hospitals at all levels, and evaluate its efficacy.&#x0D; METHODS: A questionnaire survey was conducted among third-party staff members at hospitals of different levels to assess their understanding of nosocomial infection prevention measures. Based on the survey results, a hierarchical training system was developed for nosocomial infection among the participants. After the training, a post-training assessment was carried out to evaluate the participants' comprehension of nosocomial infections.&#x0D; RESULTS: A total of 561 third-party employees participated in the baseline hospital infection knowledge questionnaire. The baseline findings unveiled disparities in the extent to which third-party staff members across various tiers of medical institutions have mastered their knowledge on nosocomial infections. After undergoing hierarchical training, the deficiencies of hospitals at all levels have been rectified, thereby effectively enhancing the level of knowledge regarding nosocomial infections among third-party personnel. The results of multivariate analysis indicate that individuals with limited work experience should enhance their training in medical waste disposal and acquire a deeper understanding of personal protection measures related to nosocomial infections. Moreover, infrequent annual training sessions may impede the comprehension of nosocomial infection among third-party staff.&#x0D; CONCLUSION: The knowledge of hospital infection among third-party staff at all levels of medical institutions exhibits varying deficiencies. Implementing a hierarchical training approach is a meaningful strategy that effectively enhances the level of hospital infection knowledge among these staff members.

Analysis on Bacterial Distribution and Change of Drug Resistance Rate in ICUs Across Southwest China from 2018 to 2022.

To analyze the distribution of bacteria and their drug resistance changes in Intensive Care Units (ICUs) across Southwest China from 2018 to 2022 and establish the antibiogram in this region to provide a basis for early empirical antimicrobial use. Non-repetitive pathogens isolated from 109 member units with qualified data were obtained from the Antimicrobial Resistance Surveillance System in Sichuan Province, southwest China. The results obtained were interpreted with reference to CLSI M100-31th, and analyzed with WHONET 5.6 software. A total of 46,728 clinical isolates in ICUs were collected from 2018 to 2022, of which gram-negative organisms accounted for 76.1%, and gram-positive were 23.9%. The top 5 were Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus, respectively. From 2018 to 2022, the resistance rates of Klebsiella pneumoniae to imipenem and meropenem changed from 14.5% and 17.8% to 14.0% and 14.4%, showing a steady downward trend. Escherichia coli was always highly sensitive to carbapenems, with a total resistance rate of 3.8%. Among non-fermented gram-negative bacteria, the resistance rates of Pseudomonas aeruginosa to imipenem and meropenem decreased significantly, changed from 25.3% and 22.9% in 2018 to 20.0% and 15.1% in 2022. However, Acinetobacter baumannii showed high resistance rates of 76.2% and 76.9% to imipenem and meropenem, respectively. MRSA and MRCNS accounted for 31.7% and 82.7%, respectively. No vancomycin and linezolid-resistant Staphylococcus aureus was isolated. Enterococcus faecalis maintained high activity to vancomycin, teicoplanin, and linezolid; no vancomycin or teicoplanin-resistant Enterococcus faecium strains were detected. From 2018 to 2022, the isolated bacteria in ICU were mainly gram-negative bacteria, and the growth of some multidrug-resistant bacteria was effectively controlled. All levels of medical institutions should continue to strengthen bacterial resistance surveillance, promote the establishment of antimicrobial stewardship program, and enhance restrictions on outpatient antimicrobial use.

Analysis of the relapse of imported Plasmodium vivax and Plasmodium ovale in five provinces of China

BackgroundThe global battle against malaria is facing formidable challenges, particularly in controlling Plasmodium vivax and Plasmodium ovale, whose cases have not been reduced as effectively as Plasmodium falciparum because of their relapse. This study investigates the current situation and underlying factors contributing to relapse or recrudescence of imported cases of P. vivax and P. ovale, and seeks to provide a reference for reducing relapse or recrudescence in malaria-free areas and offers a scientific basis for designing strategies to prevent imported re-transmission.MethodsThis study analysed imported P. vivax and P. ovale in Anhui, Zhejiang, Henan, Hubei, and Guangxi provinces during 2014–2021 by retrospective analysis. A case–control study was conducted on patients who experienced relapse or recrudescence.ResultsFrom 2014 to 2021, 306 cases of P.vivax and 896 cases of P.ovale were included in the study, while 75 cases had relapse or recrudescence, including 49 cases of P. ovale (65.33%) and 26 cases of P. vivax (34.67%). Within less than 5 weeks after returning to the country, 122 cases of P. vivax (39.87%, 122/306) and 265 cases of P. ovale (29.58%, 265/896) occurred. Within less than 53 weeks, the ratio of P. vivax was 94.77% (290/306), and that of P. ovale was 89.96% (806/896). Among the cases experiencing relapse or recrudescence, only 1 case of P. vivax (1/26 3.85%) and 3 cases of P. ovale (3/49 6.12%) occurred within less than 5 weeks after the first onset, whereas 21 cases of P. vivax (21/26 80.77%) and 42 cases of P. ovale (42/49 85.71%) occurred within less than 53 weeks after the first onset. The difference in relapse or recrudescence due to different drugs and medication regimens and medical activities at various levels of medical institutions was statistically significant.ConclusionIn areas where malaria has been eliminated, routine health screening in a scientific time frame for people returning from at-risk areas can effectively improve the efficiency of preventing re-transmission, thereby reducing prevention costs and disease burden. Preventing patients from self-treating and strengthening medication regulations in health facilities are key measures to reduce relapse or recrudescence.

The distribution of curative care expenditure on gender, age and disease system among patients with noncommunicable diseases based on SHA 2011: A cross-sectional study in 2016-2018, Beijing

To analyze the distribution of curative care expenditure on gender, age and disease system of patients with Noncommunicable Diseases (NCDs) in different level of medical institutions, thus providing reference for the Hierarchical Medical System (HMS).

The promotion of pooling level of basic medical insurance and participants’ health: impact effects and mediating mechanisms

BackgroundEnhancing the pooling of basic medical insurance plays a vital role in strengthening the resilience to risk and co-payment capacity of medical insurance funds. In China, there is a concerted effort to shift from municipal to provincial pooling of medical insurance. While existing research suggests that provincial pooling of basic health insurance affects the health of participants, the findings are not yet consistent, and there is limited research on the specific pathways of impact between the two. Therefore, this study aims to explore the influence of provincial pooling of basic medical insurance on participants' health and analyze the mediating role of medical cost burden and medical service utilization.MethodsUsing data from the 2012–2018 China Labor Dynamics Survey (CLDS), this study focuses on a sample of urban workers enrolled in basic medical insurance. After excluding samples with missing information, a total of 5,684 participants were included in the analysis. The effects of the provincial pooling policy of basic medical insurance on participants' medical cost burden, medical service utilization, and health were analyzed using double difference modeling. Furthermore, structural equation modeling was employed to explore the mediating paths between provincial pooling and health.ResultsThe findings reveal that provincial pooling of basic medical insurance significantly impacts participants' medical cost burden, medical service utilization, and health. Specifically, provincial pooling helps reduce the participants' medical cost burden (β = -0.1205; P < 0.001), improves the level of medical institutions visited (β = 1.7962; P < 0.001), and promotes health improvement (β = 1.8370; P < 0.001). The mediating effect analysis demonstrates that the direct effect of provincial pooling on health is 1.073 (P < 0.001), with a mediating effect of medical cost burden between provincial pooling and health measuring 0.129 (P < 0.001). Heterogeneity analysis indicates that provincial pooling is more effective in reducing the burden of medical costs for low-income (β = -0.2273; P < 0.001) and high-age participants (β = -0.2710; P < 0.001), and it also helps increase the burden of medical costs for low-income (β = 4.0875; P < 0.001) and high-age participants (β = 1.9010; P < 0.001) based on provider ranking. Moreover, it is found that provincial pooling is more beneficial in improving the health of high-income (β = 1.7984; P < 0.001) and middle- and high-age enrollees (β = 1.9220; P < 0.001; β = 0.5900; P < 0.001). Further analysis reveals that the provincial unified income and expenditure mode has a more positive effect than the provincial risk adjustment fund mode in reducing the medical expense burden of the insured (-0.2053 < -0.0775), improving the grade of medical institutions (1.8552 > 0.8878), and enhancing the health level (2.8406 > 0.6812).ConclusionThe study concludes that provincial pooling of basic medical insurance has a direct positive impact on participants' health and indirectly promotes health improvement by reducing the burden of medical costs. The effects of provincial pooling on participants' medical cost burden, medical service utilization, and health vary based on income and age. Additionally, the provincial-level unified collection and payment model proves to be more advantageous in optimizing the functioning of health insurance funds through the "law of large numbers" principle.

ОПТИМИЗАЦИЯ КРИТЕРИЕВ ОЦЕНКИ КАЧЕСТВА ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ЗЛОКАЧЕСТВЕННЫХ ОПУХОЛЕЙ ПИЩЕВОДА И ЖЕЛУДКА

Introduction. Cancer of the stomach and esophagus is one of the most aggressive and common malignant neoplasms in Russia. Surgical treatment is considered as one of the most important stages of complex therapy in this category of patients. Assessment of the quality of medical care for cancer patients is an essential component in the development of modern health care. For a full-fledged analysis, it is possible to use composite criteria (textbook outcomes) – integrative indicators for measuring quality, reflecting the “ideal” outcome of treatment. The purpose of this study was to study the possibility of applying new approaches to assessing the quality and effectiveness of minimally invasive and robotic operations for cancer of the esophagus and stomach. Materials and Methods. Scientific reports were searched using PubMed and the Google keyword system. Time frame 2017-2022 . The results of using a composite quality criterion to determine the effectiveness of the use of surgical intervention in cancer of the esophagus and stomach were evaluated. Particular attention was paid to materials on the effectiveness of minimally invasive and robotic operations. Results. The use of “summing” quality parameters provides new opportunities to determine the effectiveness and safety of new surgical technologies being introduced. A composite criterion (textbook outcome) was successfully used in a comparative analysis when introducing a minimally invasive technology for performing esophagectomy and gastrectomy in patients with malignant neoplasms of the corresponding localizations. The direct relationship between the indicators of composite criteria at the level of medical institutions and the outcomes of antitumor treatment is determined. Conclusions. 1. A multilevel assessment of the applied treatment algorithms and achieved outcomes will ensure significant progress in the development of predictive technologies for choosing effective strategies for individualized therapy for esophageal and gastric cancer. 2. Optimization of the quality control system of the treatment and diagnostic process will improve the efficiency and quality of specialized antitumor treatment.

Beliefs and perceptions of electronic cigarettes among medical staff in respiratory departments of Fujian Province, China, in 2021.

Due to the popularity of e-cigarettes, more and more patients ask about e-cigarettes, and it is particularly important to understand doctors' beliefs and perceptions on e-cigarettes. The aim was to evaluate the belief and perception of electronic cigarettes among medical staff in the respiratory department of medical institutions located in Fujian Province. The electronic questionnaires were conveyed to the medical staff of the respiratory department in Fujian Province during March to April 2021. Descriptive statistics were calculated for all questions, and the relationship between relevant factors and the perception of e-cigarette-related statements was analyzed by logistic regression analysis. Among 1028 medical staff in the respiratory departments of Fujian Province, 90.5% of medical staff agreed that electronic cigarettes are harmful to the human body; 61.4% of medical staff agreed that e-cigarettes cannot be regarded as a type of smoking cessation treatment; 71.7% of medical staff agreed that e-cigarettes could be a 'gateway' to other tobacco use; and 69.2% of medical staff agreed that electronic cigarettes are in 'Three No' states. The multivariate logistic regression analysis showed that the respondents' perception of 'e-cigarettes cannot be regarded as a type of smoking cessation treatment' were related to gender, professional title and whether they participated in the cessation clinic. The medical staff of the respiratory department in Fujian Province put more emphasis on the adverse effects of e-cigarettes on health, but lack the cognition of the effect of e-cigarette smoking cessation. In order to better carry out smoking cessation work, it is necessary to strengthen the training of respiratory medical staff at all levels of medical institutions on e-cigarette knowledge.

Treatment outcome and its associated factors among HIV-MTB co-infected patients in Sichuan, China: A retrospective study

Human immunodeficiency virus (HIV)-Mycobacterium tuberculosis (MTB) co-infection has become a pressing global public health problem. Although tuberculosis (TB) is both treatable and curable, it has been exacerbated by the HIV/acquired immune deficiency syndrome (AIDS) epidemic. HIV-MTB co-infected patients have a variety of disease-specific, and treatment-related factors that can adversely affect their treatment outcomes. This study was conducted to assess the outcomes of TB treatment and its associated factors among HIV-MTB co-infected patients in Sichuan, Southwest China. A retrospective study was performed on HIV-MTB co-infected patients who were diagnosed and registered in TB designated hospitals in Sichuan from January 1, 2016, to December 31, 2020. Data were collected from patients' electronic medical records regarding their demographic, clinical, and social support information, and categorical data, such as sex, were reported using numbers and percentages. χ2 and t-tests were conducted to compare groups in relation to different levels of medical institutions. A binary logistic regression model was used to identify the factors associated with unsuccessful TB treatment outcomes. For logistic regression analysis performed using an α of 0.05, odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated for various risk factors. A total of 3677 registered HIV-MTB co-infected patients were enrolled. After adjusting for other variables, male, advanced age, receiving TB treatment at the municipal medical institution, being diagnosed with external pulmonary TB, referral or tracing, being sputum smear positive, not initiating antiretroviral therapy (ART) and not using fixed-dose combinations were the main risk factors for treatment failure of HIV-MTB co-infected patients in Sichuan province. Sex, age, hospital level, patient source, other diagnostic factors (e.g., sputum smear results, anatomical site of TB), and factors of therapeutic schemes (e.g., antiretroviral therapy, fixed-dose combinations) may serve as risk factors to estimate the likely treatment outcome of HIV-TB co-infection.

Research on the Equity and Optimal Allocation of Basic Medical Services in Guangzhou in the Context of COVID-19.

Optimizing the allocation of basic medical services and ensuring their equity are necessary to improve the ability to respond to public health emergencies and promote health equity in the context of COVID-19. This study aims to analyze the equity of Guangzhou's basic medical service and identify areas where health resources are relatively scarce. The spatial distribution and patterns of basic medical services were analyzed using kernel density analysis and standard deviation ellipse. The equity was analyzed using the Gini coefficient and Lorenz curve in terms of population and geographical area, respectively. Considering the medical demand and supply sides, the Gaussian two-step floating catchment area method was used to analyze the accessibility to different levels of medical institutions. The kernel density analysis and standard deviation ellipse showed that the spatial distribution of medical and health resources in Guangzhou is unevenly distributed, and high-level hospitals and medical resources are mainly concentrated in the centrum. From the perspective of population, Guangzhou's medical equity is generally reasonable. The accessibility of medical institutions differs with different levels, and the tertiary medical institutions have the best accessibility, while the unclassified, primary, and secondary medical institutions generally have lower accessibility. The accessibility of districts in Guangzhou varies greatly. Areas in the center are most accessible to basic medical services, while accessibility in outskirt areas has gradually decreased. Conclusion: The quantity of per capita medical and health resources in Guangzhou, as evidenced by basic medical services, is sufficient, but the spatial distribution is unequal. The developed city center enjoys more adequate healthcare resources than the distant suburbs. Primary healthcare should be built, especially in distant suburbs, to strengthen basic medical service equity in Guangzhou.

Efficient Cervical Cell Lesion Recognition Method Based on Dual Path Network

Ubiquitous computing and artificial intelligence are widely used in the field of Wise Information Technology of Med. It promotes the development of intelligent diagnosis and treatment, as well as reducing the workload of doctors’ diagnosis and promoting the improvement of the diagnosis level of medical institutions in remote areas. The accurate detection of cervical cytopathy is related to the precise treatment and rehabilitation of patients. However, the low rate of accuracy in the existing cervical cytopathy image detection cannot satisfy the application needs of intelligent diagnosis. In this paper, a dual path network efficient detection method for cervical cytopathy (the proposed DSRNet50) is proposed, which is based on the deep learning method, and combines residual structure and dense connection. The proposed DSRNet50 is mainly based on residual structure, supplemented by dense connection paths, which improves the utilization of features, and maintains the ability of exploring new features by reducing feature redundancy. Meanwhile, the proposed DSRNet50 leverages packet convolution to reduce the computation burden of the network and eliminate the over fitting phenomenon of the network. The proposed DSRNet50 further exploits channel attention mechanism to recalibrate important features to suppress the propagation of irrelevant information. We use the Herlev dataset to verify the proposed DSRNet50 in the terms of the detection accuracy, parameter quantity, and computing complexity. The experiment results are presented to show the achievable performance of the proposed DSRNet50.

Super-assembly of integrated gold magnetic assay with loop-mediated isothermal amplification for point-of-care testing.

With the increasing global threat of various diseases and infections, it is essential to develop a fast, low-cost, and easy-to-use point-of-care testing (POCT) system for inspections at all levels of medical institutions and self-examination at home. In this work, gold magnetic nanoparticles (GMNPs) are used as the key material, and a rapid visual detection method is designed through integrating loop-mediated isothermal amplification (LAMP) and lateral flow assay (LFA) biosensor for detecting a variety of analytes which includes whole blood, buccal swabs, and DNA. It is worth to note that the proposed method does not need DNA extraction. Furthermore, uracil DNA glycosylase (UDG) is employed to eliminate carrier contamination for preventing false positive results. The whole detection process can be finished within 25 min. The accuracy of detection is measured by assessing the polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) C677T. The detection limit of the newly developed extraction-free detection system for MTHFR C677T is 0.16 ng/μL. A preliminary clinical study of the proposed method is carried out by analyzing 600 clinical samples (including 200 whole blood samples, 100 buccal swabs, and 300 genomic DNA samples). The results indicate that the proposed method is 100% consistent with the sequencing results which provides a new choice for POCT and shows a broad application prospect in all levels of medical clinics and at home.Electronic Supplementary MaterialSupplementary material (details for MTHFR C677T primer sequences, the cell count results of samples at different dilution ratios, genotyping results and frequency samples, a Hardy—Weinberg equilibrium test, the sensitivity of the system, detection results of multiple samples, and optimization of the system) is available in the online version of this article at 10.1007/s12274-022-4692-9.

Current issues of staffing in healthcare in Russia and in the world

Introduction. The problem of the necessary number of highly qualified medical personnel does not allow providing the population with affordable and high-quality medical care and making possible to widely use innovative technologies in practical healthcare. The purpose of this study is to analyze the availability of human resources in healthcare in Russia and in the world, and events and positive experience of personnel planning in modern conditions. Material and methods. In the course of this study, statistical data, information materials of domestic and foreign literature sources in the Pubmed, Scopus, CyberLeninka, RSCI, eLibrary databases, periodicals, including electronic resources in the Internet, were analyzed. We used such methods as: statistical, study and generalization of experience, content analysis. Results. The analysis of the availability of medical personnel in the world and in Russia revealed the gain of provision with medical staff in China, New Zealand, Norway, Germany, Hungary, Mexico, Korea. The level of provision of doctors in the Russian Federation for the period from 2000 to 2019 increased by 4%, and the provision of secondary medical personnel - by 5.6%, the number of doctors working in non-governmental institutions has almost doubled. Limitations. Based on the results of this study, it is possible to establish only statistical, but not causal relationships; the restriction turned out to be important in comparative analysis with the indicators of similar studies. Discussion. The relevance of the problem of personnel planning in healthcare is characteristic of both developed and developing countries. It is necessary to study the foreign experience of personnel planning, regulatory and legal support of this area, pay attention to the professional training of medical personnel. Conclusion. To improve the provision of medical personnel, it is necessary to adequately change approaches to remuneration, training and advanced training of personnel; to maintain the number and staffing at the level of medical institutions in the subjects.

Mechanism of Impact of Big Data Resources on Medical Collaborative Networks From the Perspective of Transaction Efficiency of Medical Services: Survey Study.

BackgroundThe application of big data resources and the development of medical collaborative networks (MCNs) boost each other. However, MCNs are often assumed to be exogenous. How big data resources affect the emergence, development, and evolution of endogenous MCNs has not been well explained.ObjectiveThis study aimed to explore and understand the influence of the mechanism of a wide range of shared and private big data resources on the transaction efficiency of medical services to reveal the impact of big data resources on the emergence and development of endogenous MCNs.MethodsThis study was conducted by administering a survey questionnaire to information technology staff and medical staff from 132 medical institutions in China. Data from information technology staff and medical staff were integrated. Structural equation modeling was used to test the direct impact of big data resources on transaction efficiency of medical services. For those big data resources that had no direct impact, we analyzed their indirect impact.ResultsSharing of diagnosis and treatment data (β=.222; P=.03) and sharing of medical research data (β=.289; P=.04) at the network level (as big data itself) positively directly affected the transaction efficiency of medical services. Network protection of the external link systems (β=.271; P=.008) at the level of medical institutions (as big data technology) positively directly affected the transaction efficiency of medical services. Encryption security of web-based data (as big data technology) at the level of medical institutions, medical service capacity available for external use, real-time data of diagnosis and treatment services (as big data itself) at the level of medical institutions, and policies and regulations at the network level indirectly affected the transaction efficiency through network protection of the external link systems at the level of medical institutions.ConclusionsThis study found that big data technology, big data itself, and policy at the network and organizational levels interact with, and influence, each other to form the transaction efficiency of medical services. On the basis of the theory of neoclassical economics, the study highlighted the implications of big data resources for the emergence and development of endogenous MCNs.

Decision-making regulatory framework of the introduction of health technologies at the hospitals in Ukraine

The limited resources of the health care system and the COVID-19 pandemic encourage more rational and cost-effective administrative and clinical decisions. To achieve the best health care within available resources, the introduction of the most efficient technologies should be supported, considering organizational, social and ethical issues. Assessment of health technologies at different levels, namely national/regional and hospital, is becoming increasingly important. Adherence to cost-effective approaches to administrative and clinical decision-making will ensure the rational use of the state budget and improve clinical outcomes, improve the quality and life expectancy of patients.&#x0D; The purpose of the study was to analyze the current regulatory framework for the introduction of health technologies (medicines and medical devices) at the hospital level. During the research the methods of content analysis, historical, system-analytical, generalization was used.&#x0D; According to the analysis of the decision-making regulatory framework for the health technology’s introduction, it was drawn the next conclusions. The active HTA development in Ukraine is noted. In a short time, a legal framework for state HTA for medicines was created and approved, amendments were made to the Law of Ukraine ‘On Public Procurement’ and other Ukraine’s laws on medicine procurement under managed entry agreements, the further steps for development of the HTA ecosystem in Ukraine were identified.&#x0D; The legal framework for the circulation of medical devices needs to be updated in Ukraine, starting with technical regulations in accordance with EU regulations №745 and №746 and further approval of the Law on Medical Devices.&#x0D; Procedures for evaluation and selection of medicines and medical devices at the level of medical institutions are absent in Ukraine and require separate elaboration. The introduction of HB-HTA will help hospital managers to make independent, transparent, reasonable, and impartial management decisions on the selection of drugs and medical devices.&#x0D; The obtained results prove the need for further research of everyday decision-making practices on the introduction of health technologies at the hospitals, development of methodology for hospital-based HTA and update regulation of HB-HTA in the current legal framework of Ukraine.

Implementation of strategic planning in the practice of modern medical institution management: methodological and applied aspects

Introduction. Dismantling of the old economic model of health care as a purely budget organization, which took place under the influence of medical reform in Ukraine, led to a new nature of economic relations, the need for work and development of hospitals as participants in a competitive environment, regional or local health services market, exacerbated the impact of opportunities and threats. Given the uncertainty and dynamism of change, this highlights the need for strategic planning primarily at the level of medical institutions that provide secondary and tertiary (specialized) care to determine priorities and focus resources on achieving their development goals, which requires attention to the scientific and methodological framework ensuring this task.Purpose. The purpose of the article is to substantiate the need for strategic planning for the development of health care facilities in the context of medical reform and to develop recommendations for its implementation in their management.Research methods. In the course of the research the following methods were used: induction and deduction, system analysis - to determine the components of strategic planning at the level of health care, PEST analysis - to identify factors influencing the development of health care and factors that indicate the need to implement strategic planning in the hospital management system, institutional and comparative analysis - to identify features of strategic planning models, SWOT-analysis, expert assessments - to assess the internal and external environment of the organization, setting goals and strategic priorities.Results. Based on the analysis of the theoretical basis, the author’s approach to the interpretation of the essential characteristics of strategic planning of health care facilities is formed. The current state of the internal and external environment of health care facilities that provide secondary care in the context of health care reform in Ukraine is assessed, problems are identified. The planning system in medical institutions of this type is analyzed. The factors of actualization of the problem of implementation of strategic planning at the present stage are revealed and the necessity of its implementation in management of health care institutions is proved. Based on empirical evaluation conducted using the methods of expert collective commission, SPEIS-analysis, SWOT-analysis, the strengths and weaknesses of modern hospitals, opportunities and threats, the degree of probability and importance of the impact of opportunities and threats on the development of medical institutions, critical issues, the mission is specified, the main strategic goals and priorities are defined. An algorithm for the implementation of strategic planning in hospital management, a system of strategies and their content characteristics is proposed.Perspectives. Further research is needed on organizational design related to the implementation of strategies of medical institutions, organization of strategies, overcoming resistance to changes related to the implementation of strategies, training staff to work in new conditions, the use of other management actions aimed at building a perfect mechanism strategic planning.

The Effect of the New Rural Social Pension Insurance Program on the Choice of Medical Institutions for Rural Elderly

To explore the effect of the New Rural Social Pension Insurance (NRSPI) program on the choice of medical institutions for rural elderly is not only an effective entry point to test the influence of the NRSPI program, but also plays an significant role in maintaining people's health, improving our nation’s retirement pension system and the construction of the new countryside. To this end, based on the five periods of Chinese Family Panel Studies (CFPS) data from 2010 to 2018, this paper used Logit model and DID model to empirically investigate the impact of the NRSPI program on the choice of medical institutions for rural elderly. The empirical results show that: first, the NRSPI program can significantly promote the rural elderly to choose higher level of medical institutions for medical treatment. Specifically, receiving the NRSPI pension will increase the probability of rural elderly choosing hospitals at the county level and above by 8.6%, the hospitals at the township level by 2.5%, and will decrease the likelihood of choosing hospitals at the village level by 5.5%.Second, the effects of the NRSPI program are heterogeneous. Compared with the rural elderly in high income families, the program has a greater impact on the choice of medical institutions for those in low income families. Compared with the rural elderly in the eastern region, the program has a greater impact on the selection of county level hospitals and above by those in the central and western regions, but has less impact on the selection of village level hospitals.

The severity of adverse drug reactions and their influencing factors based on the ADR monitoring center of Henan Province

Adverse drug reactions (ADRs) may be a serious public health problem and have received widespread attention in recent years. This study has analyzed the factors leading to the occurrence of serious ADRs (SADRs), determined the factors affecting the prognosis of patients with severe adverse reactions at different levels of medical institutions, and finally made corresponding recommendations for the monitoring, prevention, and treatment of SADRs. We used descriptive analysis and chi-square test to analyze the year, age, gender, proportion of SADRs, and the results of the ADRs in the report. Use the logistic regression to analyze the factors affecting the prognosis of SADRs in different levels of medical institutions. A total of 387 642 people’s 394 037 ADRs were collected from the Henan Provincial Adverse Drug Reaction Monitoring Center from 2016 to 2020. Among them 35 742 cases of serious ADRs (9.1%), 96.1% were eventually relieved or cured, but 39 cases of SADRs caused death. The main causes of death included hemorrhages, organ failure, and allergies. Age, number of medication and illnesses, level of medical institution, history of adverse reactions, and type and method of medication were all factors that affected the severity of ADR. The prognosis of SADRs is worse than normal ADRs. The ADRs in autumn and winter and new adverse reactions are unique risk factors found in this study. The elderly and patients with multiple diseases or taking multiple drugs should pay attention to their adverse reactions. They should be closely observed within a week after taking the medicine. The supervision of patients with a history of allergies and new adverse reactions should be strengthened by primary medical institutions, and in nonprimary medical institutions should paid attention with past medical histories, and use imported drugs and biological agents with caution to ensure the safety and health of patients.