Medical Reform Research Articles

Can single disease payment impact hospitalization expenses and quality in district hospital? A case study in Fujian, China

BackgroundChina is exploring payment reform methods for patients to address the escalating issue of increasing medical costs. While most district hospitals were still in the stage of Single Disease Payment (SDP) due to conditions, there is a scarcity of research on comprehensive assessment of SDP. This study aims to evaluate the implementation of SDP in a district hospital, and provided data support and scientific reference for improving SDP method and accelerating medical insurance payment reform at district hospitals.MethodsData was collected from 2337 inpatient medical records at a district hospital in Fuzhou, China from 2016 to 2021. These diagnoses principally included type 2 diabetes, planned cesarean sections, and lacunar infarction. Structural variation analysis was conducted to examine changes in the internal cost structure and dynamic shifts in medical expenses for both the insured (treatment group) and uninsured (control group) patients, pre- and post-implementation of the SDP policy on August 1, 2018. The difference-in-differences (DID) method was employed to assess changes in hospitalization expenses and quality indicators pre- and post-implementation. Furthermore, subjective evaluation of medical quality was enhanced through questionnaire surveys with 181 patients and 138 medical staff members.ResultsThe implementation of SDP decreased the medical expenses decreased significantly (P < 0.05), which can also optimize the cost structure. The drug cost ratio descended significantly, and the proportion of laboratory fee rose slightly. The changes in infection rate, cure rate, and length of stay indicated enhanced medical quality (P < 0.05). The satisfaction of inpatients with SDP was high (89.2%). Medical staff expressed an upper middle level of satisfaction (77.2%) but identified difficulties with the implementation such as “insufficient coverage of disease types”.ConclusionAfter the implementation of SDP in district hospitals, considerable progress has been achieved in restraining medical expenses, coupled with notable enhancements in both medical quality and patient satisfaction levels. However, challenges persist regarding cost structure optimization and underutilization of medical resources. This study suggests that district hospitals can expedite insurance payment reform by optimizing drug procurement policies, sharing examination information, and strengthening the management of medical records.

Understanding the experience of family caregivers of patients with leukemia: a qualitative analysis of online blogs

Although family caregiving is a demanding task, it has the potential to increase the significance and satisfaction of the caregiving process, while also enabling better response to the patient’s condition. This study aims to qualitatively explore, describe and analyze the experiences of family caregivers who are taking care of patients with leukemia. With an inductive thematic analysis, data collected from 997 online blog posts generated by 32 Chinese family caregivers of both adult and pediatric patients with leukemia were thoroughly examined. Through a detailed analysis of the blog posts, three main themes were identified: (1) family caregivers’ (FCGs’) reactions to the leukemia diagnosis, (2) challenges faced in caregiving, and (3) effective coping strategies. The study reveals significant implications for improving the quality of life for family caregivers and enhancing health services for patients with leukemia. Gaining a comprehensive understanding of challenges and hardships faced by FCGs can shed light on enhancing the current medical services. A detailed account of the financial and psychological burdens experienced by FCGs offers valuable insights that can influence the decision-making of healthcare institutions and policymakers, facilitating the implementation of effective medical reforms. The findings underscore the importance of addressing the psycho-social needs of family caregivers, thereby suggesting the need of improved implementation of effective psycho-social support to enhance their overall quality of life. It is recommended that future research focus on developing more socially integrated approaches specifically tailored for family caregivers of patients with leukemia. While this study is primarily exploratory and descriptive, it forms a foundation for further investigation and understanding of the comprehensive family caregiving system for patients with leukemia.

The effect of hierarchical medical treatment reform——research based on 205 prefecture-level cities

ABSTRACT The problems, such as difficult and expensive medical treatment, high medical costs, and low efficiency in utilizing medical resources, have been prominent for a long time. The state has taken a series of measures to solve these problems, and hierarchical medical treatment reform is one of the critical measures. This paper uses a staggered DID to empirically analyse the effect of hierarchical medical treatment in 205 prefecture-level cities. The results show that hierarchical medical treatment significantly shortens the hospital day but has no significant impact on visit ratio to primary medical institutions, and average outpatient and inpatient costs in hospitals. The reduction in the hospital stay is smaller in areas with higher vertical fiscal imbalance and fewer medical resources. The important reason for the failure of hierarchical medical treatment to achieve orderly treatment is that, it didn’t effectively improve the resources ratio in primary medical institutions. And the most fundamental reason lies in the incentive of the fiscal decentralization system. Therefore, this necessitates a more targeted approach in the reform to achieve the intended orderly treatment process.

Evaluation of nurse practitioners' roles and competencies among rheumatology nurses: Results of a national survey.

To investigate nurse practitioners' roles and competencies among rheumatology nurses in China, an online, cross-sectional survey was conducted between July 7 and 14, 2020 among the national cooperation group of nursing experts on management of rheumatic and immune diseases. A total of 796 valid questionnaires were returned and participants' mean total scores on the Nurse Practitioners' Roles and Competencies Scale (NPRCS) was 2.51 (SD = 0.55), indicating a medium level. Medical assistance, leadership reform, and clinical research had low scores in the six dimensions of the NPRCS. Nurse practitioners' roles and competencies in the area of rheumatology require improvement. Training should focus on medical assistance, leadership reform, and clinical research. The current study can provide a reference for an improved training framework of nursing practitioners in the rheumatology field.

A Hospital Journal. Reforming Psychiatry in Colonial Algeria during Wartime (1953–1959)

Between 1953 and 1959, the Blida-Joinville Psychiatric Hospital (HPB) published a weekly magazine with the sober title Notre Journal. It was written jointly by the colonial hospital’s patients, nursing staff and doctors, and was seen as the “social cement” of a vast medical reform undertaken on the initiative of Dr Frantz Fanon. The journal was a supporter and a privileged witness of the reform, and was one of the places where socialtherapy was developed in word and deed, and where its achievements, representations and contradictions could be seen most clearly. By analysing the 165 issues that appeared in the course of the weekly’s six years of existence, this article points out the interest this source has for the history of psychiatry and its reform in colonial Algeria. A study of the copies of the journal makes it possible to separate the history of Algerian collective psychotherapy from that of its pioneer. Without downplaying Dr Fanon’s influence on the trajectory of a medical reform of which he was the architect, the aim of this article is to give the project back its historical and collective depth. By revealing the ways the junior doctors, nursing staff and patients appropriated and implemented the principles defended by the Martinican psychiatrist on a daily basis, it reminds us that socialtherapy was not simply part of the actions and itinerary of one man alone: just as the signs of collective psychotherapy preceded Frantz Fanon’s arrival in Algeria, the reform survived his departure, in spite of the problems that followed it.The article makes the in-house weekly its topic of interest and principal source, and in so doing assesses the role played by Notre Journal in the transformation of psychiatric practices at the HPB. By turns a vehicle for dissemination, a therapeutic resource, a tool for professionalisation and a political forum, the magazine was unquestionably one of the principal representatives of the paradigm supported by Dr Fanon. While it contributed to a change in the level of the reformist dynamic and was a collective voice for patients’ claims and recriminations, it also revealed a variable geometry of reform: depending on their beliefs, resources or personal status, psychiatrist, junior doctors, nurses and patients took hold of the project begun by Dr Fanon in different ways.Finally, while it makes the portrait of Algerian socialtherapy more complex, this article invites us not to overestimate the specificity of the reform engaged at the HPB. In terms of the rhetoric used in the pages of the in-house weekly, and of the protocol and treatment techniques applied, the approach that was begun in Algeria was inspired by previous experiences in Metropolitan France. What was unique about the overseas experience was for the most part of the interest shown in the local culture and beliefs, which gave rise to a cross-community paradigm that acted as a radical, alternative societal project. In the context of colonial Algeria during wartime, the journal had great difficulty maintaining its status as a safeguard in the face of intensifying political and military tensions, which in all likelihood had an impact on its disappearance.

ПЕРСПЕКТИВИ РОЗВИТКУ КОРПОРАТИВНОГО МЕДИЧНОГО СТРАХУВАННЯ В УКРАЇНІ В СУЧАСНИХ УМОВАХ

The article examines the evolution of the health insurance system in Ukraine, and also analyzes the advantages and disadvantages of using corporate insurance to expand voluntary health insurance programs. It is noted that the Ukrainian health care system is at the stage of reform, and mandatory health insurance has not yet been implemented. The main participants of voluntary health insurance are corporate clients. The purpose of medical insurance is to provide guaranteed medical care in the event of an insured event at the expense of accumulated funds. In addition, the insurance system is aimed at financing preventive measures and improving the quality and expanding access to medical services. A significant outflow of labor from Ukraine and, as a result, increased competition for qualified personnel forces companies to use new strategies to ensure employee loyalty. This is especially relevant for those who have survived the crisis in recent years and intend to strengthen their positions in the market. The successful management experience of companies, their practices, including personnel management, serve as an example for other participants in Ukrainian business. The medical reform that began in the country is the subject of active discussions in social networks and mass media, it is difficult to assess its direct impact on market growth indicators. In our opinion, while waiting for the changes, employers are showing much more interest in paying for medical treatment for their employees, and more and more employees are getting an insurance policy from their employer. The purpose of medical insurance is to provide guaranteed medical care in the event of an insured event at the expense of accumulated funds. In addition, the insurance system is aimed at financing preventive measures and improving the quality and expanding access to medical services. In connection with the ambiguity of the legislation regarding the mandatory form of health insurance in Ukraine, within the framework of our study, we will focus on its voluntary form. Thus, voluntary medical insurance is a type of insurance designed to provide the policyholder with a guarantee of full or partial reimbursement by the insurer of additional costs associated with contacting a medical institution for a service provided in accordance with the voluntary medical insurance program. Demand for voluntary health insurance products in Ukraine is very low. Insureds are mainly corporate clients, namely employers who insure their employees. Thus, it is possible to consider corporate health insurance as a separate segment of health insurance, which is part of the system of ensuring the human right to health.

Application and evaluation of the hybrid "Problem-Based Learning" model based on "Rain Classroom" in experimental courses of medical molecular biology.

With the advancement of society, the cultivation of medical professionals equipped with solid theoretical knowledge, a strong sense of innovation, and critical thinking has become a crucial goal in the reform of medical higher education. Over recent years, the hybrid Problem-Based Learning (hPBL) model, a blend of Problem-Based Learning (PBL) and Lecture-Based Learning (LBL), has emerged as a novel approach in the medical education reform landscape of China. The application and efficacy of the hPBL model in medical experimental courses have piqued the interest of medical educators. The aim of this study was to appraise the application and effectiveness of the hPBL model in the experimental course of Medical Molecular Biology at Beihua University. Utilizing the "Rain Classroom" platform, students from the Preventive Medicine and Medical Imaging programs were allocated to either the hPBL or LBL method for their Medical Molecular Biology experimental courses. The hPBL model's impact on students' performance was evaluated across four domains: experimental theory, experimental operation, experimental report, and practical application. Questionnaires were employed to gauge students' experiences and perceptions. The results indicated that the final assessment scores of the hPBL group were significantly superior to those of the LBL group. Moreover, the hPBL model effectively amplified students' self-learning capability, practical application skills, and communication competencies. Students expressed a high degree of satisfaction with this blended learning model. The hPBL model, which amalgamates PBL and LBL, has demonstrated its effectiveness in medical education. Its implementation in the experimental course of Medical Molecular Biology at Beihua University yielded positive outcomes, enhancing students' performance and satisfaction levels. Consequently, it is recommended that the hPBL model be further promulgated in other medical experimental courses.

Reform Strategies of Internal Medicine Nursing Teaching Methods in Higher Vocational Colleges under the Background of Internet+

With the extensive development of educational information technology in China, significant changes have been brought to all stages of education in China, including medical nursing teaching system in higher vocational colleges. Under the background of Internet+, the internal medicine nursing teaching in higher vocational colleges should also carry out targeted reform, flexibly utilize various new teaching methods, so as to improve the final teaching results. This paper first expounds the importance of medical nursing teaching reform in higher vocational colleges under the background of Internet+. Based on the analysis of the basic situation of internal medicine nursing teaching, it thoroughly and comprehensively analyzes the reform of medical nursing teaching methods in higher vocational colleges under the Internet+ background from four aspects, which refer to improving teachers’ Internet literacy, integrating traditional teaching methods into Internet technology contents, actively using all kinds of modern information technology and emphasize interaction between teachers and students in various teaching methods.

Механізми публічного управління у сфері охорони здоров’я в Україні: стан і системотворення

Public administration in the field of healthcare is carried out using certain tools (methods, techniques, operations, algorithms of actions, procedures and techniques of action, management technologies, communication strategies, etc.). The composition of the mechanisms of public administration in the sphere of healthcare is proposed, which is determined by the results of the analysis of the content and results of the medical reform in Ukraine. The aim (purpose of application), features of action, limitations and degree of completeness of public administration mechanisms in the field of healthcare in Ukraine are considered. Further improvement of public administration in the field of healthcare in Ukraine lies in the plane of system creation of its instrumental base. The system of public administration mechanisms in the field of healthcare is a set of various mechanisms, the simultaneous action of which in terms of interconnection and interdependence allows to ensure high-quality public administration in the most important socioeconomic sector of the country, which is healthcare. The features of the system of mechanisms of public administration in the sphere of healthcare are characterized. The formation of a system of public administration mechanisms in the field of healthcare in Ukraine should have a fundamental basis, which is formed in the form of appropriate conceptual foundations. The conceptual foundations of the formation of the system of public administration mechanisms in the field of healthcare in Ukraine contain a set of attitudes, principles, provisions, guidelines and vectors of action of state institutions, combined into constructs, the reliance on which will allow the formation of such a really effective system. The creation of a system of public administration mechanisms in the field of healthcare in Ukraine is important for improving the quality of public administration, and therefore great attention should be paid to this process.

Research on the Development Strategy of PDS Maternal and Child Health Hospital under the Background of New Medical Reform—Based on PEST and SWOT Model

Research on the Development Strategy of PDS Maternal and Child Health Hospital under the Background of New Medical Reform—Based on PEST and SWOT Model

Аналіз експертних оцінок результативності реформи системи охорони здоров’я України

The effectiveness, completeness, and timeliness of measures to reform the health care sector can be assessed differently by individual stakeholders, such as specialists, scientists, experts, and the public. Each of these interested parties has its own priorities regarding the results of reforming the medical industry. Despite this, the comparison of different evaluation points of view makes it possible to generalize the available results and to develop further steps to improve the operating conditions of the medical field. The results of the office analysis of data collected during 2020-2021 by WHO experts regarding the state of the Ukrainian primary medical care system were analyzed. Assessments of Ukrainian and foreign scientists, experts, specialists regarding the positive and negative results of reforming the medical industry are summarized. The results of a nationwide public opinion survey conducted by the SOCIS Center in 2019 and 2020 regarding the public's perception of the results of health care reform were analyzed, as well as the results of a survey of 1,000 Ukrainians in April 2023 conducted by the sociological company Factum Group within the scope of social “YOUkraina” initiative. In many respects, the representatives of academic and scientific circles agree with the opinions of WHO experts, who attributed the following to the shortcomings of health care reform: imperfect organization and insufficient funding, limited subject-legal relations, gaps in the functioning of the health care system, inefficient management of human resources and contradictory legislation. According to the patients, as a result of the reform measures, there were no significant changes in the level of quality of the provision of medical services. At the same time, the level of support for the medical reform from the country's population is insufficient, and almost 40% of respondents consider the reform to be unsuccessful.

Health Technology Assessment in China’s Health Care Sector: Development and Applications

ABSTRACT China’s health system is facing severe challenges from social transition and the double burden of population aging and non-communicable diseases. Addressing the tension between the public’s increasing demand for health services and the limited availability of medical resources has become a critical issue for health care policymakers and medical insurance fund administrators. In promoting its medical insurance system reform, China is actively developing health technology assessment (HTA) with principles and applications adapted to the Chinese context. This study aims to analyze the evolution of HTA in China with a focus on context, actors, process, content, and challenges encountered through applying a modified verson of Walt and Gilson’s policy triangle framework. Currently, HTA plays an indispensable part in the reform of China’s health care and medical insurance system, especially in the formulation and adjustment of the National Reimbursement Drug List (NRDL). While HTA is increasingly used in China, there remain challenges, such as the slow development of HTA related disciplines, lack of an independent national HTA authority, and limited scope in the use of HTA. Despite the identified challenges, HTA has the potential to support a wide range of applications in China’s health care sector, building on the progress achieved over the last three decades.

Analysis of implementing the Ukrainian healthcare reform in 2023

The main research task is to study the issue of effectiveness of implementing the healthcare reform in Ukraine using the main levers of influence on the most significant items of expenditure in the medical industry itself. Also, we investigate the main items of income and expenses of medical service providers, their specific weight and management methods for more rational use. It is worth noting that the positive dynamics in the direction of effectiveness of the healthcare industry is not only the main priority. It is also a direct tool that drives the general processes in the medical industry. Increasing the level of social protection is one of the primary goals of medicine and, as a result, improving the quality of state population life. In a chain reaction, this will lead to a reduction in costs for the healthcare industry due to faster recovery of patients and reduction of time spent in a state of temporary incapacity. One of the key aspects of the medical reform efficiency remains the issue of remuneration of workers. Before carrying out reform measures, doctor salaries were officially at the minimum level. Therefore, the principle of treatment for the patient’s money was widespread in the industry. The main motivating element of the human capital efficiency is salary – reward for work results. So, if the salary directly depends on the target indicators that must be achieved in the production process, then the employee’s motivation increases. Based on the fact that the main direction of funds expenditure at medical institutions is labour costs, the main efforts and attention should be paid in the organisational and administrative plan to work with the effective use of this item of expenses. It is worth noting that the salary of any employee is the main measure of his work efficiency. It is a motivator to improve the quality and treatment efficiency. If the amount of reward depends on the employee’s performance indicators, the system will have additional motivation not only in the quantitative characteristics of the work result, but also in the qualitative parameters.

Can Comprehensive Medical Reform Improve the Efficiency of Medical Resource Allocation? Evidence From China.

Objectives: To evaluate the impact of comprehensive medical reform on the efficiency of medical resource allocation in China. Methods: This study employs the Slacks-Based Measure- Directional Distance Function (SBM-DDF) to estimate the efficiency of medical resource allocation (MRAE) in China, using panel data from 30 provinces during 2009-2021. Moreover, a multi-period Difference in differences (DID) model is developed to explore the effect of the comprehensive medical reform pilot (CMRP) strategy on efficiency of medical resource allocation in China. Results: The results show that the average value of China's medical resources allocation efficiency is 0.861 during the sample period. Coastal area has a higher MRAE than that in the inland area. The DID results show that the comprehensive medical reform pilot strategy has a good, long-lasting impact on the efficiency of medical resource allocation. And the results remain valid after a series of robustness analysis. Additionally, the comprehensive medical reform policy has heterogeneous impact on efficiency of medical resource allocation. The promotion effect is only statistically significant in the eastern and central regions, the groups of higher MRAE and larger population size. Conclusion: China's comprehensive medical reform policy can effectively promote the improvement of regional efficiency of medical resource allocation.

Financial Analysis of the Pharmaceutical Industry Based on Dupont Analysis: Taking Guangzhou Baiyunshan Pharmaceutical Group as an Example

As an infrastructure industry, the pharmaceutical industry is related to peoples livelihood and social stability and is one of the pillar industries of society. With the in-depth advancement of various medical policy reforms since 2021, the scale of Chinas pharmaceutical market has continued to rise, and the revenue and profit of the pharmaceutical industry have maintained steady growth, so the industry still has outstanding growth advantages. Based on the pharmaceutical industry, this paper selects Guangzhou Baiyunshan Pharmaceutical Group as the research object, takes the companys financial data from 2018 to 2022 as the basis, conducts a comprehensive study on the companys operating conditions based on DuPont analysis, and finds that Guangzhou Baiyunshan has problems such as high financial risk, low turnover of receivables and low profitability during its development. The paper puts forward the corresponding suggestions of saving expenditure, increasing income and focusing on sustainable development in solvency; improving enterprise credit policy and strengthening accounts receivable management in operational capacity; and optimizing pharmaceutical R&amp;D investment and management in profitability.

Delay and settlement: The disposition of medical negligence claims in Ireland

AbstractReflecting the international experience, statistics show that most medical negligence cases in Ireland settle. Less is known, however, about the duration of these cases, though anecdotal evidence suggests that they are protracted in nature. Procedurally focused reforms, aimed at reducing costs and facilitating more expedient resolution of these disputes have been proposed in Ireland, yet await implementation. As such, the pace of litigation is largely determined by the parties to the dispute. Drawing on the findings of an empirical study (an analysis of closed case files and qualitative interviews), this article explores two questions: first, how long do medical negligence cases take to resolve; and secondly, what contributes to delay in this context. Whilst causes of delay may vary by case, it is important to attempt to identify and explore common factors which contribute to delay. If these factors can be problematised and understood, possible solutions may be reached. In doing so, the article contributes to the debate on medical negligence reform across common law jurisdictions, evidencing the broader considerations, in addition to procedurally focused reforms, which are required when considering the issue of delay.

A comparative evaluation of child health care in China using multicriteria decision analysis methods

Child health is an important public health issue in China and the Chinese government always attached great importance to child health care. With the implementation of a series of medical and health reforms in China in recent decades, the status of child health improved year by year. Objectives This study aims to comprehensively evaluate if the measures implemented in the medical and health reforms effectively promoted the development of Chinese child health care in recent years and provide theoretical support for future decision-making on the policies of child health care in China. Methods A total of six indicators were selected from the China Health Statistics Yearbook. Based on the multi-criteria decision analysis (MCDA) algorithm, three different evaluation methods were applied in the study, which are the weighted technique for order preference by similarity to an ideal solution (TOPSIS) method, the weighted rank-sum ratio (RSR) method, and the fuzzy comprehensive evaluation (FCE). Each indicator's weight was calculated by the entropy weight methods objectively. The sensitivity analysis was conducted to validate the stability and accuracy of the rank results.Results The results indicated that the rank values of each year’s child health care calculated by the different evaluation methods were not exactly the same, but the overall trend is consistent which is that child health care in China improved year by year from 2000 to 2020. The top 5 were ranked from 2016-2020 and the bottom 5 were ranked from 2000-2004. Conclusions The results indicated that the policies and measures implemented in the medical and health reforms, as well as improved sanitation conditions, availability of healthy food and water, etc., have jointly promoted the development of child health care in China in the past 20 years, providing a scientific theoretical basis for future policy-making to promote child health care.

Medical insurance, labor supply, and anti‐poverty initiatives: Micro‐evidence from China

AbstractThe high cost of medical care and its association with poverty have given rise to a growing concern for developing countries, but how insurance plans affect household income and alleviate poverty has been rarely discussed. This study aims to bridge this research gap by examining a medical insurance reform in China, a major program of the targeted poverty alleviation (TPA) strategy, which offers higher reimbursement rates and lower medical deductibles for low‐income households. We use an administrative data set on impoverished people in a Chinese county to examine how exogenous changes in the medical insurance system affect the income structure of low‐income households. We apply a two‐part model to a Difference‐in‐Differences framework, with households that received reimbursement of the insurance reform as the treatment group and others as the control group. Our results imply that the medical insurance reform could increase the overall household income diversity. The mechanism analysis suggests that the medical insurance reform improves the health conditions of patients and encourages caregivers to engage more in off‐farm work.

The heterogeneous effects of China's hierarchical medical system reforms on health service utilisation and health outcomes among elderly populations: a longitudinal quasi-experimental study

BackgroundSystem-wide, comprehensive, primary health care (PHC)-oriented health reforms are infrequently introduced in low-income and middle-income countries and often poorly studied. China initiated a large-scale reform in 2015 that included multiple policies: partial gatekeeping, a family physician scheme, and increased system integration. These policies aimed to build a PHC-oriented health system and improve primary care utilisation. This study assessed the heterogeneous effects of the reforms on health service utilisation and health outcomes across regions and over time. MethodsIn this longitudinal quasi-experimental study, we used longitudinal data (2011–18) from a national survey on elderly populations and governmental yearbooks. This study exploits the staggered rollout of the reforms at the city level identified using web-scrapping. We employed an event study design to assess reform effects on (1) visits to PHC facilities, (2) admissions to hospital, (3) out-of-pocket expenditures (OOPEs), and (4) self-reported health. Models were adjusted for city and time fixed effects, along with demographic and socioeconomic characteristics at individual and provincial levels. Analysis was separated into rural and urban populations. Findings18 988 Chinese individuals aged 45 and older (mean age 60·4 years [SD 10·3], 9990 [52·6%] women, 8998 [47·4%] men) were included in the analysis. The reform was associated with increasing odds of visiting PHC facilities among rural populations, which became stronger in the 2 years after the reform (adjusted odd ratio [aOR] 1·35, 95% CI 1·02–1·84, p=0·0374; absolute effect sizes [probability] 3%) before it faded. Meanwhile, urban populations were unaffected (from aOR 1·22, 0·82–1·81 to 0·89, 0·50–1·57). The reform did not have a significant effect on admission to hospital (rural: from 0·97, 0·72–1·31 to 1·47, 0·85–2·55; urban: from 1·00, 0·69–1·43 to 1·59, 0·76–3·30) or OOPEs (rural: from 260·32 Chinese Yuan, 95% CI –6·34 to 526·97, to 693·07 Chinese Yuan, –102·96 to 1489·09; urban: from 235·37 Chinese Yuan, –405·10 to 875·83, to 859·93 Chinese Yuan, –199·02 to 1918·88). Urban populations reported higher self-reported health after the reforms than the year before the reforms (1·50, 1·12–2·01, p=0·0002; 5%). InterpretationSystem-wide PHC-oriented reforms might contribute to short-term increases in primary care utilisation in elderly populations with implications for urban–rural inequalities. Effects on financial protection and health inequality were limited. Efforts in improving the accessibility and quality of primary care in deprived areas are indispensable to addressing the persistent inverse care law and to achieving Universal Health Coverage for all countries. FundingNone.

Impact of Humble Leadership Behaviours of Hospital Leaders on The Innovation Performance and Work Engagement of Employees

Currently, the medical environment of hospitals is in a constant state of change, with the advancement of medical and healthcare system reforms. The organizational environment of hospitals is also becoming more and more dynamic, uncertain, and unpredictable. Relying only on the experience and knowledge of hospital administrators is no longer sufficient, necessitating employee participation. Vital to this is the provision of opportunities enabling employees to boost their motivation levels and encourage innovative practices. Four scales - leadership humility, innovation performance, psychological capital and job involvement - organize and design a questionnaire in this paper. Statistical methods are utilized to scrutinize and validate questionnaire data for quantitative research. This paper examines the factors that influence employees' innovative performance and work engagement. The aim is to identify ways in which the humble behaviour of hospital leaders can contribute concretely to enhance employees' work initiative and performance, thereby providing a substantive basis for better functioning of hospital departments.