Understanding the supply-demand relationship of medical services is essential for regional planning. Existing city-scale studies typically exclude cross-city flows, whereas national-scale studies often overlook intra-city heterogeneity. In urban agglomerations, healthcare resources and transport infrastructure are usually planned by cities, although patients may cross city boundaries to seek care. The implications of cross-city trips for regional medical services remain insufficiently understood. Taking the Pearl River Delta as a case, this study investigates cross-city hospital visiting trips and their implications for medical service evaluation. Using 91.2million automobile navigation records collected in 2019, 1.37million hospital visiting trips to Grade 3 hospitals were identified through a modified spatial join method. A population-hospital bipartite network and a multi-scale analytical framework were constructed. Cross-city demand and supply indices were developed at the city, subdistrict, and hospital scales to characterize cross-city medical service patterns and influencing factors. Accessibility and Gini coefficients were computed under intra-city and regional evaluation scenarios to assess how incorporating cross-city hospital visiting trips affects medical service evaluation. Based on automobile navigation data, 9.1% of identified hospital visiting trips crossed city boundaries. Guangzhou and Shenzhen served as dominant regional suppliers, with cross-city supply indices of 55.9% and 21.8%, respectively. Cross-city demand was negatively associated with distance to boundary, GDP per capita, and hospital beds. Cross-city service share was negatively associated with distance to boundary, whereas contributions to regional cross-city service provision were positively associated with hospital size and hospital grade. Incorporating cross-city flows increased accessibility in most peripheral areas and reduced the regional population-weighted Gini coefficient from 0.596 to 0.522. Based on automobile navigation data, cross-city hospital visiting trips constitute an important component of medical service utilization in urban agglomerations. At the subdistrict scale, cross-city demand was jointly associated with boundary proximity and local economic and medical conditions. At the hospital scale, the cross-city service share was higher among hospitals closer to city boundaries, whereas contributions to regional cross-city medical service provision were greater among larger and higher-grade hospitals. Evaluation frameworks relying solely on intra-city data tend to underestimate accessibility in boundary areas and, in most cases, overestimate the Gini coefficient.

Depopulation and healthcare service decline: Spatial evidence of a vicious cycle in South Korea

Field transfusion of whole blood is vital for patients in hemorrhagic shock, particularly in austere or resource-limited environments. Military use of warm fresh whole blood (WFWB) has inspired civilian interest in walking blood banks (WBBs) for rural, prehospital, and mass casualty settings where blood product access is limited. However, standardized training and proficiency benchmarks are lacking. This project developed a checklist and established validity evidence to assess provider proficiency in WFWB collection and transfusion. A multidisciplinary panel created a checklist and modified an existing training video for WFWB collection and transfusion. Using simulation, medical students, nurses, nurse practitioners, physicians, and emergency medical service providers were evaluated to validate the checklist and define proficiency thresholds. Participants (n = 41) were categorized as novice (n = 12), intermediate (n = 13), or expert (n = 16) based on experience. After reviewing the video, participants performed simulated procedures graded by independent evaluators. The maximum score was 47 points, with competency defined by expert performance. Analyses of variance revealed significant differences between novice and intermediate (p <.01) and novice and expert (p<.01) groups, but not between intermediate and expert (p = .09). Mean rubric scores and completion times were: novice (31/47; 41 min 17 s), intermediate (38/47; 33 min 7 s), expert (41/47; 29 min 19 s). The competency threshold was set at 41/47 and 33 min 27 s. The validated checklist and training video provide a foundation for standardized WFWB education and proficiency assessment, supporting safe WBB implementation in military and civilian settings.

The NHS Ten Year Health Plan introduces Multi-Neighbourhood Providers (MNPs) as organisations delivering integrated, preventive and community-based care to populations exceeding 250 000. No registry exists of at-scale primary care organisations in England, which limits our understanding of existing provision and organisational architecture. To identify and characterise existing at-scale general practice organisations in England that could serve as prospective MNPs, describing their geographical distribution and key characteristics. A cross-sectional study of Care Quality Commission (CQC) registered primary medical service providers (June 2025) and NHS Integrated Care Board expenditure data reporting transactions over £25 000 (April 2024 - May 2025). At-scale providers were defined through consensus with policymakers and provider leaders as organisations delivering primary medical services to populations exceeding 100 000 patients. Keyword searches (Federation, Alliance, Partnership), multi-location provision, and specific organisational structures (incorporated organisations, limited liability partnerships, Community Interest Companies) informed inclusion criteria. Two reviewers screened organisations via website review; a third reviewer resolved discrepancies. From 56 030 registered providers and expenditure data, 661 organisations were shortlisted for screening. Screening is ongoing and results will be presented in full at the conference as choropleth maps, including details of provider- and practice-level characteristics. This first systematic mapping of at-scale primary care providers reveals substantial existing infrastructure operating at multi-neighbourhood scale, with significant variation in structure and maturity. Findings provide essential baseline intelligence for implementing MNP policy and commissioning decisions. The methodology offers a replicable approach for ongoing surveillance of primary care organisational development in England.

Few reports detail the operation of Japan's unique disaster countermeasures, mobile pharmacy vehicles (MPVs). This case report draws on the authors' direct operational experience and anonymized, retrospective open-access data to describe the current system and actual operations of MPVs and examine the feasibility of their international implementation. During the Noto Peninsula Earthquake in January 2024, 13 MPVs were deployed to the affected areas following dispatch requests, and 1,834 disaster prescriptions were issued. In accordance with the local medical care delivery system, the deployment of MPVs was coordinated by the disaster pharmacy coordinator, contributing to the rapid and flexible provision of medical services. These results demonstrate the potential international applicability of the MPV system. Further development of information management and operational systems, along with their adaptation for other uses, may enhance the utility of the MPV model as a component of disaster medical support in other countries.

The article examines the role of digitalization of healthcare management processes as a tool for increasing the efficiency of the system's functioning in the context of military challenges and post-war reconstruction of Ukraine. The relevance of the study is due to the need to modernize public management mechanisms in the healthcare sector, increase the efficiency of resource use, and ensure the sustainability of the medical system in the context of large-scale transformations. Modern scientific approaches to interpreting the concepts of digitalization and digital transformation in public management, as well as their application in the healthcare sector, are analyzed. It is determined that digitalization of management processes involves the integration of information and communication technologies into the management system, which contributes to increased transparency, efficiency of management decision-making, improved interinstitutional interaction, and more efficient use of financial, human, and material and technical resources. Particular attention is paid to the analysis of digital tools for managing the healthcare system, in particular electronic medical records, telemedicine, big data analytics and artificial intelligence technologies, which create opportunities for optimizing resource management, monitoring the state of medical infrastructure and forecasting the population's needs for medical services. It is substantiated that the use of digital platforms and integrated information systems contributes to the formation of a single information space for the healthcare system, which allows increasing management efficiency and ensuring better provision of medical services. A conceptual model for digitalizing healthcare system management is proposed, which involves the integration of digital tools into the public management system at the strategic, managerial and operational levels and ensures interaction between state authorities, regional management structures, medical institutions and citizens. It is proven that digitalizing management processes can be an important tool for increasing the efficiency of restoring the healthcare system of Ukraine, ensuring transparency of management processes, coordination between management entities and optimizing the use of resources during the post-war reconstruction period.

At present, retention of staff capacity and extension of professional longevity of the working-age population is an urgent task for the Russian healthcare. This task is particularly important for workers of industrial and remote enterprises, when the specifics of the approach to the organization of medical support is determined by many factors — from the features of production environment to the climatic and geographical conditions of industrial facility location. Objective. To analyze the activities of a large private medical organization engaged in providing medical care to industrial workers, describing the approaches and capabilities of organizing service in different conditions, including in the absence of any medical infrastructure, in order to extend the professional longevity of working contingents. Materials and methods. Legal and regulatory framework and requirements for medical support of workers in the industrial sector of the economy in the Russian Federation as well as domestic scientific publications describing the capabilities, specifics and problems of modern approaches to organization were analyzed. Data of local statutory instruments of private medical service provider regulating the process of organization of medical support of industrial facilities were systematized. Analytical and graphical research methods were used. Results. The experience and approaches of a private medical service provider ensuring medical support to industrial facilities, including maritime ones, in more than 20 regions of Russia were presented and systematized. Conclusion. One of the effective models for organizing comprehensive medical support for workers at industrial facilities is to involve private medical organizations in this task, which allows to supplement and strengthen state mechanisms for protecting the health of workers in the industrial sector.

Aim. To study regulatory changes for the period from Q4 2025 to January- February 2026 that impacted the management and delivery of primary health care in the Russian Federation. Material and methods. We analyzed regulatory legal acts in the Russian Federation adopted during the period under review, including the Healthcare Development Strategy to 2030, the updated list of vital and essential medicines, and the new version of the State Medical Assistance Program for 2026-2028. Results. The adopted regulatory legal acts form a comprehensive model for the modernization of primary health care, focused on prevention, digitalization, and improving governance of the sector. Key changes include extending the modernization program until 2030, expanding preventive measures and outpatient follow-up, implementing remote patient monitoring, developing telemedicine technologies, clarifying funding and tariff setting within the compulsory health insurance system, as well as introducing novel management approaches to staffing and pharmaceutical provision. Particular attention is given to specific social groups, including participants in the special military operation, persons with disabilities, and residents of remote or hard-to-reach areas. The implementation of these regulatory innovations creates institutional prerequisites for improving the accessibility and quality of care, as well as for optimizing managerial and financial processes in the health system. Conclusion. The analysis of legislative changes from Q4 2025 to early 2026 demonstrates their systemic impact on the transformation of the legal and structural framework of primary health care in the Russian Federation. The new regulatory solutions are aimed at strengthening the preventive care model, advancing digital technologies, increasing the targeted provision of medical services, and improving financial mechanisms. Collectively, these measures create the legal framework for sustainable modernization of primary health care, more efficient use of health system resources, and improved accessibility of medical services for the population.

Traditional medical care accounts for 10% of health outcomes, whereas SDOH account for over 60%. Optimal care of older adults with chronic illnesses requires integration of medical and social service providers. Such partnerships remain uncommon. The authors describe a successful health system/Area Agency on Aging (AAA) integrated team model that meets weekly to discuss challenging community-dwelling older adults and generate care recommendations back to the primary care providers. As part of a quality improvement project, outcomes measured over 6 months during 1 year show a statistically significant decline in the number of important threats to independent living related to the 4Ms (ie, lower fall risk, fewer high-risk medication issues, less behavioral health concerns, and less frequent health care utilization). AAA care managers expressed high satisfaction with the team process and indicated that it helped them address important issues. This model is easily replicated and modifiable to differing local needs. If replicable in rigorously designed research studies, these results would argue for changes in Medicare and Medicaid reimbursement policies to support this interagency integrated model of collaborative care.

The purpose of the study. The article discusses practical issues and problematic aspects related to the daily activities of medical organizations in legal relations with customers, patients, administrative and regulatory authorities. The analysis of the current regulatory legal acts, materials of judicial practice in the field under consideration is given. The purpose of the study is to identify problematic issues, as well as ways to resolve them legally. Conclusions. As a result of the conducted research, the author comes to the conclusion that the provision of medical services is characterized by special specifics, which are regulated by special legislation. Practical examples provide recommendations for proper interaction with the subjects of the legal relationship in question.

"That's not my world yet": A qualitative study on what older people in rural Saxony-Anhalt think about participating in an online health community

The number of calls for ambulances in Australia has been rising faster than population growth, but it is unclear what is driving this demand. This study aims to quantify and compare the drivers of emergency ambulance demand in Victoria, Australia, before and after the COVID-19 pandemic, including demographic and clinical factors. We conducted a retrospective cohort study of all emergency ambulance calls in Victoria from January 1, 2016, to December 31, 2023. Using negative binomial segmented time series regression models, adjusted for population growth and seasonality, we estimated trend and level changes across demographic and clinical subgroups. 5,239,378 calls were analysed. Ambulance demand increased annually by 4.3% [95% CI 3.6,5.1] pre-COVID-19, but slowed to 2.7% [95% CI 0.9, 4.5] post-pandemic. Post-COVID-19, there was a decreasing trend in calls among children, rural residents, and patients with lower socioeconomic advantage. The trend in demand also declined for calls related to chest pain, cardiac arrest, and falls. In contrast, there was an increasing trend among older adults and for complaints including headaches, heart problems, and trauma. Psychiatric calls showed continued growth across all periods, despite a level decrease at the end of COVID-19. Altered patterns of ambulance utilisation were observed in Victoria post-COVID-19. Reduced demand growth post-COVID-19 may reflect a diversion toward urgent care centres and the growing role of telehealth. Ongoing increases in psychiatric demand highlight the need for system-level interventions to manage mental health presentations. Calls for falls increased proportionally with population growth, indicating that falls are not a significant driver of ambulance demand. Ambulance demand in Australia has been rising faster than population growth, but the long-term impact of the COVID-19 pandemic remains unclear. This research quantifies changes in the trends of emergency ambulance calls, both overall and across key clinical and demographic subpopulations. These findings provide an evidence base to support the provision of emergency medical services and may inform optimisation of referral pathways and alternative care models.

Hospitals serve two million victims of interpersonal violence per year and may be the only place survivors seek services. Other formal systems may have little or inconsistent communication with hospitals, to the detriment of survivors. To improve responses to survivors, four counties in California piloted a web-based platform for forensic examination documentation and electronic communication of nonaccidental injury reports among medical, legal, and support services providers. The research team conducted a qualitative implementation evaluation, guided by the Consolidated Framework for Implementation Research for Process Redesign (CFIR PR), which captures implementation determinants of process change. We conducted descriptive analysis of platform metrics to demonstrate implementation over an eight-month period, scoping sessions with potential users during testing, and interviews with users. We identified constructs across six CFIR PR domains that impacted three intervention processes: (1) forensic exam documentation of injuries, (2) sharing documentation of injuries with law enforcement, and (3) sharing victim referrals with VSPs. Implementation varied across counties. Forensic examiners used the platform most and reported a mix of increased and decreased efficiencies. Tracking reports through the system increased accountability within and between organizations, while many report receivers needed to use previous processes. In these four pilot counties, technology use reflected leaders’ implementation strategy regardless of goals. In counties that had less collaborative implementation approaches, there was also reduced platform use. Successful implementation may be challenged by an absence of intentional collaboration and a shared implementation process. Future research may explore how planning and engagement strategies impact adoption and engagement long term.

From battlefield to bedside: How military surgeons advanced pediatric critical care transport and ECMO.

The issue of the admissibility of including human reproductive biomaterials temporarily separated from his body during the use of assisted reproductive technologies in the subject of contracts aimed at the transfer of ownership is subject to research. The article substantiates the position according to which neither singular nor universal succession is allowed in relation to germ cells, tissues of reproductive organs, as well as embryos obtained during the provision of medical services using ART. It has been established that the separation of the reproductive biomaterial from the human body (the originator) accompanies the infertility treatment of a couple or a single woman and does not pursue the goal of creating an object of law. The originator's object of interest is not a reproductive biomaterial that is temporarily separated from his body, but a medical organization's service that consists of performing a set of medical interventions aimed at preventing, diagnosing, and treating infertility. The persons from whom the reproductive biomaterial originates exercise control not over the biomaterial, but over their health, which results in a certain fate of germ cells and embryos in vitro. It is proved that the reproductive biomaterial lacks marketability properties, it is inextricably linked with the personality of the patients (recipients) undergoing treatment.

Introduction: The Israeli health system was responsible for leading the fight against SARS-COV-2 as a medical emergency, making delivering real-time, professional information to the population crucial. The survival of the Israeli healthcare system during disasters is closely linked to the provision of medical services by the four HMOs. Professional and relevant spokespeople must ensure effective information delivery by adhering to the highest standards. This study assesses how professional information is communicated to the Israeli public. Methods: During the COVID-19 pandemic (2020-2022), thirteen influential individuals from the Israeli healthcare system, actively involved in leading the country’s response, were extensively interviewed using a semi-structured approach. The interviews underwent evaluation by a peer review panel. Access to participants was obtained, and the interviews were conducted in person or via Zoom. The participants were provided with the questionnaire format in advance. The data analysis was done with ATLS.TI 22, resulting in the identification of six themes. One of these themes emphasized the importance of delivering professional information to establish public trustworthiness during emergencies. The themes were derived by identifying recurring concepts and categories within the participants’ quotes. Results: Many instances were uncovered, illustrating the paramount significance of professional information delivery in shaping the trustworthiness of the public during the COVID-19 pandemic. All 13 interviewees unequivocally recognized the impact of professional information dissemination. They supported their viewpoints with concrete illustrations, emphasizing the role of physicians as spokespersons, the need for media interaction through question-and-answer sessions during conferences, and the importance of unified messaging across all media platforms and among all professionals involved. Conclusion: The study demonstrates the approach adopted by the Israeli healthcare system in managing the pandemic, encompassing an examination of the ramifications of professional information delivery. The abundance of lessons and examples presented may also hold relevance for other countries, offering potential for broader application.

BackgroundAs the core providers of medical and health services, public hospitals play an irreplaceable role in ensuring basic medical care, safeguarding health equity, and fulfilling social responsibilities. Their operational efficiency and institutional design not only influence the national health status but also relate to the stability and development of the entire healthcare system. Therefore, continuously optimizing support policies and management mechanisms for public hospitals has become a crucial issue for governments worldwide in advancing healthcare system reforms.MethodsThis paper systematically reviews the policy trajectories supporting the development of public hospitals in five major global economies, namely the United States, the United Kingdom, Germany, Japan, and Singapore. Primary sources included government legislation and policy documents, official statistical publications issued by health authorities and insurance agencies, and peer-reviewed journal articles indexed in Web of Science, PubMed, and Scopus. The analysis focused on key institutional dimensions, including financing arrangements, governance structures, payment systems, and performance evaluation mechanisms. Through cross-country comparisons and longitudinal historical analysis, it reveals the commonalities and differences among various policy models.ResultsThe study finds that in the United States, support policies for public hospitals are primarily market-driven, supplemented by public programs. Public health insurance programs such as Medicare and Medicaid provide funding for public hospitals, and market-oriented management models are relied upon to enhance operational efficiency. The United Kingdom adopts the National Health Service system, which is based on tax financing and constructs a public hospital system that combines government leadership, internal marketization, and performance governance. Germany ensures the financial stability and operational efficiency of public hospitals through a dual governance structure of social health insurance and government capital investment. Under the universal health insurance system in Japan, a refined payment system and a local government responsibility-sharing mechanism drive public hospitals toward efficiency and equity. Singapore centers its approach on government subsidies and the 3M health insurance system, combined with group management of public hospitals, achieving equitable access and efficient operation of healthcare services. In China, the development of public hospitals follows a clear path of government leadership, with the basic medical insurance system serving as a solid guarantee. A diversified compensation mechanism has been established to ensure their stable operation. In terms of management, active efforts are made to advance the reform of separating management from operation while adhering to the core principle of public welfare orientation.ConclusionsThere are differences among countries in the selection of policy tools and practical effects to support the development of public hospitals, but all demonstrate an ongoing balance between ensuring the supply of basic medical services, enhancing the efficiency of the service system, and addressing structural challenges. China should draw on international experience, taking into account its national conditions, to further strengthen the central government's coordinating role, clarify the boundaries of financial investment, optimize health insurance payment and price formation mechanisms, promote the reform of public hospitals toward legal person status and group management, accelerate digital transformation and the implementation of a tiered diagnosis and treatment system, and build an efficient, equitable, and sustainable development model for public hospitals.

The article considers the theoretical and applied provisions of the use of digital technologies as a factor in improving the process of anti-crisis management of healthcare institutions. The purpose of the article is to improve existing theoretical approaches to anti-crisis management of healthcare institutions based on digitalization tools. The world experience in the direction of digitalization of the healthcare system is studied, the main tasks that digital technologies solve as a tool of anti-crisis management have been identified. It has been noted, that the main problems that characterize the state of the domestic healthcare system are the demographic aging, the spread of chronic diseases among the population, rising costs, the difficulty of providing quality services in conditions of military operations and limited energy supply, and the development of information technologies. The effectiveness of the use of digital technologies in the management of a medical institution and the provision of medical services has been substantiated. It has been noted that digital transformation in the context of anti-crisis management of a medical institution involves a change in the management paradigm, a transition to new management practices, and the introduction of a new system of values within the framework of corporate culture. For the effective use of digitalization in the context of anti-crisis management of a medical institution, the system integration of technologies is important, that is, a set of digital solutions aimed at the implementation of electronic medical records, telemedicine, and digital platforms. The implementation of these changes will provide an opportunity to create a new anti-crisis model of management of a healthcare institution, which will ensure adaptation to the conditions of economic instability.The main digital tools used in the system of anti-crisis management of healthcare institutions have been considered, namely digital platforms, telemedicine and artificial intelligence. In the context of an integrated approach, the development of a roadmap has been proposed to determine specific tools, areas of action and results both at the state level and with the coverage of the relevant transformations of the meso- and micro-levels of the healthcare system.

Telehealth has become a transformative advancement in healthcare delivery, facilitating the remote provision of medical services and broadening healthcare accessibility. This study explores the relationship between e-health literacy, treatment compliance, and telehealth accessibility among users in the United Arab Emirates (UAE). Employing a cross-sectional design, 400 adults from diverse demographic backgrounds were surveyed to assess their telehealth knowledge, treatment adherence, and perceived access to care. Results show significant associations between individual components of e-health literacy, and self-reported treatment compliance and healthcare accessibility. Participants with greater e-health literacy demonstrated significantly higher compliance with remote treatment plans and reported enhanced access to healthcare, particularly among individuals encountering physical or logistical challenges. Of the 199 participants familiar with the definition of telehealth, 167 (83.9%) noted improved compliance with remote treatment plans, while 178 (89.4%) indicated enhanced healthcare access. These results emphasize the critical role of e-health literacy in optimizing telehealth effectiveness and suggest that initiatives aimed at enhancing e-health literacy may further promote positive telehealth outcomes.

Abstract: Emergency medical services (EMS) personnel provide medical care for many low-income and underserved individuals, including people experiencing homelessness (PEH). However, whereas EMS providers report positive explicit attitudes toward PEH, when seeking care, PEH report being the target of discrimination, which may reflect automatic or implicit prejudice that EMS providers hold toward them. To examine if EMS providers hold implicit prejudice toward PEH, 42 certified emergency medical technician (EMT) workers from Southern Arizona completed an Implicit Associations Test (IAT). The results showed a moderate and significant level of implicit prejudice against PEH, with male EMTs reporting significantly higher levels than female EMTs. The results indicate that developing new education and training in implicit bias for EMS providers may improve care for PEH.