Level Of Medical Technology Research Articles

Choosing health facilities and impact factors of the choice in context of tiered medical system: A questionnaire survey of opinions of patients with multi-morbidity

BackgroundIn recent years, there has been limited research in China on the behavior of patients with multi-morbidity in choosing healthcare facilities under tiered medical system. Exploring the pattern of their choice will inform to better policy practice. ObjectiveThis study aims to analyze the behavior of patients with multi-morbidity in choosing healthcare facilities in context of tiered medical system, and its influencing factors. This will provide a reference for further implementing the tiered medical system and the rational allocation of medical resources. MethodsUsing a random sampling method, we selected patients with multi-morbidity who attended from June 1, 2019, to January 1, 2020, at the Shanghai Yangpu District Central Hospital Regional Medical Group, which includes Shanghai Yangpu District Central Hospital and three community health centers (Dinghai, Yanji, and Changbai). A self-designed questionnaire was used to collect general data from patients with multi-morbidity, to understand their awareness and actual compliance with the tiered medical system policy, their willingness to first visit community health centers under different disease control conditions, and the factors they consider when choosing healthcare facilities. Binary logistic regression was used to analyze the factors influencing the decision of patients with multi-morbidity to choose community health center for their initial consultation. ResultsA total of 1,100 questionnaires were distributed, and 1,072 valid questionnaires were completed, with a response rate of 97.45 %. Of the 1,072 participants with multi-morbidity, 912 (85.07 %) were aged above 60 years old; 624 participants (58.21 %) were aware of the tiered medical system; 940 participants (87.69 %) were willing to follow the design of medical treatment process under tiered medical system; 368 participants (34.33 %) were very familiar with the “1+1+1” (patients can choose one community health centre, one district hospital and one city hospital as preferred medical facilities, so called ‘1+1+1’ preference) combination contract project; 964 participants (89.93 %) had participated in the “1+1+1” combination contract project, but among these, 44 participants (4.56 %) chose non-contract medical facilities for their current medical treatment. 86.57 % (928/1072) patients with stable multiple conditions and 85.82 % (920/1072) patients with mild poorly controlled conditions choose community health centre as their first preferred medical provider. The factors considered by participants with multi-morbidity when choosing healthcare facilities were ranked by average score as follows: medical accessibility (5.50), medical technology level (5.13), patient satisfaction (3.74), medical insurance (3.60), medical expenses (2.93), and other factors (2.24). Binary logistic regression analysis showed that age and medical insurance were significant influencing factors in the decision to choose community health center for their initial consultation (P<0.05). ConclusionOlder adults are the most affected group by multi-morbidity and the main group choosing community health centre as their preferred medical service providers. Compared to regional medical centers, community health center has higher accessibility, which is a favorable factor for achieving first consultations in primary care for patients with multi-morbidity. Therefore, accelerating the construction of regional medical group, promoting the sharing and applying of high-quality resources in primary care, and improving the service quality and capacity of primary care facilities are beneficial for achieving the first consultations in primary care advocated by tiered medical system.

Middle-aged and older people’s preference for medical-elderly care integrated institutions in China: a discrete choice experiment study

BackgroundWith the continuing impact of the aging population, medical-elderly care integrated institutions, as a way to bear the pressure of medical and elderly care, effectively ensure the quality of life of the elderly in their later years.ObjectivesTo explore the preferences of medical-elderly care integrated institutions among Chinese middle-aged and older people and to provide a reference for establishing elderly-oriented development of medical-elderly care integrated institutions.MethodsIn this study, a discrete choice experiment (DCE) was used to investigate the preferences of people aged 45 years and older in medical-elderly care integrated institutions in China from October 20, 2022, to November 10, 2022. A mixed logit regression model was used to analyze the DCE data. Participants’ willingness to pay for each attribute was also calculated.ResultsData from 420 participants who provided valid responses were included in the analysis. In terms of the choice preference, moderate service quality (vs. poor service quality: β = 1.707, p < 0.001, 95% CI 1.343 ~ 2.071) and high medical technology level (vs. low medical technology level: β = 1.535, p < 0.001, 95% CI 1.240 ~ 1.830) were the most important attributes to middle-aged and older people, followed by monthly cost, environmental facilities, the convenience of transportation, and entertainment activities. Regarding the willingness to pay, participants were more willing to pay for service quality and medical technology level than for other attributes. They were willing to pay $3156 and $2838 more for “poor service quality” and “low medical technology level,” respectively, to receive “moderate service quality " (p = 0.007, 95% CI 963 ~ 5349) and “high medical technology level” (p = 0.005, 95% CI 852 ~ 4824).ConclusionsThe state should attach great importance to the development of medical-elderly care integrated services industry, actively optimize the model of the medical-elderly care integrated service, improve the facilities, and create a healthy environment. At the same time, give full play to the role of medical insurance, long-term care insurance, and commercial insurance, so as to improve the comprehensive quality of life of the elderly.Public contributionThe design of the experimental selection was guided by 10 experts in the field, 5 Chinese government officials, and interviews and focus group discussions, without whose participation this study would not have been possible.

베트남 의료관광 수요 결정요인에 관한 연구

Purpose – The purpose of this study is to identify the predictive factors of medical tourism in Vietnam by analyzing the variables that lead to the annual visitor number. Design/methodology/approach – This study collected data from Vietnamese with experience in domestic and international medical tourism, and focused on Hanoi, Vietnam. In this study, the variable of medical tourism preferences was applied independently. Factors that impacted the number of annual visitors were estimated by the truncated Poisson model. Findings – The results of the TP model analysis of demand for medical tourism are as follows. Among the variables related to socio-economic characteristics, age, marital status, and occupation had a significantly positive effect on the number of annual medical visits. These results imply that it is important to understand socio-economic characteristics to expand demand for medical tourism in Vietnam, which shows high growth potential. The top three variables that gave a significant positive effect on the number of annual medical visitors are the level of medical technology, waiting time, and price, as well as medical service experience. Research implications – The results indicate the need to develop medical tourism products tailored to consumer tastes by subdividing medical technology levels, waiting for time and price, medical experience services, and so on. Thus, the results presented by this study create a starting point for the development of demand forecasting models for the domestic, international, and Vietnamese medical tourism markets in the future.

The Role of Information in Management of Modern Hospital: Experience of Medical Reform in Shenmu, China

Objective: The objective of this review is to explore the role of information technology in the construction and management of modern hospitals, and how to use information technology to promote the development and management of hospitals.&#x0D; Methods: The relevant medical information and data at home and abroad were collected from the Internet, and the actual situation of the hospital, the diagnosis, treatment and management of outpatients were compared and analyzed to compare the role of medical information in hospital development.&#x0D; Results: After the effective implementation of medical information in the hospital, the technical level and efficiency of diagnosis, treatment and management technology in the hospital were obviously improved, so that patients could see a doctor more conveniently, and doctors and nurses could have a higher level of diagnosis and treatment.&#x0D; Conclusions: The use of medical information can significantly improve the overall management level of the hospital, make it more convenient for patients to see a doctor, and improve the construction and management of modern hospitals, which is of great significance to the improvement of the level of medical technology.

Influence of the Integrated Delivery System on the Medical Serviceability of Primary Hospitals

Objective To explore the change in the medical serviceability of primary hospitals since the establishment of the Huzhou No. 1 People's Hospital medical care group incorporating the integrated delivery system. Methods With reference to the “Grade Evaluation Standard of General Hospitals in Zhejiang Province” and the “Guidelines for Service Capacity Evaluation of Township Hospitals (2019 Edition),” we analyzed the influence of the integrated delivery system on the capacity of primary medical services and selected the targeted core indicators. From the four dimensions of diagnosis and treatment breadth, diagnosis and treatment efficiency, surgical ability, and patient satisfaction, an index evaluation system was established to explore the changes in the medical serviceability in primary hospitals. Results The measurements were aimed at four specific issues, that is, the low medical technology level of grassroots personnel, the poor information communication among medical institutions, the difficulty in recruiting people, and the imperfect training mechanism in primary hospitals. After establishing a series of measurements related to the problems faced by the primary healthcare sector in China, the score of breadth of diagnosis and treatment, efficiency of diagnosis and treatment ability, surgical ability, and patient satisfaction of the primary hospitals in our medical group have greatly increased. Conclusion The integrated delivery system improved the primary hospitals' medical health ability obviously. Our study also provides various useful and operable suggestions for primary healthcare.

The Landscape of Hospital Competition for Technology Adoption: A New Medical Arms Race

The objective of our study is to explore the dual influences of market competition and the prevalence of technology in the market on a hospital’s level of medical technology. Following the core tenets of contingency theory and institutional theory, we hypothesized a positive influence of both the increasing level of hospital competition in the market and the peer hospital’s level of technology in the market on the hospital’s greater level of medical technology. With a multilevel modeling with random effects, we analyzed 13,217 general acute care hospitals in the U.S. between the years 2012-2018, which exclude critical access hospitals and federally-governed hospitals. We expect this paper can help administrators and policymakers balance between the costs and potential benefits of technology utilization for better health outcomes. The findings of our study indicate that a hospital’s medical technology level corresponds not only to competitiveness in the market but also to its competitor’s behaviors with respect to instituting advanced medical technology. It is surprising that hospitals tend to be less responsive to the market or societal needs. We suggest that health care managers need to be more attentive to societal needs when making investment decisions. Health policymakers may take hospitals’ lack of social responsiveness into consideration in order to guide them toward adequate and appropriate medical technology adoption strategies that may increase social welfare, assure quality, and establish a safer healthcare environment.

RETRACTED ARTICLE: Application of wireless sensor network in remote medical monitoring system

In today's social development system, people have begun to pursue more and more physical health and quality of life materials under the wave of economic development. In people's daily work and study life, medical and health care services are an important part of people's physical health. People need to ensure their physical and mental health to improve their quality of life. In many areas, the development level of medical technology is not very high, but information technology and computer network technology have brought people a new development model. The development of telemedicine has solved the problem of backward medical technology in remote areas and created more for people. Safe medical environment. In the context of the development of the new era, the development of wireless sensor technology has gradually enriched the construction of the telemedicine system. This article analyzes the relevant principles of wireless sensor network connection to study and design a system that can realize remote medical control and monitoring. To design a new medical monitoring system, you need to apply sensor technology and wireless sensor network technology. This article studies the specific conditions of these two technologies, and confirms the reliability of the new system in daily life through actual analysis.

Effective Analysis of Inpatient Satisfaction: The Random Forest Algorithm.

PurposeTo identify the factors influencing inpatient satisfaction by fitting the optimal discriminant model.Patients and MethodsA cross-sectional survey of inpatient satisfaction was conducted with 3888 patients in 16 large public hospitals in Zhejiang Province. Independent variables were screened by single-factor analysis, and the importance of all variables was comprehensively evaluated. The relationship between patients’ overall satisfaction and influencing factors was established, the relative risk was evaluated by marginal benefit, and the optimal model was fitted using the receiver operating characteristic curve.ResultsPatients’ overall satisfaction was 79.73%. The five most influential factors on inpatient satisfaction, in this order, were: patients’ right to know, timely nursing response, satisfaction with medical staff service, integrity of medical staff, and accuracy of diagnosis. The prediction accuracy of the random forest model was higher than that of the multiple logistic regression and naive Bayesian models.ConclusionInpatient satisfaction is related to healthcare quality, diagnosis, and treatment process. Rapid identification and active improvement of the factors affecting patient satisfaction can reduce public hospital operating costs and improve patient experiences and the efficiency of health resource allocation. Public hospitals should strengthen the exchange of medical information between doctors and patients, shorten waiting time, and improve the level of medical technology, service attitude, and transparency of information disclosure.

Clinical Study on Electronic Medical Neuroelectric Stimulation Based on the Internet of Things to Treat Epilepsy Patients with Anxiety and Depression.

With the continuous development and improvement of the level of medical technology in our country in recent years, the treatment of epilepsy has been constantly updated and developed. Nerve electrical stimulation is considered to be a very effective method for treating epilepsy with anxiety and depression. There are many traditional methods for the treatment of epilepsy. For example, vagus nerve stimulation (VNS) has been applied earlier, and the therapeutic effect has been confirmed, but it will cause serious complications and is easier to be uncomfortable; deep brain stimulation for epilepsy is still in the immature stage, and there is no final conclusion. Therefore, this article proposes a clinical study on the treatment of patients with epilepsy with anxiety and depression based on the electronic medical nerve stimulation of the Internet of Things. First of all, this article uses the literature method to study the causes of epilepsy and previous treatment methods. Then, we designed an experimental study of epilepsy with depression based on the Internet of Things electronic medical neuroelectric stimulation therapy and selected the core quality of life questionnaire, SDS, and SAS as observation indicators. Finally, the comparison of epilepsy symptoms and depression and anxiety between the control group and the observation group before and after treatment was analyzed. The results of the experiment showed that, among the 50 subjects in the study, the observation group that used electrical nerve stimulation therapy had 5 people who stopped seizures after treatment, accounting for 10%, while in the control group of traditional drug treatment methods, after treatment, only one person stopped the seizure, accounting for 2%. In addition, the SAS and SDS scores of the observation group were also lower than those of the control group. Therefore, the use of nerve electrical stimulation to treat epilepsy with anxiety and depression symptoms has better performance and can help patients recover as soon as possible.

Medical Equipment Comprehensive Management System Based on Cloud Computing and Internet of Things.

The continuous progress in modern medicine is not only the level of medical technology, but also various high-tech medical auxiliary equipment. With the rapid development of hospital information construction, medical equipment plays a very important role in the diagnosis, treatment, and prognosis observation of the disease. However, the continuous growth of the types and quantity of medical equipment has caused considerable difficulties in the management of hospital equipment. In order to improve the efficiency of medical equipment management in hospital, based on cloud computing and the Internet of Things, this paper develops a comprehensive management system of medical equipment and uses the improved particle swarm optimization algorithm and chicken swarm algorithm to help the system reasonably achieve dynamic task scheduling. The purpose of this paper is to develop a comprehensive intelligent management system to master the procurement, maintenance, and use of all medical equipment in the hospital, so as to maximize the scientific management of medical equipment in the hospital. Scientific Management. It is very necessary to develop a preventive maintenance plan for medical equipment. From the experimental data, it can be seen that when the system simultaneously accesses 100 simulated users online, the corresponding time for submitting the equipment maintenance application form is 1228 ms, and the accuracy rate is 99.8%. When there are 1000 simulated online users, the corresponding time for submitting the equipment maintenance application form is 5123 ms, and the correct rate is 99.4%. On the whole, the medical equipment management information system has excellent performance in stress testing. It not only predicts the initial performance requirements, but also provides a large amount of data support for equipment management and maintenance.

Nursing Graduates and Quality of Acute Hospital Care in 33 OECD Countries: Evidence From Generalized Linear Models and Data Envelopment Analysis.

BackgroundThere is a lack of cross-national research to examine the role of new graduate nurses in improving the quality of nursing care and patient outcomes.PurposeTo measure the role and clinical effectiveness of new graduate nurses in improving the quality of acute hospital care in the members of Organisation for Economic Co-operation and Development (OECD).MethodsThe total number of nursing graduates per 100,000 population and three OECD’s Health Care Quality Indicators (HCQI) in acute care including 30-day in-hospital and out-of-hospital mortality rates per 100 patients based on acute myocardial infarction (MORTAMIO), hemorrhagic stroke (MORTHSTO) and ischemic stroke (MORTISTO) were collected in 33 OECD countries. Four control variables including the number of medical graduates, practicing nurses and doctors densities per 1000 population (proxies for other health professions) and the total number of Computed Tomography scanners per one million population (proxy of medical technology level) were added in investigations. The statistical technique of Generalized Linear Models (GLM) and Data Envelopment Analysis (DEA) were used in data analysis.ResultsResults of GLM confirm the existence of meaningful association between the density of nursing graduates and improving the quality of acute care i.e. a 1% rise in the number of nursing graduates in year 2015 reduced MORTAMIO, MORTHSTO and MORTISTO by 1.11%, 0.08% and 0.46%, respectively. According to the result of DEA, clinical effectiveness of new graduate nurses – i.e. reaching the higher clinical outcomes with the same staffing level – in reducing mortality rates in patients with life-threatening conditions were at highest level in Luxembourg, Finland, Japan, Italy, Norway, Sweden and Switzerland.ConclusionsHigher staffing level of new graduate nurses associates with better patient outcomes in acute care, although the clinical effectiveness of nursing graduates – associated with the level of education and practice – is the determinant factor of improving the quality of acute hospital care and patient survival rates in OECD.

Recreational potential of medical tourism of Russia

Since January 1, 2019, the Russian Federation has entered the global medical tourism market thanks to the approved federal project "Development of the export of medical services". The level of attractiveness of a country as a global destination for medical tourists is determined by a number of factors: the level of medical technology, transport accessibility, proximity to donor countries of foreign patients; the level of realization of export potential, international reputation, medical marketing; the level of healthcare organization, international staff training, etc. Among the factors determining the success of the country as the destination of medical tourism, a special place is held by the recreational complex, spa treatment. The level of development of the recreational complex within the framework of medical tourism performs several tasks at once: it provides a full cycle of medical assistance to foreign medical tourists - from outpatient admissions and in-patient treatment to rehabilitation and recovery; sanatorium-resort treatment and rehabilitation are considered not only as an integral part of the complex of medical services, but also as an independent promising direction for the export of medical services by domestic health resorts. Also, the fight against the consequences of COVID-19, when hundreds of thousands of neighboring states citizens need qualified rehabilitation, can become a driver for the development of the sanatorium-resort complex of Russia. The purpose of the study is to identify bottlenecks in the development strategy of the recreational potential of the regions of the Russian Federation and make suggestions for its improvement. The number of foreign patients who received medical care from January to May 2020 in the federal districts is 729,000. This indicator was achieved during the pandemic, and therefore does not reflect the true potential of rehabilitation as an element of the full cycle of medical care for foreign patients. The target audience for rehabilitation programs is up to 100,000 foreign patients.

Analysis of the effect of serious illness medical insurance on relieving the economic burden of rural residents in China: a case study in Jinzhai County

BackgroundIn 2003, China established a New Rural Cooperative Medical System (NRCMS) for rural residents to alleviate the burden of medical expenses among rural residents. However, its reimbursement for high medical costs was insufficient. Therefore, China gradually established the Serious Illness Insurance System (SIMIS) based on NRCMS. After receiving payment through NRCMS, patients in rural areas who met the requirements of SIMIS policy would receive a second payment for their high medical expenses. This study aimed to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County.MethodsThe study used the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province, from 2013 to 2016. We adopted descriptive and regression discontinuity (RD) methods to analyze the payment effect of SIMIS. The RD analysis targeted patients (n = 7353) whose annual serious illness expenses were between CNY 10,000 (1414 USD) and CNY 30,000 (4242 USD), whereas the descriptive analysis was used for data of the patients compensated by SIMIS (n = 2720).ResultsThe results of RD showed that the actual medical insurance payment proportion increased by about 2.5% (lwald = 0.025, P < 0.01), inside medical insurance self-payment proportion increased by about 2% (lwald = 0.020, P < 0.10), and outside medical insurance self-payment proportion decreased by about 1.6% (lwald = − 0.016, P < 0.05). The descriptive results showed that patients with serious illnesses mostly chose to go to a hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out-of-pocket medical expenses were still high.ConclusionThe medical technology level of Jinzhai County could not meet the needs of patients with seriously illnesses, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of the rural residents was insufficient. The high out-of-pocket expenses increased the possibility that only people with good economic conditions could benefit from the reimbursement of SIMIS, resulting in inequity.

Design and Implementation of High-Throughput Magnetic Separation Module for Automated Nucleic Acid Detection System Based on Magnetic Nano-Beads.

With the higher and higher application level of medical technology, more and more genetic diseases have been diagnosed. Nucleic acid, as an important genetic material, has been found to have important functions in the storage and transmission of the genetic information in the replication and synthesis of proteins. As the first step in nucleic acid detection experiments, nucleic acid extraction performance is associated with the purity of target nucleic acid samples, which is very important for the downstream steps. In this paper, we employed the magnetic bead for extracting nucleic acids based on the platform of large liquid handling workstation and designed a matching magnetic separation module. It was shown that the temperature control block designed in this paper has reliable stability, high accuracy by using the incremental PID algorithm, with the control accuracy up to ±0.5 °C, and the control stabilization time is about 90 s, which can satisfy the experimental requirements. Besides, the average magnetic bead transfer rate of this module was further verified by mimicking the manual magnetic bead nucleic acid extraction process. The results proved that the module has an excellent performance with the average magnetic bead transfer rate greater than 95% and the magnetic bead transfer rate in each well greater than 90%, which could be consistent with the experimental indictors of nucleic acid extraction.

Product design and development of googles and hand stick for blind people

Project vision to world focuses on the field of medical science, which paves a way to the next level of medical technology. The theme of the vision to world is to bring back the vision to the blind people, with the help of this gadget. It is a blind helper device. The Gadget is engaged with UV emitter and receiver, sound senor, LED, circuit board, spectacles. It can be used by all kinds of people. It doesn’t need much knowledge. The device works by detecting the signals outdoor through the UV signals and that signals were converted into electric signals through which the sound and light signals were produced. The sound signal is used as an indicator to the blind and the light signal is used as an indicator to the normal people. It creates a mutual understanding with the blind and the normal people. This helps to rectify the visual problem of blind people. The gadget is in the shape of normal spectacles so it would be easier to carry everywhere. The origin of this device is bionic eye; the concept of bionic eye is to fix an electrode in the eyes. But in order to rectify that this project vision plays a major role in serving blind. The main objective is to give vision to the blind with artificial means without any side effects.

Physicians\u2019 brain drain - a gravity model of migration flows

BackgroundThe past two decades have been marked by impressive growth in the migration of medical doctors. The medical profession is among the most mobile of highly skilled professions, particularly in Europe, and is also the sector that experiences the most serious labour shortages. However, surprisingly little is known about how medical doctors choose their destinations. In addition, the literature is scarce on the factors determining the sharp rise in the migration of doctors from Africa, Asia and Eastern and Southeastern Europe, and how the last economic crisis has shaped the migration flows of health professionals.MethodsWe use the new module on health worker migration provided by the Organisation for Economic Co-operation and Development (OECD) for 2000–2016 in order to examine the channels through which OECD countries attract foreign physicians from abroad. We estimate a gravity model using the Pseudo-Poisson Maximum Likelihood estimator.ResultsOur results reveal that a lower unemployment rate, good remuneration of physicians, an aging population, and a high level of medical technology at the destination are among the main drivers of physicians’ brain drain. Furthermore, an analysis of the mobility of medical doctors from a number of regions worldwide shows that individuals react differently on a country-wise basis to various determinants present in the destination countries. Physicians from African countries are particularly attracted to destination countries offering higher wages, and to those where the density of medical doctors is relatively low. Concurrently, a higher demand for healthcare services and better medical technology in the receiving country drives the inflow of medical doctors from Central and Eastern Europe, while Asian doctors seem to preferentially migrate to countries with better school systems.ConclusionsThis study contributes to a deeper understanding of the channels through which OECD countries attract foreign medical doctors from abroad. We find that, apart from dyadic factors, a lower unemployment rate, good remuneration of physicians, an aging population, and good medical infrastructure in the host country are among the main drivers of physicians’ brain drain. Furthermore, we find that utility from migration to specific countries may be explained by the heterogeneity of origin countries.

An Analysis of the Causes of Low Cataract Surgical Rate

In this paper, the phenomenon of cataract in the elderly without surgery is investigated and analyzed, and the causes are analyzed and counted through questionnaire, field trip, hospital interview and other methods. The three reasons of low operation rate are economic condition, awareness towards the disease and medical technology level. The solutions and suggestions are presented. It is of great significance to improve the health level and life happiness index of the elderly.

Access to health care, medical progress and the emergence of the longevity gap: A general equilibrium analysis

We study skill- and income-related differences in the access to health care as drivers of longevity inequality from a theoretical life-cycle as well as from a macroeconomic perspective. To do so, we develop an overlapping generations model populated by heterogeneous agents subject to endogenous mortality. We model two groups of individuals for whom differences in skills translate into differences in income and in the ability to use medical technology effectively in curbing mortality. We derive the skill- and age-specific individual demand for health care based on the value of life, the level of medical technology and the market prices. Calibrating the model to the development of the US economy and the longevity gap between the skilled and unskilled, we study the impact of rising effectiveness of medical care in improving individual health and examine how disparities in health care utilisation and mortality emerge as a consequence. In so doing, we explore the role of skill-biased earnings growth, skill-bias in the ability to access state-of-the art health care and to use it effectively, and skill-related differences in health insurance coverage. We pay attention to the macroeconomic feedback, especially to medical price inflation. Our findings indicate that skill-bias related to the effectiveness of health care explains a large part of the increase in the longevity with earnings-related differences in the utilisation of health care taking second place. Both channels tend to be reinforced by medical progress.

Never form the same interests and goals of all parties? How to make the integrated medical reform really promote people's health: a case study of Anhui

Since 2009, China is carrying out a new round of medical and health system reform, the ultimate goal is to reduce the economic burden of patients, promote the health of residents. However, there are still serious conflicts of interest between medical institutions, medical insurance and patients in the past eight years. Most local governments rely on administrative measure to reform, medical institutions are in a passive position, do not pay attention to the economic burden and health of patients, the reform is not sustainable. This study investigates the new experiment in Anhui Province that is expected to solve the problem of administration and fragmentation of the service system by promoting the reform of the county medical service alliance. The targeted population of the reform are government administrators, hospital administrators, medical staff and rural and remote residents. Through the medical insurance payment with global budget according to regional population, the policy can form the community of interests and responsibility of the county medical service alliance. Medicare department funds fund to the leader hospital of the alliance, the county hospital and the rural hospitals can improve population health, promote patients to the rural areas, increase the balance of health care fund by the police of health promotion and prevention with the family doctors contract service, the county hospitals with counterpart assistance and so on. Anhui Province uses the way of county medical service alliance and payment reform to adjust the interests of the main relationship through the operation of medical insurance funds, by other factors less affected, so the reform has good transferability. Through the integration of the nearly two years, the relationship of the county and township medical institutions is more closely, the medical technology level of the primary medical institutions has been improved obviously. The health consciousness and health level of the rural and remote residents have been improved. The residents gradually choose to be first diagnosed at the primary medical institutions, the economic burden of the residents' diseases is reduced, the function of the rural doctors has changed and they become more concerned about the importance of basic medical care, meanwhile the policy enhances the enthusiasm of rural doctor.

Practice and Development of the New Round Talent Cultivation held by Qingpu Health System

In order to further deepen the reform of public hospitals, to improve the qualified personnel training in Qingpu, and to enhance the overall level of medical health development, Qingpu Municipal Commission of Health and Family Planning In October 2011, a new round of disciplinary construction and personnel training project was also started. Moreover, financial support has been provided to the project. By assessing the whole process, not only has the level of discipline personnel training and medical technology shown significant improvement, the tutors who provided the training also express academic interest and have new a vision for talent cultivation.Qingpu Municipal Commission of Health and Family Planning launched a new round of comprehensive program on researcher training and disciplinary construction in 2011, aimed to further deepen the reform of public hospitals, improve the capacity of health research in Qingpu, Shanghai. We have assessed this program and found that this program has significantly improved the quality of training, and medical technology level in those hospitals; in addition, trainees has shown the increase in the interesting in conducting research and raised vision and prospects. Key words: health; personnel training; visioning