Background: Diagnosis-related group (DRG) payment policies are increasingly recognized as crucial instruments for addressing health care overprovision and escalating health care costs. The synthetic control method (SCM) has emerged as a robust tool for evaluating the efficacy of health policies worldwide. Methods: This study focused on Panzhihua city in Sichuan Province, a pilot city for DRG payment reform implementation, serving as the treatment group. In contrast, 20 nonpilot cities within the province were utilized as potential control units. A counterfactual control group was constructed to evaluate the changes in average inpatient stay duration and health care organization costs following the DRG payment reform initiated in 2018. Results: Focusing on Panzhihua, Sichuan Province, the analysis reveals that following the reform in March 2018, the average length of hospital stay in Panzhihua decreased by 1.35 days during 2019– 2021. Additionally, the average cost per hospitalization dropped by 855.48 RMB, the average cost of medication per hospitalization decreased by 68.51 RMB, and the average cost of diagnostic and therapeutic procedures per hospitalization declined by 136.37 RMB. While global evidence backs DRGs for efficiency and cost reduction, challenges persist in addressing emerging issues like new conditions. Conclusion: Since its introduction in 2018, the DRG payment reform in Sichuan Province has effectively reduced both the duration of hospital stays and the operational costs of health care facilities. However, potential drawbacks include compromised service quality and an elevated risk of patient readmission, indicating a need for further refinement in the implementation of DRG payment reforms in China.

HIV remains a critical global public health challenge, with 39 million people living with HIV as of 2022 and over 40.4 million lives lost to the epidemic. In China, the burden is similarly significant, with over 1.33 million HIV cases reported as of 2024. The challenges are particularly acute in western regions like Yunnan Province, which face resource limitations, socio-demographic disparities, and a high prevalence of HIV among ethnic minorities. This study examines the challenges in HIV diagnosis, treatment, and prevention across various institutions in Yunnan Province, including government bodies, hospitals, disease control centers, and primary healthcare institutions. This study aims to identify key challenges in integrating HIV prevention and treatment in China’s border mountainous regions to inform targeted strategies for ethnic minority and impoverished communities. This study adopts a grounded theory approach to explore the systemic, socio-demographic, and cultural barriers impeding the integration of HIV prevention and treatment in M City, a resource-constrained border region in Yunnan Province. From May 2024 to January 2025, a comprehensive review of regional HIV prevention and control literature, alongside relevant World Health Organization (WHO) guidelines, was undertaken to contextualize the research. To capture multi-level insights, semi-structured interviews were conducted between August and December 2024 with 23 purposively selected participants, including individuals living with HIV, village doctors, healthcare providers, and local policymakers. The qualitative data were analyzed through a rigorous three-stage coding process—comprising open coding, axial coding, and selective coding—consistent with grounded theory methodology, to systematically construct and refine conceptual categories underpinning the integration challenges. This study included 23 participants from Yunnan Province. Through three-level coding, three major themes were identified. In HIV prevention, key challenges included patients' inattention to prevention, difficulties for village doctors in home-based screening, and poor enthusiasm for prevention in hospitals. In HIV treatment, difficulties included limited government support, variability in patients' conditions, poor medication adherence, poor quality of village clinic services, challenges for healthcare staff, uncertain effects of Chinese and Western medicine synergy, and unsmooth referral mechanisms. In integration of HIV prevention and treatment, major issues involved low referral rates, loose inter-agency cooperation, and systemic barriers to integration. This study highlights the complex challenges in HIV prevention, treatment, and integration in economically underdeveloped regions, emphasizing the need for improved patient awareness, healthcare system efficiency, and cross-institutional collaboration. Future research should focus on multi-center, longitudinal studies and real-world implementation to refine and scale the integration model for sustainable HIV care in these regions.

Background: This study evaluates the impact of the DRG-based payment reform pilot, initiated in January 2023, in an underdeveloped city in Southwest China. The reform’s implications are particularly relevant for resource-limited settings, where healthcare cost control and service efficiency are critical for improving patient care. Purpose: This study aims to evaluate the impact of this reform on the inpatient service capacity, cost, and efficiency of the Neurology Department in the leading hospital within a county-level medical community. Material and Methods: We conducted a controlled interrupted time series (ITS) analysis using monthly administrative data from January 2021 to June 2024, focusing on inpatients treated in the Neurology Department of M Hospital, A City, Yunnan Province. Eleven outcome indicators were assessed, including Total DRG Weight, Case Mix Index (CMI), Average Length of Stay (ALOS), and Average Inpatient Cost (measured in Renminbi, RMB). A comparable control group was used to strengthen causal inference. Results: Following the DRG reform, the Neurology Department experienced a 32.37% increase in Total DRG Weight, a 12.21% rise in CMI, and an 8.94% increase in the number of DRG groups, while ALOS decreased by 9.85%. The ITS model revealed a significant upward trend in Total DRG Weight (trend change = 2.16, <![CDATA[$P$]]> < 0.01) and a downward trend in ALOS (trend change = – 0.04, <![CDATA[$P$]]> < 0.01). Additionally, the average inpatient cost declined significantly, with a trend reduction of 121.65 RMB per month (<![CDATA[$P$]]> < 0.01). Conclusion: The implementation of DRG-based payment reform in A City was associated with enhanced inpatient service efficiency in the Neurology Department, including improved case complexity management, shorter hospital stays, and reduced costs. However, medical equipment-related expenses remained unaffected, potentially due to increasing patient severity and ongoing technology investments. These findings offer valuable evidence for policymakers aiming to optimize hospital performance through payment system reform in resource-limited settings.

Background: Integrated care for patients living with HIV in rural and economically disadvantaged regions remains a critical challenge. This study aims to develop a 3D evaluation index system to assess the effectiveness of integrated medical care and prevention for patients living with HIV in county-level regions of China. The framework encompasses disease prevention, clinical treatment, and the integration of medical services with public health interventions. Objective: This study aims to develop a scientifically validated, 3D evaluation index system for assessing the effectiveness of integrated medical care and prevention for patients living with HIV in county-level regions of China. Methods: A structured Delphi method will be used to establish consensus among experts on key evaluation indicators. The study will begin with focus group discussions guided by the Valentijn Rainbow Model, followed by multiple rounds of Delphi surveys to refine the indicator system. A total of 75 experts will include clinical professionals, public health specialists, health policy researchers, and representatives from nongovernmental organizations. Experts will participate in iterative rounds, ranking and validating indicators using statistical methods such as the analytic hierarchy process and Kendall W coefficient to assess consensus. Results: The Delphi study was initiated in April 2025, with 3 rounds of questionnaires distributed between May and September 2025. Data analysis is ongoing, and the finalized county-level HIV integration index system is expected to be published by spring 2026. The study is projected to be completed by January 2026. Conclusions: The developed evaluation system will offer a comprehensive and scientifically validated tool for assessing health care outcomes in resource-constrained settings, contributing to policy improvements for HIV service integration in China and other low-resource settings globally.

The global rise in elderly populations and chronic disease patients has increased the demand for hospital-at-home (HaH) services, which could help reduce hospitalization costs. To assess the impact of two policies on the implementation of HaH services in Shanghai. A two-stage interrupted time series (ITS) analysis with a control group was conducted to examine changes in three areas—institutional capacity, home-based medical services, and HaH beds—using 11 indicators from 2007 to –2022 across all community health service centres and hospitals providing HaH services. After the first policy was implemented, the number of institutions providing HaH services significantly increased $${(\beta }_{1}$$ + $${\beta }_{3}+ {\beta }_{5}$$ + $${\beta }_{7}$$ =8.200, $$P$$ <0.001). HaH beds in hospitals increased after the first policy was implemented $$({\beta }_{3}$$ = 247.717 $$,$$ $$P$$ < 0.01) but decreased after the second policy was implemented ( $${\beta }_{1}$$ + $${\beta }_{3}+$$ $${\beta }_{9}$$ = -76.500, $$P$$ < 0.01). In community health service centres (stations), the number of active HaH beds per 10,000 population at year-end (beds/10,000 people) increased significantly after the first policy implementation ( $${\beta }_{1}$$ + $${\beta }_{3}+ {\beta }_{5}$$ + $${\beta }_{7}$$ = 0.406 $$,P$$ < 0.001), with a significant increase in the slope difference compared with hospitals ( $${\beta }_{5}$$ + $${\beta }_{7}$$ =0.429 $$, P$$ < 0.001). These policies may increase the number of HaH institutions and beds but decrease home-based medical visits, likely due to the risks of home care and a shortage of health care personnel. Further policy support is needed to meet the growing demand for home-based services in China.

BACKGROUND Global drug shortages have posed persistent public health challenges, while internet-based drug sales have recently emerged as a promising solution, especially during the COVID-19 pandemic. However, systematic analyses of national-level regulatory policies for online pharmacies regulation remain limited. OBJECTIVE To explore the structure, thematic focuses, and internal consistency of China's national policies regulating online pharmacies. METHODS Two researchers independently retrieved and screened 22 national policies issued by Chinese government agencies by April 1, 2025, based on predefined criteria. Latent Dirichlet Allocation (LDA) was used for topic extraction, and a Policy Modeling Consistency (PMC) Index Model was constructed, incorporating literature review and focus group insights to quantitatively assess policy comprehensiveness and quality. RESULTS First, the issuance of online drug sales regulation policies in China has accelerated significantly between 2016 and 2022. Second, Latent Dirichlet Allocation (LDA) analysis categorized the 22 policies into five major thematic areas: (1) Internet Drug Trading and Health Service Management; (2) Regulation of Illegal Sales and Pharmacy Online Transactions; (3) Integration of Traditional Medicine and Treatment Data; (4) Diagnosis Qualification and Medical Institution Accreditation; and (5) Healthcare Personnel Management and Institutional Development. Third, a PMC evaluation framework was constructed, encompassing 10 primary variables and 43 secondary indicators, covering dimensions such as Policy Nature, Timeliness, Issuing Agency, Incentives and Constraints, Policy Content, and Stakeholder Protection. Fourth, the average PMC Index score was 5.04, classifying the policies as “acceptable,” with individual scores ranging from 2.45 to 6.93. Strengths were identified in regulating online drug transactions, curbing counterfeit drug incidents, enhancing traceability and recall mechanisms, protecting consumer rights, and promoting compliant online pharmacies. However, deficiencies were notable in Policy Nature, Timeliness, and Issuing Agency dimensions. CONCLUSIONS While China’s regulatory efforts in internet-based drug sales have advanced, critical gaps persist. Strengthening oversight of drug circulation and storage in online transactions and mitigating risks from prescription-free drug purchases remain urgent priorities. Future policy refinements could benefit from international best practices, such as Germany’s rigorous online prescription verification systems. CLINICALTRIAL None