As the acceleration of urbanization and population aging in China, the prevalence of various chronic diseases among residents is increasing, the prevention and control of various chronic diseases in the medical care and public health fields are becoming more and more severe. As one of the important treatment modalities, physical activity referral schemes (PARS) have achieved remarkable results in the prevention and treatment of chronic diseases abroad, among which PARS in Australia has become a model for "treatment + co-treatment". This study overviews the formation and development of PARS in Australia comprehensively, summarizes and analyzes its implementation experience. It is recommended to build a sharing and interaction mechanism of general practice and sports co-treatment in China in the context of the current development situation of medical care and sports rehabilitation in China from the following aspects: building a referral structure with general practice as the core, promoting the synergistic governance of general practice and sports co-treatment; improving the personnel training system of general practice and exercise physiology, accelerating the training of medical exercise and health coaches; promoting the innovation of the service system, accelerating the construction of scientific process of general practice and sports co-treatment; exerting the advantages of the Internet vigorously to build a data and information platform of general practice and sports co-treatment.
General practitioners are medical personnel with high integrated degree, and are the "gatekeepers" of residents' health. Violent incidents affecting health care not only seriously harm the the physical and psychological health of general practitioners, also affect the quality and level of basic medical services, which increases the turnover of general practitioners and the economic burden on the health care system. Previous studies have shown that more than half of general practitioners had experienced workplace violence, with the most common types including verbal violence and threats, followed by physical violence, sexual harassment and assault, patients and their family members were the main perpetrators. The failure of the medical services quality to meet the demands of patients, alcohol abuse, drug abuse and mental disorders of perpetrators, poor physician-patient communication were important factors associated with workplace violence. It is suggested to improve policies and regulations, norms of conduct related to workplace violence of healthcare workers, establish and improve the reporting and punishment mechanisms, enhance the capacity of healthcare workers and health care institutions to provide medical services and prevent workplace violence, give proper play to the role of the public media, promote the establishment of "zero-tolerance" system for violence.
In China, the performance appraisal system measuring the performance in delivering essential public health services and medical services, and the patient payment system for these services in primary health institutions are still imperfect. The UK Quality and Outcomes Framework (QOF) has been modified many times, and the latest version (2021—2022) places more emphasis on chronic disease prevention and control and the quality of disease management. We introduced the UK QOF, involving its management and operation system, modification process of the indicators, and the indicator composition, scoring rules and performance management of its latest version, particularly detailed the design and operation of its latest version, and summarized the following insights: the UK QOF is a result-oriented quality control system and a reward-oriented incentive mechanism, which focuses on the management of major chronic diseases and their risk factors. Through the establishment of a three-level management system for each major disease, with defined scores and corresponding payment for the indicators, the general practices obtain the payment according to their service quality, thereby increasing the efficiency of the healthcare system in the UK as a whole. The design and operation of the UK QOF will contribute to the improvement of China's national essential public health service specifications and performance assessment systems as well as payment methods for chronic disease outpatient management services in primary care, which in turn boosts the appropriate allocation of the fund for essential public health services and the basic medical insurance fund generally.
China is facing both the rapid growth of medical expenses and challenge of quality care. Paying for quality for healthcare providers used by international healthcare systems has proven to be effective in solving the problems. We systematically reviewed the UK Quality and Outcomes Framework (QOF) , a typical case of paying for quality, with a description of its content, effectiveness of implementation and future prospect, which may have implications for China's healthcare payment system. We analyzed the applicable feasibility of paying for quality in China's healthcare payment system using the policy analytical framework in accordance with China's political, technological, economic and administrative conditions, and suggested that paying for quality may have a good application prospect but with limitations for fully implementation. In the future, it could be first used as a payment method for chronic disease outpatient care or Chinese medicine services as a pilot program, and integrated into the multiple composite medical insurance payment system, and applied to other fields exploratorily.
Cuba's Community Health Services：Introduction and Implications to China
Cuba has a three-level healthcare system, and offers free universal healthcare, of which community health services occupy a decisive position. Cuba has accumulated abundant experience in implementing public health services, primary healthcare, and general practitioner training. China has gained fruitful achievements in decades of developing primary healthcare, but there is still much room for development. We introduced Cuba's development and current status of healthcare system, implementation of community health services and general practitioner trainings, as well as community-based measures taken for chronic disease management and infectious disease prevention and control, and compared theses aspects with relevant information of China, offering insights into further development of community health services in China.
The Development Status of Community Health Management in Japan and Its Enlightenment to China
Community health management is an important element in promoting the Health China initiative and health promotion. As the world's longest-living country, Japan's community health management has become increasingly mature. This paper briefly reviews the development of community health management in Japan under the guidance of the National Health Strategy, compares the assessment framework of its community health management, and summarizes its specific actions in three areas: health check-ups and cancer screening, lifestyle and behavioral interventions and health management of key populations, and proposes inspirations for Japan's community health management for China based on its successful experience.
