Regulated multi-sited practice for physicians in China: incentives and barriers

The multi-sited practices (MSP) policy in China is expected to exert found implications upon uneven distribution of high-quality medical resources,coupled with the widespread phenomenon of physician's informal practices on multiple sites.Since 2009,the Chinese government has upheld a policy that allows medical doctors to take on secondary jobs for the purpose of encouraging talented physicians to work in medical institutions and underdeveloped areas where their expertise is badly needed.This paper focuses on the MSP policy in China by examining how it has been implemented at the national and provincial levels through a review of government documents,statistical information,academic papers,and newspaper accounts.Despite the MSP policy is to offer incentive to physicians at first-tier public hospitals to work in primary care centers or areas where their expertise,the evidence is hard to find.This paper identifies several outstanding challenges to the MSP policy:(1) The importance of the MSP policy which is made by the central government is perceived differently at the provincial level by health officials and hospital administrators;(2) Interest in implementing the policy varies among physicians and hospitals;(3) Concerns about quality control and legal responsibilities for medical doctors to take on secondary jobs are widespread.China's MSP policy differs from the 'dual practice' policy in many countries because of its top-down approach,with its emphasis on government's role and administrative intervention.This paper's findings may be useful for other developing countries where medical expertise is unevenly distributed due to market forces.On the special occasion of the Alma Ata Declaration's 40th anniversary and for the sake of promoting Universal Health Coverage,this paper also aims at sharing with other countries China's experience in trying to develop an adequate force of primary care professionals.At the end of this paper,a four-point proposal is made for policy makers in China.

Effect of Honghua (Flos Carthami) on nitric oxide production in RAW 264.7 cells and α-glucosidase activity

OBJECTIVE： To study the effects of extracts from Honghua （Flos Carthaml~ on lipopolysaccharide in- duced nitric oxide （NO） production in RAW 264.7 cells and the influence of the extracts on yeast a-glucosidase activity. The total flavonoid content of the extracts was also determined. METHODS： Cytotoxicity of the extracts to RAW 264.7 cells was evaluated by the ATPliteTM method. Inhibitory effects of the extracts on NO production were evaluated by Griess assay. Curcumin was used as a positive control. Screening of extracts for po- tential a-glucosidase inhibitors was done by a fiuo- rometric assay. The assay was based on the hydroly- sis of 4-methylumbelliferyl-a-D-glucopyranoside toform the fluorescent product, 4-methylumbellifer- one. Acarbose was used as a positive control. The total t3avonoid content was tested using kaempfer- ol as the standard. RESULTS： There were significant inhibitory effects on NO production when the extracts were 25-100 μg/ mL （P〈0.05） and curcumin was 2-4 μg/mL （P〈 0.001）. The extracts showed an inhibitory effect on a-glucosidase activity at the concentrations of 15.6-125 μg/mL with a half maximal （50%）inhibito- ry concentration （ICs0） of （32.8± 5.7） μg/mL, com- pared with the ICs0 of acarbose at （1.8±0.4） μg/mL. There was a significant difference between the two IC50 values （P〈0.001）. The total content of flavo- noids per gram of dried herb was 1.14 mg. CONCLUSION： Honghua （Flos Carthami） showed in- hibitory effects on NO production in activated RAW 264.7 macrophage cells and an inhibitory effect on yeast a-glucosidase. There might be a relationship between these pharmacological effects and its fla- vonoid content.