Inflammation is associated with metabolic alterations that can lead to the release of volatile organic compounds (VOCs) reflecting cellular biochemical activity. Profiling these volatile metabolites may provide insight into cellular responses to inflammatory stimuli, although their characterization in skin-derived cells remains limited. In this exploratory proof-of-concept study, we investigated the volatile metabolite profiles of human skin fibroblasts exposed to different inflammatory stimuli. Fibroblast cell lines were stimulated with polyinosinic:polycytidylic acid (Poly I:C), tumor necrosis factor-alpha (TNF-α), and lipopolysaccharide (LPS) to model viral-, cytokine-, and bacterial-associated stress conditions. Headspace solid-phase microextraction coupled with comprehensive two-dimensional gas chromatography and time-of-flight mass spectrometry (HS-SPME-GC×GC-TOFMS) was applied to analyze volatile metabolites released from the cell cultures, enabling exploratory profiling of the fibroblast volatilome. A data-processing workflow including pairwise comparisons between experimental groups and statistical filtering was implemented to identify volatile features associated with the different conditions. Several VOCs were tentatively identified, mainly belonging to alcohol, ester, and hydrocarbon classes, and showed differential abundance patterns between stimulated and control samples. Multivariate analysis indicated a separation between stimulated and non-stimulated groups, suggesting stimulus-associated differences in the volatile profiles of fibroblast cultures. While these observations may reflect metabolic responses occurring under inflammatory stimulation, the chemical identity and biochemical origins of several detected features remain to be confirmed. All in all, this study demonstrates the feasibility of applying HS-SPME-GC×GC-TOFMS-based volatilome profiling to investigate stimulus-associated changes in fibroblast cultures. The detected VOC patterns should therefore be considered preliminary observations requiring further chemical characterization and independent validation. Future studies including larger sample numbers, complementary biological verification of the inflammatory response, and more physiologically relevant experimental models will be necessary to further assess the robustness and potential relevance of these volatile signatures in the context of inflammatory processes.
This cross-sectional study explores expenditures, negotiated pricing, and potential additional savings for top-selling cancer products in Medicare Part B and Part D.
Robust pharmacoeconomic evidence regarding the long-term affordability of sacituzumab tirumotecan (sac-TMT) in treatment of metastatic triple-negative breast cancer (TNBC) remains lacking. We evaluated the cost-effectiveness of sac-TMT versus chemotherapy for previously treated metastatic TNBC from the perspective of Chinese payers. A partitioned survival model was developed using clinical efficacy and safety data from the OptiTROP-Breast01 trial. Key inputs included survival probability, incidence of adverse events, direct medical costs, and utility values. Total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated as main outputs. Sensitivity analyses tested parameter uncertainty. Sac-TMT provided an incremental survival benefit of 0.40 QALYs compared to chemotherapy but incurred significantly higher lifetime costs. The corresponding ICER was $82,573.83/QALY, substantially exceeding the conventional willingness-to-pay (WTP) thresholds of $40,343.68/QALY. Drivers of unaffordability were utility value of progressive disease, body weight, and price of sac-TMT. Probabilistic sensitivity analysis showed 0.68% probability of sac-TMT being cost-effective at prevailing WTP threshold, and price simulation manifested that a 77.5% price reduction for sac-TMT makes it economical with a probability over 50%. Sac-TMT is not cost-effective for metastatic TNBC compared to chemotherapy at current pricing. Significant price reductions are essential to justify its economic value in resource-constrained settings.
Biosimilars have emerged as a key strategy to improve access to biologic therapies in moderate-to-severe psoriasis, addressing long-standing limitations related to treatment costs and availability. This narrative review summarizes the current evidence on biosimilars approved for psoriasis, including tumor necrosis factor inhibitors and ustekinumab, focusing on efficacy, safety, interchangeability, and pharmacoeconomic impact. A literature search was conducted in PubMed/MEDLINE and Embase to identify relevant clinical trials, real-world studies, and pharmacoeconomic analyses published between January 2015 and January 2026. Available data consistently demonstrate that biosimilars are highly similar to their reference biologics, with no clinically meaningful differences in efficacy, safety, or immunogenicity. Pharmacoeconomic studies across Europe confirm substantial cost savings and reduced cost-per-responder, supporting broader and earlier access to biologic therapy. Biosimilars should be considered as first-line biologic options when appropriate, not only as cost-saving alternatives. Their wider use may enable earlier intervention, potentially reducing long-term disease burden and improving health system sustainability.
A 2021 federal rule permits opioid treatment programs (OTPs) to provide methadone through mobile medication units (MMUs), creating an opportunity to provide medication for people in residential care facilities. We used simulations to quantify the potential of MMUs to expand methadone access to people residing in residential substance use treatment facilities (RTF), skilled nursing facilities (SNF), and nursing facilities (NF) in New York State under different scenarios. For each facility (RTF, SNF, and NF), a need score was created using three items: facility opioid use disorder (OUD) population, driving distance to nearest OTP, and county overdose mortality rate. We then demonstrated potential patient reach following the launch of 50 hypothetical MMUs making one stop per day to the highest need facilities. In refinements, we examined three additional scenarios involving more daily stops and prioritizing rural areas. Our sample included 3214 people with OUD estimated to be housed in 1052 facilities in New York, with the majority in RTFs (51.5%). The demonstrated percentage of OUD population served ranged from 23.5% to 35.8%, and the percentage of facilities served ranged from 23.8% to 37.4%. Each scenario reached a large percentage of rural facilities (73-76%). Prioritizing rural facilities decreased the proportion of OUD population served (10% reduction) but did not substantially increase driving time. Allowing multiple stops increased the proportion of OUD population served (32-36% vs. 24-26%). Using methods based on location information and spatial relationships, state officials can develop priorities and assess tradeoffs of MMU deployment and distribution strategies.
Optic neuropathy represents a leading cause of irreversible vision loss, in which oxidative stress, chronic inflammation, dysregulated lipid metabolism, and mitochondrial dysfunction contribute to the progressive degeneration of retinal ganglion cells (RGCs). In recent years, a number of nutraceuticals have been investigated as potential neuroprotective agents; however, the molecular mechanisms through which they exert their effects remain incompletely understood and are often considered in isolation. In the present in silico study, an integrative network-based approach was applied for a systematic analysis of the predicted molecular targets of selected nutraceuticals with antioxidant and anti-inflammatory potential. By combining target prediction, protein-protein interaction analysis, and functional enrichment, their functional convergence was assessed in the context of optic nerve pathophysiology. The results indicate that, despite their chemical and functional heterogeneity, the investigated nutraceuticals do not act through fully independent mechanisms but instead converge on interconnected regulatory axes. In particular, lipid-inflammatory signaling, epigenetic and stress-adaptive mechanisms, as well as nuclear-receptor mediated transcriptional regulation emerged as key pathways. These pathways form integrated molecular models potentially determining cellular susceptibility to injury and the adaptive capacity of RGCs. In conclusion, the present analysis provides a systems-level framework for understanding the neuroprotective potential of nutraceuticals, highlighting the importance of network convergence and multi-target activity. The obtained results support the conceptual shift from isolated antioxidant strategies towards integrative, network-oriented approaches in the study of optic neuropathy.
Background/Objectives: Chronic diseases pose a major challenge for healthcare systems, requiring integrated, patient-centered approaches that combine clinical management, prevention, and self-care. Lifestyle Medicine (LM) and lifestyle in general offers complementary frameworks to address these needs. However, the potential integration of LM within community nursing-particularly through the role of Family and Community Nurse (FCN)-has not been comprehensively synthesized. This narrative review aimed to synthesize international evidence on the role of community nursing-particularly FCN-in integrating chronic care management and LM view. Methods: For quality assessment, a narrative review was conducted in accordance with the SANRA criteria to enable the integration of heterogeneous evidence and a comprehensive synthesis of this complex topic. Literature searches were performed in the PubMed-Medline database, and the final screening of references from included studies was used to identify relevant manuscripts. Primary studies published in English over the past ten years were screened and analyzed using the PICOS framework. Sixteen eligible studies were included in the final synthesis. Results: The included studies indicated that nurse-led community interventions in LM view were associated with improvements in self-management, treatment adherence, and selected clinical outcomes, such as blood pressure, glycated hemoglobin, and physical activity levels. Empowerment-based approaches and the use of digital or telehealth tools supported patient engagement and health literacy. At the organizational level, multidisciplinary collaboration, shared protocols, and professional leadership emerged as key factors in sustaining continuity and quality of care, while organizational fragmentation and limited training in behavioral counseling were commonly reported barriers. Conclusions: Community nursing, particularly through FCNs, plays a relevant role in integrating chronic care management and LM approaches, contributing to improved self-management, treatment adherence, and selected clinical outcomes. The evidence highlights the importance of empowerment-based interventions, digital support tools, and multidisciplinary collaboration in enhancing care continuity and patient engagement. Addressing organizational barriers and strengthening behavioral counseling training remain essential to support effective implementation in community settings.
Quality-adjusted life years (QALYs) have been widely used in cost-effectiveness analyses (CEAs). Nonetheless, critics argue that this measure may inherently discriminate against people with disabilities. To investigate whether the use of QALYs disadvantages disabled populations through combining theoretical analysis with examination of empirical evidence. For the theoretical analysis, we constructed five scenarios to compare incremental QALYs between disabled and non-disabled patients reflecting different treatment effects on health-related quality of life or survival. We then searched the Tufts CEA Registry to identify published CEAs for selected chronic diseases including rheumatoid arthritis, type 2 diabetes, and chronic kidney disease to match published evidence with these scenarios. Across five scenarios, the differences in incremental QALYs between disabled and non-disabled groups were driven by relative changes in utility and life years, rather than indicating a systematic bias. In 9 of 11 published CEAs, the disabled subgroup achieved greater incremental QALY, lower (more favorable) ICERs, or dominant results. These findings suggest that, within the theoretical scenarios and empirical contexts examined, QALY-based CEAs do not appear to inherently disadvantage patients with disabilities.
Countries in Latin America and the Caribbean (LAC) often lack a systematic approach to assessing the maturity and effectiveness of their policies for promoting off-patent (generic and biosimilar) medicines. Currently, no comprehensive, region-specific methodology exists that encompasses both generics and biosimilars. The objective of this paper is to develop a framework for assessing the performance of off-patent medicines policies that LAC countries can use to identify opportunities to improve access to these medicines in their territories. Through a scoping review of over 300 studies, this study identifies key supply- and demand-side policy interventions to promote generics and biosimilars, along with corresponding outcome indicators. This informs a logic-model-based framework, where supply-side policies are organized according to the pharmaceutical value chain, and demand-side policies are based on the target population. The framework maps key policy actions, such as regulation, pricing, and substitution, to expected outcomes, such as affordability, uptake, and trust. The review highlights major regional gaps, including insufficient biosimilar policies, limited empirical evaluations, and the unique duality between public and private healthcare sectors in LAC. The existing literature gives greater attention to demand-side policies as potential factors driving higher market participation in generic and biosimilar medicines. Within this component, the emphasis is on factors aimed at education and awareness initiatives for users (41.6%). Supply-side policies are discussed less frequently, with price regulation (28.9%) most cited. By contrast, limited attention is given to other key factors such as horizon scanning, and mark-up regulation. The proposed framework serves as a diagnostic, analytical, and benchmarking instrument for policymakers and academia. It facilitates structured assessment, supports policy design, and fosters regional learning. Piloting and further empirical research are recommended to refine and validate the framework using a specific tool designed for this purpose.
Psychological resources are critical to employee well-being and are widely regarded as enabling resilient functioning in the face of uncertainty. Evidence from non-Western contexts, however, remains limited. This cross-national pilot study examined whether psychological resources, operationalized as a composite of mental well-being (WEMWBS), flourishing (Flourishing Scale), and work engagement (UWES-3), predicted life satisfaction (SWLS) directly and/or indirectly via perceived stress (PSS-4) among employees in South Africa and India. The findings are discussed in relation to their implications for employee resilience theory and resource-building practice. An explanatory-sequential mixed-methods design was used. The quantitative phase comprised South African pharmaceutical employees (n = 87) and Indian IT employees (n = 65), for a total of N = 152. After z-standardizing indicators within each country, we formed a Resources composite. We estimated simple mediation (Resources → PSS → SWLS) within each country and a pooled moderation model (standardized SWLS) with Country and interaction terms. The qualitative phase included 2 focus groups and 29 one-on-one interviews (South Africa n = 19; India n = 10), which were analyzed using reflexive thematic analysis to explain statistical patterns. Resources showed a strong, positive association with life satisfaction (pooled model: b = 0.71, SE = 0.11, p < 0.001; R2  = 0.358). Resources were linked to lower perceived stress (South Africa: a = -0.88, p < 0.001; India: a = -0.69, p = 0.016). However, perceived stress did not uniquely predict life satisfaction once Resources were included (pooled b = -0.10, SE = 0.10, p = 0.331), while bootstrapped indirect effects included zero in both countries. Country did not moderate the relationship between Resources and life satisfaction, nor between perceived stress and life satisfaction (Resources × Country: p = 0.165; PSS × Country: p = 0.782). Qualitative themes explained the resource-dominant pathway: in South Africa, Ubuntu-based meaning, complex family support, masculine help-seeking norms, and economic/infrastructure strain characterized the resource-dominant pathway; whereas in India, technology-sector pride and aspirational mobility offset AI-related job insecurity, urban infrastructure burdens, and family separation characterized the resource-dominant pathway. The findings support resource-building interventions and motivate future testing of alternative mediators (e.g., meaningful work, positive affect, self-efficacy) through adequately powered longitudinal studies. The cross-country similarity suggests functional equivalence of mechanisms with culturally specific content.
The approval of the biosimilar insulin glargine-yfgn presents a cost-effective alternative for diabetes management. This study assessed insulin glargine-yfgn initiation among older adults using insulin glargine in Pennsylvania. This retrospective cohort study included insulin glargine users 65 years and older who were enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly program from July 1, 2021, to June 30, 2023. The primary exposure variable, prior insulin glargine use between July 1 and December 31, 2021, was classified into 5 categories: no use, Lantus alone, Basaglar alone, Toujeo alone, and multiple insulin glargine types. The main outcome, insulin glargine-yfgn initiation, was classified based on having at least 1 insulin glargine-yfgn (branded Semglee or unbranded version) prescription between January 1, 2022, and June 30, 2023. Chi-square tests and multivariate logistic regression were used to examine factors associated with insulin glargine-yfgn initiation. Among 6866 patients, 3.7% initiated insulin glargine-yfgn. Insulin glargine-yfgn initiators were less likely than noninitiators to have previously used Lantus, Basaglar, or Toujeo. They were more likely to reside in rural counties (adjusted OR [AOR], 1.39; P = .0135), be in long-term care facilities (AOR, 2.10; P = .0069), and have multiple prescribers (≥ 3 prescribers: AOR, 3.23; P < .0001) compared with noninitiators. Only 1.6% of insulin glargine prescriptions were for insulin glargine-yfgn, with relatively more prescriptions filled at nursing home pharmacies and written by physicians. Insulin glargine-yfgn use among older adults is low despite its cost-effectiveness. Overcoming barriers related to prescribing patterns, formulary placement and reimbursement challenges, and pharmacy channels could improve insulin glargine-yfgn adoption, reducing diabetes care costs.
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Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is a heterogeneous chronic condition whose clinical management has been advanced by the availability of molecularly targeted therapies. Despite this progress, marked inter- and intra-patient variability limits the effectiveness of a one-size-fits-all treatment approach. Precision medicine is a promising solution, but its implementation in routine care is limited. In this manifesto, we propose a multidimensional conceptual framework for the dynamic clinical profiling of IBD patients to be used in real-world clinical settings. Here, we first review key aspects of gut mucosal immunology, including epithelial-immune-stromal interactions and "angry" immune cells as mechanistic drivers of therapeutic variability. We then discuss five domains that are critical for clinical decision making in IBD: disease complexity (phenotype, history, and prior therapeutic exposure); patient frailty and comorbidities; extraintestinal manifestations; patients' needs and preferences; and sustainability. Integrating these domains into a treat-to-target strategy requires the iterative reassessment of patients and the acknowledgment of the evolving nature of both the disease and the patient. We then provide general recommendations for incorporating these elements into the choice of therapy. Finally, we argue that future IBD care should merge the analysis of composite molecular signatures with holistic, patient-centered, dynamic clinical profiling to guide treatment choice, monitoring, and de-escalation. By reframing personalized medical care as a continuous process - a dynamic profiling - rather than a static assessment, this framework should optimize therapeutic outcomes, enhance patients' quality of life, and improve the sustainability of IBD care.
Productivity losses from illness, treatment, and informal caregiving impose a substantial economic burden on patients, caregivers, employers, and society in the United States (US), but measurement remains inconsistent and often omits key domains, such as presenteeism and unpaid non-market work productivity. These gaps limit the integration of productivity into economic evaluations and policy and may lead to undervaluation of interventions that improve health and reduce disease burden. The aim was to identify evidence priorities and methodological improvements for measuring and valuing productivity in US economic evaluations. A targeted literature review (TLR) of US-based studies published from 2020 to 2024 was conducted to evaluate measurement of absenteeism, presenteeism, or unpaid non-market work productivity. Definitions, instruments, valuation methods, and reporting practices were extracted. Findings informed a virtual workshop with eight stakeholders, who completed prioritization exercises and participated in facilitated discussions to refine evidence priorities and methodological recommendations. Thirty studies met the TLR inclusion criteria. Absenteeism was assessed in 77%, unpaid non-market work productivity in 67%, and presenteeism in 37%. The Work Productivity and Activity Impairment questionnaire was used in 40%. Only 30% assessed informal caregiving-related productivity losses, 23% included fringe benefits, and 37% used longitudinal designs. In the workshop, stakeholders prioritized four predefined domains for future evidence generation and value assessment: (1) measuring longitudinal fluctuations in productivity by disease severity; (2) valuing unpaid non-market work productivity; (3) measuring presenteeism; and (4) disaggregating productivity by job types and wfork environments. Recommendations included transparent, perspective-specific valuation; capturing total compensation in absenteeism costs; disaggregating time-based and monetary outcomes; and developing instruments suitable for remote, hybrid, and gig work. Productivity losses are an underrecognized component of disease burden in the US. More consistent use of validated instruments, particularly for measuring longitudinal and unpaid non-market work productivity, may improve the reliability and policy relevance of productivity estimates.
Medicine stockouts (MSOs) remain a significant challenge to delivering quality health services in primary care, primarily due to inefficiencies in Medicine Supply Chain Management (MSCM). This study reviewed existing MSCM models and key factors to develop strategies for strengthening their implementation in primary care settings. A scoping review was conducted, including original studies published in the PubMed, Scopus, and EBSCO databases between January 2010 and January 2025. The included studies assessed pharmaceutical supply chain models or interventions addressing MSO in primary health care. Studies focused on industry supply chains, wholesalers, vaccines, or reviews were excluded. The Antecedent, Decision, and Outcome (ADO) method was used to lead a systematic scoping review. Antecedents were defined as factors associated with MSCM, decisions referred to the MSCM models, and outcomes represented their performance. Data were thematically analysed using the Pharmaceutical Management Framework, and the reported study followed PRISMA-ScR guidelines. Out of 307 identified articles, 28 met the inclusion criteria. Some countries adopted digital solutions, such as stock tracking tools and Geographic Information Systems. At the same time, those with limited infrastructure focused on strengthening governance and supervision, such as through the Supervision, Performance Assessment, and Recognition Strategy. Contributing factors to MSOs include weaknesses in medicine management, inadequate managerial support, policy gaps, and external disruptions to the supply chain. Successful models for MSOs integrate key factors such as digital technology, strengthened human resource capacity, and supportive governance structures. Future strategies should prioritise systems that are adaptable, data-driven, and backed by strong government commitment.
Longitudinal data on weight change, its timing, and the age of obesity onset in relation to cause-specific mortality are limited. From ODDS, a nationwide pooled cohort study in Sweden, we included 258,269 men and 361,784 women with at least three weight assessments between ages 17 and 60, collected in 1963-2015. We applied linear mixed-effects models to estimate weight trajectories, age of obesity onset, and age-specific weight changes between ages 17 and 60. Outcomes were all-cause and cause-specific mortality, assessed from 5 years after the last weight assessment until death, emigration, or 31 December 2020. Associations with mortality were calculated using multivariable Cox regression models. Over a median follow-up of 23.3 years in men and 11.7 years in women, 86,673 men and 29,076 women died. The median weight change between ages 17 and 60 was 0.42 kg/year in both sexes. A steep weight gain trajectory over this period, early obesity onset, and high weight gain between ages 17 and 29 were associated with higher all-cause mortality and with 13 of 23 specific causes of death investigated in men and 12 of 19 in women. Affected causes included cardiovascular diseases (including most subtypes), cancer (including specific types), type 2 diabetes, and digestive and genitourinary diseases. Hazard ratios (95% confidence intervals) of all-cause mortality associated with obesity onset at ages 17-29 vs. never by age 60 were 1.69 (1.60-1.79) in men and 1.71 (1.55-1.88) in women; and per 0.5 kg/year weight change at ages 17-29, 1.18 (1.17-1.19) and 1.16 (1.14-1.18), respectively. Weight gain later in adulthood generally showed weaker associations, except for cancer mortality in women, where the association was similar to that observed with earlier weight gain. Weight gain in adulthood, especially in young adulthood, and obesity onset before age 30 are strong risk factors for mortality from multiple non-communicable diseases, underscoring the importance of early obesity prevention. Future studies should incorporate richer confounding data and, ideally, measures of changes in central adiposity and muscle mass. The Swedish Research Council, Swedish Cancer Society, Crafoord Foundation, Malmö General Hospital Cancer Foundation, and the Swedish Foundation for Strategic Research.
Nanotechnology has transformed oncology, providing novel approaches for the detection, treatment, and management of skin cancer. This chapter examines the economic and healthcare ramifications of nanotechnology in skin cancer, emphasizing cost-effectiveness, accessibility, and the possible strain on healthcare systems. The incorporation of nanotechnology-driven therapeutics, including nanoparticle drug carriers, targeted treatments, and diagnostic nanodevices, has shown greater patient outcomes, less side effects, and increased drug bioavailability. Nonetheless, the substantial expenses associated with research, development, and regulatory approval provide obstacles to wider use. The chapter assesses the cost-benefit analysis of nanomedicine relative to traditional therapies from an economic standpoint, taking into account manufacturing expenses, reimbursement regulations, and market accessibility. Although early expenditures in nanotechnology are substantial, the long-term advantages-such as decreased hospitalizations, tailored treatment approaches, and improved therapeutic efficacy-could result in total cost reductions for healthcare systems. From a healthcare standpoint, nanotechnology offers prospects for enhancing early diagnosis, tailored medication delivery, and less invasive therapies, hence diminishing treatment-related problems. Nonetheless, issues like nanoparticle toxicity, prolonged safety concerns, and regulatory obstacles must be resolved. This chapter emphasizes the capability of nanotechnology to transform the economic and healthcare framework of skin cancer therapy. By harmonizing innovation with cost-effectiveness and accessibility, nanomedicine might enhance sustainable and efficient healthcare solutions, facilitating future progress in cancer.
The pharmaceutical sector in Kazakhstan faces a complex interplay of regulatory, economic, and social challenges, including a high dependency on imports, fragmented policy perspectives, and limited integration of international innovation practices. This study applied Q-methodology to identify and structure the dominant and latent viewpoints within the professional community regarding the development of Kazakhstan's pharmaceutical industry. A set of 39 statements was developed through literature review, policy document analysis, and preliminary interviews with sector stakeholders. Twenty experts were selected based on professional relevance from public agencies, academia, and the pharmaceutical industry. Factor analysis using principal components with varimax rotation was conducted to extract shared perspectives. Three distinct factors were identified, representing structured ideological positions. Factor 1 supports strong state involvement in pricing, R&D, and domestic production; Factor 2 expresses skepticism toward state-led strategies, emphasizing economic pragmatism and reliance on imports; Factor 3 advocates for deregulation, market-driven growth, and international integration. Each factor was aligned with specific professional backgrounds and interpreted through follow-up interviews. Market indicators (imports, investment projects, sales dynamics) were used to contextualize the factor interpretations and to illustrate how each viewpoint reads the same empirical baseline, rather than to validate the factors as accurate or inaccurate. The findings reveal a significant divergence of expert opinion, which may hinder cohesive policy development in the pharmaceutical sector. Ideological fragmentation poses risks in the context of weak institutional coordination and external market pressures. Q-methodology proved effective in mapping nuanced perspectives and may serve as a tool for informed policy dialogue in healthcare governance.
The harmonious development of healthcare, medical insurance, and pharmaceutical systems is crucial for advancing healthcare reform in China. This study evaluates the coordination level of China's three medical systems and examines their dynamic evolution trajectories and spatial effects from 2013 to 2023. Data from 31 provinces were analyzed using a coupling coordination degree (CCD) model to assess spatiotemporal evolution. Kernel density estimation and Markov chain models were applied to explore dynamic characteristics, while spatial Durbin models were employed to evaluate interregional spillover effects and influencing factors. From 2013 to 2023, the CCD of China's three medical systems exhibited a steady upward trend. Eastern regions consistently sustained higher levels of coordination, while central and western regions achieved notable improvements. Some provinces transitioned from disequilibrium to preliminary coordination; Dynamic evolution revealed diminishing absolute disparities but widening relative differences, with intensified multipolarization in eastern and western regions and significant internal variation in central provinces; Spatial analysis identified pronounced spatial autocorrelation and spillover effects, with high-high clustering zones expanding into the Yangtze River Delta, while low-low clustering zones remained concentrated in the northwest. Economic development, urbanization, and human capital contributed significantly to coordination, while government healthcare expenditure exerted a negative impact, and aging effect exhibits a significant threshold effect. The level of coordination among China's three major medical systems show sustained improvement, yet significant regional disparities persist, primarily due to uneven pharmaceutical development. Coordination follows a path-dependent trajectory, limiting rapid advancement. Positive spatial spillover effects generate economic influence on neighboring regions. Policies should focus on balancing regional coordination with differentiated strategies, enhancing interdepartmental and interregional mechanisms, and optimizing resource allocation.