Study On Mechanism Of National Macro Health Financing System Based On System Dynamics

Objective and significance: To construct SD model and build policy experiment platform of national macro health financing system based on related theory of complex system and modeling technique of system dynamics. The main sub-objectives are listed as follows: confirming the structure of macro HFS and its sub-system; Constructing HFS foundamental theory based on CS; describing the actuality and summing up the focus problem of HFS; constructing the aim measurement system of HFS; constructing the system dynamics model of HFS; simulating the structure and action mechanism of HFS; disclosing the forming mechanism of HFS focus problem; filtering intervention experiment group of macro health policy and providing related policy suggestions. The study has realized visual simulation of complex inner structure and action characteristic of macro HFS complex system, which provide continuous research tool and decision supporting system of evidence-based policy for establishing macro health policy and making up the blank of foundamental system theory research of health financing policy. Reseach Methods: Compartmentalize the system structure of HFS based on theory of CS and system analysis method; Describe actuality and filter focus problem of the system by methods of documents assembly, comparison research, expert consulting and so on; collect related data from the sample area, information of national health service survey and other statistical data by method of typical area investigation, quantitive economics, statistical data extraction; estimate and supplement the missing data by supplementary spot investigation, expert consult and expert interview; access the performance of macro HFS by Thell Index difference analysis , DEA, statisfaction index, index of fairness of financial contribution and Kakwani; construct the concept model,logic model and SD model by system archtype analysis, agent action analysis, system relating analysis and VensimDSS professional software; simulate dynamics action characteristic and mechanism of HFS through policy intervention and simulation experiment of SD model.Research procedure:(1) Collect data, carry through pre-investigation of small sample, design the experiment plan; (2) Descrptive analysis and qualitative research of national health financing system; (3) Construct the concept model of national HFS; (4) Construct the logic model of national HFS; (5) Construct the SD model of national HFS; (6) Intervention of policy and simulation experiment; (7) Put forward policy suggestions.Research contents: (1)Qualitative study of HFS. Define the foundamental elements, clarify the resource structure, organization structure, administration structure, system regulation of macro HFS and its sub-system, comfirm the outside environment in which HFS is existing, analyze each agent action of HFS and construct the HFS concept model; (2) Descriptive analysis of HFS. Study domestic and foreign health financing model, analyze present situation of China macro HFS, conclude the focus problem of HFS, construct the object measurement system of HFS and make elementary diagnosis of macro HFS; (3)Logic analysis of macro HFS. Carry through agent related analysis of macro HFS and its sub-system, make certain the main loop and feedback mechanism of HFS sub-system, and construct logic model of HFS by methods of multiple factors analysis, expert consult and system dynamics; (4) Construct of SD model of HFS. Make certain the simulation observation index and policy intervention index according to study aim, work out the flow chart of system dynamics by VENSIM software, evaluate the main variable and function relation, and construct SD model of national HFS; (5) Simulation and policy intervention research of national HFS. Simulate complex action mechanism of HFS structure evolvement by applying synthetically system dynamics and computer simulation technique; illuminate the formation mechanism of focus problem of HFS; filter the intervention experiment group of macro health policy and put forward correlative policy suggestions.Results of research: Construct the foundamental theory of HFS based on CS; clarify the radical framework and its sub-system structure of macro HFS; construct concept model, logic model and SD model. And simulate the system structure and action rule of national macro HFS, expose the formation mechanism of HFS focus problem and put foword the policy suggestions of solving the focus problem by policy intervention experiment.Conclusion of research: (1)Results of simulation: HFS has the structure limitation such as: the three agent (government, society, individual) of Cc-HFS contend each other, financing structure lean to individual; the structure of Cu-HFS is unreasonable which lean to medicine fare; the structure of Ca-HFS is imbalance which lean to medical institution. HFS function of the leaning structure is weaken little by little, which influent the justice of health financing and counteract the development of national medical health service system, even more endeavor the health of most people; (2) Results of intervention experiments: enlarge the cover rate of medical insurance, reduce ratio of drug fare is in favor of optimizing the structure of HFS and improve the justice of health financing. At the same time, the results of government interference reveal: Only enhancing the government capital input in not effective to change the structure of HFS, because the performance of HFS is not sensitive to government input and most dependent on the macro health financing structure. Therefore we put forward that the center of government health work is truly turned into making better health financing policy and effectively improve the structure of HFS.