| Government report of fifth conference of 10th National People's Congress pointed out thatto serve the changes of health service need structure with the development of social economyand life levels, we must expedite the reform and evolution of health industry by the means ofprimary health care regulations covering all people, new rural cooperatives health servicesystem, new urban health delivery system based on community health services, and citiesinhabitant basic medical insurance experiment aiming at severe diseases. Howere, thedevelopment of Chinese health delivery system (HDS) contributed a lot to the improvementof population health and the advancement of economy and society, the reform of HDSaroused great disputes all over the country in recent years, which centrally reflected as"difficult and expensice to see doctors", and sudden public health events. This requestsChinese HDS to have to adjust the internal structure, take "population health" as the systemgoal, carry on the structure diagnosis and the rearrangement to the system, vigorously developcommunity medical service, rural primary health service and the public health service, andreconstruct new health delivery system that suits the situation of our country.This research is one direction of the emphasis project subsidized by National NatureScience Foundation of China (NSFC), which named "Medical Service Management Researchbased on Population Health"(70333002); and is also subsidized by graduate studentinnovation scientific research project of Second Military Medical University in 2005 by thename of "Research on Multi-Agent Microscopic Model of Health Delivery Sytem".This research is based on the complexity science and system engineering theory. With thehelp of health service research methods and especially system dynamics modeling techniqueto anlyze situation of Chinese HDS, system interior causes and effects feedback relations andexternal environmental substance, information exchange route are determined. Literaturereview and META analysis are used to diagnose the main problems of Chinese HDS, onwhich the concept model, logical model, and SD model are built up. System structuresimulation and decision support system are developed to carry on health policy experimentsto discusses the dynamic characteristics of macro HDS behavior and internal mechanism, discover system structure problems, roots, and the function mechanism. Solutions to structureproblems are proposed to enhance macro HDS performance, and to provide auxiliary tool forpolicy-making.Data and methods: data of this research comes from investigations of former projects,national health service survey 1993, 1998, and 2003, national statistical yearbooks 2000-2005,supplement investigation, and 8 related journals, etc. Under direction of overall structuralframing, structure problems are analyzed by the means of description statistical analysismethods and the system analysis methods on current situation of macro HDS and foreigncomparison research. Using literature review to induce HDS existence questions andconstructs the HDS performance model with factor analysis method. By the application ofsystem thinking and analysis of system dynamics, carry on the systematic analysis of macroHDS structure, screen main feedbacks and essential variablesand carries on the quantification,construct in turn macro HDS concept model, logical model, and SD model. The application ofcomplex system simulation technology and software helps to construct the macro HDSsimulation and the intervention experiment software platform, ont which we can simulatesystem dynamic behavior, analyze characteristic of internal mechanism, and put forward ourmacro HDS system development policy proposal in this foundation.Main research results are listed here:Present situation analysis result: In the period of HDS transforming from plannedeconomy system to marker system, macro HDS assumes the structure characteristics of"collapse triangle" contrary to the health service need, which means more weight on medicalservice against pervension service, more weight on cities against country, and more weight onhospitals against community service. Although under certain historical period and conditions,it promoted rapid growth of medical science, technology, HDS system resources, andpopulation health level, but health distribution is imbalanced, while financing fairness andsystem reactivity keeps dropping. In a word, the overall performance level of macro HDS islow. Facing with similar situation of HDS all around the world, Chinese HDS have to copewith resource finity and structure peoblems, that is to say, efficiency and fairness are hard todivide.System structure analysis result: macro HDS is mainly composed of 3 types of agent,government, health service organization, and the crowd. With the purpose of population health promotion, macro HDS tries to improve system performance by the means of healthresourse reasonable allocation. The system core is the crowd in flowing dual structure of HDS,UHDS and RHDS. The research embarks from the modelling angle and HDS consumer isdiscriminated into healthy crowd, ordinary sick crowd, and serious sick crowd accordingto itsnatural state, according to the different function position and type, the HDS suppliers aredivided into MDS, PHS, CHS, and RHDS. The alternative infection of supply and need, withthe effect of external environment, composes the overall characteristiesof macro HDS.System dynamics analysis result: conclude the main problems of macro HDS structurewith the help of literature META analysis; build up logical model of macro HDS with mainfeedback loop analysis and subdivide system into 8 modules, such as social environment,population flow, population decision and choice, MDS, CHS, PHS, RHDS. Constructure SDmodel of macro HDS on the clue of basic supply characters, influence of agent behavior, andHDS resource structure.Simulation and intervention result: Chinese HDS represents the character of hospitaloriented, and the behavior excurses the goal of population health, which induced the problemsof expensive cost, unfairness and low efficiency. Because of the miss of normal compensationroute, CHS could hardly develop under present system structure. Intervention research foundthat agent behavior and the polarization of macro HDS structure are very difficult to control,while suppliers of the system chasing for compensation. The buildup feedback loop ofpopulation health contributes a little and the capability of policy intervention remains weak.Advices on system development: with the control of MDS, great devotion to CHS, PHSand RHDS should be excuted. The internal structure of macro HDS could be adjusted by theway of deposite resource regulation and supplement resource allocation to improve systemperformance. The role of government control should be more and more powerful, and steerthe structure evolvement of macro HDS.This research takes macro HDS model system as the laboratory of HDS simulation andpolicy intervention. By the simulation of system structure, regulations, health policy, andenvironment changes, dynamic behavior charactes and mechanism of macro HDS is gained.And the simulation tool of health policy experiment is provided to serve the need of systemstructure research. During the process of this research, the author published 12 papers oninterior core journals, 1 monograph (Modeling of Health Delivery System, subedior), took part in 2 important meetings, and obtained the Shanghai technological second prize in 2006(fourth author).
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