Feedback & Simulation Study On The Effect Of Rural Healthcare Service Supply Chain System In Jiangxi Province

Medical problems in rural areas are the weakest and the most difficulty problem in health system reform in China. It has not only impact on the stability and development of rural society and the health lives of rural residents, but also hinder solving the "three agricultural problems". At the same time, it has an important influence on the construction of new countryside and rural medical system reform. In recently 20 years, the health system reform model in China is marketization. The previous health system reform has really solved the problem of deficiency of medical treatment, but also contributed to the phenomenon of luxury hospital. The decreased fairness of medical services access and the inefficiency of macro heath investment have contrary to the basic principles and laws that medical services is public goods, which result in the problem that expensive medical bills and difficult access to quality medical services for residents become serious, and then the phenomenon that drinking poison to quench thirst is generated. Nowadays, the new health system reform has performed, and the rural health system reform also has implemented simultaneously. A series of macro health reform policies which the worldwide people concerned are performed by government. But new problems in health reform have emerged, which showed that there exist a typical systemic symptoms that external policies have little effect on system behavioral interventions. So it is urgent to apply multiple methodologies to further analysis the cause of problem in previous health system reform to provide reference for the new health care reform, and to further demonstrate the correctness of policy in the new health system reform, and to prevent the generation of the new problems of drinking poison to quench thirst, concentrating on details but forget the main purpose or objective, and competating viciously. The medical and health services system in China is a complex system, there are a lot of problems need to study by scientific methods. Based on above problem, it is significant to study rural healthcare service supply chain by system dynamics methods.In the dissertation, firstly, rural healthcare service supply chain structure model is built by both reviewing the papers on rural healthcare and its service supply chain at home and abroad, and investigating in rural health system reform in China. the first-hand survey data and information of health care system reform are obtained by both investigating in five county hospitals in Pingxiang city, including Luxi County People's Hospital, Shangli County People's Hospital, Lianhua county People's Hospital, Xiangdong District People's Hospital and Anyuan District People's Hospital, and interviewing with experts in health department of Jiangxi province and rural residents in Xiabu town. Based on theory of supply chain, rural healthcare service supply chain structure model is built, in which composed of governments, medical product suppliers, rural hospitals and rural residents.Secondly, based on research and structure model of supply chain, unitary regression analysis method, multiple regression analysis method and Logistic regression method are used to construct the regression model of influencing factors of behavior in different links of rural healthcare supply chain respectively. And we have obtain its core variable by variable selection of regression, which include in the number of participants in the new rural cooperative medical system, department in county hospital, medical staff, medical skills, medical equipment, medical prices, medical security and so on. And we have conduct analysis on their influence degree, which pave the way for the simulation of variable selection.Thirdly, based on the rural healthcare service supply chain structure model and theory of complex systems, the archetypes is built in the different links of the service supply chain, in which included government, medical products supplier, hospital, and rural patient link.24 archetypes are constructed and analyzed, a series of restrictive factors in rural healthcare service supply chain are founded. Eight management countermeasures are put forward, but the most important three management countermeasures as follows:(1) Further improving the new rural cooperative medical system. (2) Speeding up the reform of rural hospitals; (3) Increasing fund for rural hospitals by government.Fourthly, based on archetype analysis in the overall medical and health system reform, and the core variable data of system dynamics, the rate variable fundamental in-tree models, feedback loop branch vector determinant computation, management countermeasures, and the new in-tree-feedback-simulation-force five-step analysis method, according to the feedback set structure and in an innovatively perspective of force, the four management countermeasures are put forward and the correctness of them are proved. The four countermeasures come from the four force generated by the new rural medical cooperation system, which include the inner-generated-force, economic support force, attraction and motive force. By constructing the core variable base model, establishing simulation flow graph model of the new rural cooperative medical system and conducting simulation experiments, implemented effect of the new rural cooperative medical policy is revealed quantitatively. The negative feedback loop limited principle is put forward innovatively in this dissertation, that is, it is necessary to firstly realize the respective responsibilities, objectives and interests, including the government, rural hospitals, rural residents, city hospitals, pharmaceutical supply and production enterprise in order to achieve the overall objective of eradicating negative feedback loop constraints in rural medical services supply chain system. Four forces are generated in the operation processes of the new rural cooperative medical system, which include inner-generated-force, economic support force, attraction and motive force. And four countermeasures about the development of rural healthcare services supply chain are put forward based on the four forces. They are as follows:(1)subsidies proportion of health care in rise by central and local government to strengthen the economic support force for medical and health of peasant; (2)the participation peasant increased greatly, the coverage of participation continually expanded, which empower the inner-generated force for rural health care; (3)the increase of the numbers of medical compensation peasant and the expand of compensation benefit scope will strengthen the peasants'attractive to reform rural health system;(4) to speed up the development of the new rural cooperative medical system will strengthen the motivation to realize their goals for the four subsystems, include health insurance subsystem, hospital subsystem, medicine subsystem and public health subsystem.Fifthly, based on archetype analysis in the overall medical and health system reform, we have deeply research on the subsystem of rural hospital reform. A new system dynamics method that is causal chain transfer effect by countermeasure force is built, and be applied to prove the cause of expensive medical bills and difficult access to quality medical service for residents. The correctness of six management countermeasures of county hospital comprehensive development is proved. And we have innovatively set a rate variable basic in-tree as control parameter to simulate and prove the correctness of countermeasures by the new method of causal chain transfer effect by force.Based on the new ideas that core variables are atoms and causal chain is molecules in system, we have innovatively built a new systemic causal chain transfer effect by force method. According to the historic data from the deeply research on the five county hospital in Pingxiang city, a new set of core variables is built, and a causal chain sequence is established, and then a causal chain vertex degree sequence is built. A upper limit growth archetype which is composed of core variable in service delivery supply chain of county hospitals is built by the vertex degree sequence of causal chain link force. Based on the causal chain structure of the upper limit growth archetype, we have innovatively applied causal chain transfer effect method to prove and analysis the cause of expensive medical bills and difficult access to quality medical services for residents. The correctness of six management countermeasures in subsystem of county hospital development is proposed based on the principle of restricted negative feedback loop in medical service supply chain system of county hospital. Nine rate variable basic in-trees are built. We have innovatively use a new method that-set a new rural cooperative medical rate variable basic in-tree as control parameter to simulate and test the correctness and reliability of countermeasures by causal chain transfer effect.Finally, a series of proposals about China's new rural health system reform were put forward based on simulation force effect analysis. They are as follows.(1) when making and implementing policies for the new rural cooperative medical system, governments in different level should pay attention to the four forces, including economic support force, inner-generated force, attraction and motive force, and should prompt the new rural cooperative medical system to develop continuously by making the four forces to keep constant reinforce.(2) In the process of health system reform, governments and managers should recognize, before achieving the overall goal of health system reform, it is necessary to firstly realize their own objectives, including government, hospitals, pharmaceutical companies, rural and urban residents.(3) Based on feedback loop effect analysis, the dissertation holds that it will restrict peasants to take part in the new rural cooperation medical system if they pay a high proportion fee. So, the dissertation suggest when making policy for the new rural cooperative medical system, policy-makers should pay attention to control the fee proportion which paid by peasants.(4) The new rural cooperative policy has positive effects on the outpatient, hospital patient, and medical staff in county hospitals, so it is necessary to strengthen the policy and promote the development of county hospitals.(5) It is proved that county hospitals can not afford to finance enough in construction of section and medical equipment on their own based on the feedback simulation analysis, therefore it is necessary to further increase government finance in the construction of county hospitals...