System Dynamics Modeling Study On Hierarchical Medical Care System And Policy Simulation

ObjectivesThe Chinese healthcare system reform is committed to explore the ways of hieratical medical care system construction;however,the ordered medical care process has not been established yet.There are problems of disordered medical server seeking,poor two-way referral,unreasonable resources allocation,inadequate treatment capacity of primary healthcare institutions,and services overtopping of hospitals.Reasonable decision-making supported by research work is needed in the reform.The medical care system is a complex social system with confounding interactions,multiple feedbacks among,and dynamic changes.Therefore,it is necessary to study the system from multi-dimension with comprehensive and dynamic analysis.This study built a visual medical care system dynamics model,to simulate the influences of patient’s medical care seeking behavior,resources allocation,primary health care institution’sservice capability,the hospital’s profit-seeking motivation,and health insurance The study is aiming to provide quantitative and solutions for decision-making,and provide reference for further reformation.MethodsThe data was collected by existing data collection and analysis,the expert consultation,questionnaire survey and in-depth interviews,et al.This study built the conceptual model and logical model,propose the system-optimize intervention target hypothesis,on the basis of core problem mathematical analysis.The methods used are:literature analysis,expert consultation,logistic regression analysis,structural equation model,data envelopment analysis,archetype feedback analysis,health economics theoretical analysis such as price-demand curve analysis.Then,the system dynamics model was built with the data from Zhejiang Province,the target hypothesis was versified by modeling simulation,and finally the system-optimizing scheme was proposed.The system dynamics model was built by VENSIM.The population prediction with Markova model,and the Cobb-Douglas production function was also used to set the model constraint.Some official statistics was used to back up the system-optimizing scheme.Modeling analysis of Zhejiang Province’s reform policy"health care talents down-ward allocation" was used to check the feasibility of the system dynamics model.ResultsThe analysis of core problems shown that,resourcesshortage in primary health care institutions and insufficient utilization by patients are core problems leading to functional disturbance.It is demonstrated that the factors of suppliers and the medical insurance may influence patients’ choices.Thus,wepropose the system-optimizing intervention target spots hypothesis:the primary health care institutions’ service technical level,responsiveness,price,suppliers-induced-demands,health care insurance reimbursement methods.Resources allocation are also adopted as well.Modeling simulation of the hieratical medical care system dynamics model:Take the demander and supplier as a subsystem of the inner system,government,the health insurance,population development and social and economic development as the external environment.An approximate image realizing the reality system was built,and the concept model was also built.Base on the analysis of concept model and core problem,the system dynamics logical model was built.Then the SD model was built by Vensim software.Simulation of the influence of the system-optimizing intervention target shown that,increase in primary health care institutions’ service technical level,responsiveness,decrease in price,adjustment in health care insurance reimbursement methods,health care insurance reimbursement methods,all promote the function of hieratical medical care system,especially the price,the responsiveness and health care insurance reimbursement methods.With these intervention,in 2020,the first-contact in primary health institution will increase to 80.4%(50.19%without intervention),and 29.91 million patients will be down-ward allocated(73.19%of the patient who should be down-ward allocated).5.9 million patients who use self-treatment will seek professional treatment.However,suppliers-induced-demands will increase with patient’s down-ward allocation,may up to 9.01%of the total service.Direct cost fund invested in primary healthcare institutions should increase by 20.84%in outpatitont care,and by 55.14%in inpatient care,about 1,4000 doctors should be down-allcated.The health services survey of Zhejiang province provide evidence of the system-optimizing intervention target,including primary institutions technical level,responsiveness,and price.The modeling simulation of Zhejiang Province’s reform policy" health care talents down-ward allocation" verified the feasibility of the system dynamics model.Conclusions and SuggestionsThe primary health care institution’s servicecapability,and the health insurance institutions service capability and health insurance reimbursement methods are key influencing factors of patients’ health care service seeking behavior.It is suggested that the government take the resources allocation as the breakthrough point,take comprehensive measures to enhance the service capability,responsibility,and highlight the "people-oriented" service concept and the medical professional spirit,in order to promote the establishment of doctor-patient trust.It is also suggested that,establish reasonable incentive constraint mechanism,increase medical insurance compensate lever,design reasonable compensate methods,and hierarchical disparity gradient,in order to guide the patients’ down-ward allocation.Additionally,government function should be strengthen,to appropriately compensate the hospitals’ profits losses,and reduce the resistance of reform.This study simulated the influence of intervention targets,proposed system-optimize intervention scheme,and build the quantitative analysis platform of hieratical medical care system.The results of analysis of core problem of the system was adopted by the government of Zhejiang province,and was applied in the framework designing of the reform in this province.Since many factors and feedback pathway are involved in the hierarchical diagnostic system,this study selected the core factors and critical pathways,rather than involving every factors.The model is still needed to be optimized to make it more appropriate.We will collect data of the social economic underdeveloped regions to build the hierarchical medical care system model,and keep track of policy intervention,in order to provide reference for reform in China.