Research On Non - Medical Influencing Factors Of Health System Performance Based On System Dynamics

Objective:Based on the perspective of system thinking, review and summarize the existing study that the impact to the health system performance of non-medical factors, analysis the system dynamic logic of the role of various factors on health system performance, find the important decisions intervention point, provide the reference and suggestion to build a more scientific and reasonable health system performance evaluation index system.Contents:1. The non-medical factors which affecting health in the existing studies;2. The system dynamic logic that the non-medical factors impact the health system performance;3. The proposal to improve health system performance based on the present situation of China, from the perspective of non-medical factors.Methods:1. Literature ReviewThrough collecting and organizing documents, complete the literature review, including the international framework of health system performance evaluation, the factors influencing health system performance, the progress and methods of the existing studies; Based on the principles and methods of the system review, according to the classification of the non-medical factors, establish the searching strategy, sums up the non-medical factors influencing health system performance.2. The System DynamicsApplying the theory and method of system dynamics, draw the causality diagrams/flow diagrams of non-medical factors and health system performance, within the defined areas and scope, describe and analysis the logical relationship between the influence factors and the health system performance, find the key factors which is worth to pay close attention to and get revelation.Results:1. In the social factors, the degree of education most widely affects residents’health and health services utilization. The level of education, employment and migration are the important policy intervention point; Nationality/household registration system influences the health system fairness through affecting the fairness of education, employment and social security system.2. Among the economic factors, the domestic economic development mainly establishes the positive feedback and promotes the health system performance through the per capita income, social public resources and health technology development three variables. Economic globalization’s influence on the health system performance has two sides. There is also certain influence of different industry structures to the health system performance. The development of health industry has positive effects on the health system, while the influence of the information industry development to the health system performance mainly through five ways. The income of people positively affects the health system performance, while the income distribution inequality negatively effects the health system performance.3. The influence of environmental factors on health systems performance mainly embodied in the health. The mediation mechanism includes direct effects and indirectly effects which are through psychological factors.Conclusions:1. Reduce the unfair of social economic system is the urgent need to improve health system performance; The more prominent problems among it is the household registration system and the income gap; It mainly affect people’s health through a direct impact on health service utilization, and an indirect effect on people’s psychological health factors.2. Based on the perspective of systems thinking in the long run, stability, sustained and intensive economic development is an important driving force to improve health system performance. China’s current economic environment is favorable to improve health system performance, and it need to grasp the timing of the economic transformation, promote health and economic coordinated development.3. In the social and economic factors, education, employment and migration effects on the health system performance should be highly valued. Increase education investment on the urban and rural, and reduce regional and gender unfair, and break the barriers of household registration system and social security system which causes the fair employment; Fully promote the migration to enjoy the treatment of citizens in terms of the social security system.4. The existing studies of non-medical factors impact on health system performance are mainly related to the health and health fairness two dimensions, while relative lack of research on the influence of the reactive mechanism; There are less measurable indicators of non-medical factors, then the available and usable data is relatively difficult to get, and it need to further strengthen related research of non-medical factors impact on the mechanism of health system reactivity; Raise the scientific nature of the statistical work to strengthen the construction of the database from the national level.Suggestions:1. Reduce unfair in the social and economic macro policy and non-medical factors should be brought into the health system performance evaluation index system;2. Improve education, employment and migration factors of unfair issues;3. Seize the favorable opportunity of economic transformation, promoting health and economic coordinated development;4. Achieve the whole society mobilization and participation, attaches great importance to the mental health;5. Promote health impact assessment, to early find potential environmental risk factors;6. Strengthen the construction of database of non-medical factors and the development of statistical methods, and further non-medical factors effects on the health system performance research.