| BACKGROUDSThe 16th Central Committee of the Communist Party of China (CPC) has brought forward the striving goal of "To build a well-off society in an all-round way and to work hard to create a new situation in building socialism with Chinese characteristics" and treated the aim of "To establish the health delivery system and medical care system seasoned with the situation" as one of the basis content of the country economic construction and reform. Urban Medical Delivery System (U-MDS). As the important part of the Health Delivery System (HDS), has exerted signify function in the course of the prevention and treatment of disease for people and the guarantee of the health of city resident. The development of social economy and improvement of people' s standard of living influence the health demand structure, so we should adjust the internal structure of U-MDS in time, take the "improvement of the people' health level" as the goal of system, diagnosis and re-construct on U-MDS and establish a new U-MDS giving priority to community medical service.This study was a introduction research of "Study on Medical Delivery Management based on Community Health" (No. 70333002) which was a major project of Natural Science Foundation of China. Chief project aimed at the community health, took HDS as Decision Making Unit (DMU), focused on the system structure and its ratio and divided HDS into Medical Delivery System (MDS) Public Health System (PHS) and Public Health Community (PHC) according to the source of medical funds. At present, our research group had established the structure frame of HDS focused on the system resource structure the organization structure and the administration structure, restricted by the management and safeguard rules and influenced by the common environment. However, there is shortage of analysis on the internal structure ofHDS and the construction of System Dynamics (SD) model. OBJECTIVESThe theory and methods of Complex Adapted system (CAS), system thinking and analysis of SD and meta analysis methods were used in this study. Based on the series achievements on macroscopic and microscopic research of military health resource allocation and research of military medical demand, through system analysis of U-MDS, we found the internal feeding-back relationship of U-MDS and the substance and information communication with the environment, Aimed at the main question which was confirmed by meta analysis and the technique of SD we established macro SD model of U-MDS. So we could analysis the dynamic behavior character and internal mechanism of the system and find the rootstock of the question by simulation used the macro SD model. Therefore, we could put forward some policy advice aimed at the development of the system..MATERIALSData used in this study includes the correlated literature data in 8 kinds of magazines such as 《Chinese Journal of Hospital Administration》《Chinese Health Economics 》 《 Foreign Medical Sciences 》《Chinese Hospital Management》 during 1998-2003, data of statistic yearbook of country during 1994-2004, data of investigation of medical service in 1993, 1998 and 2003. Additionally, some data on the management of U-MDS and related data on national health resource allocation were referred to.METHODSAccording to the general research frame of chief project, through demonstration study and descriptive study and SD method, to describe the development and main structural issue of U-MDS. Adopting meta analysis, to confirm the main question of U-MDS so we can confirm the objective to build model. By means of system thinking and system analysis, to establish macro SD model so as to reveal the dynamic behavior character and internal mechanism ofU-MDS and put forward the policy advice aimed at the development of the system.RESULTSDescriptive study of U-MDS show that the U-MDS has developed from the foundation period development period to the transition period. Its behavior has the trends of expansion in system size, increase of total medical resource and decline of the utility of medical service following by the optimization of industry structure and the quickness of industrialization of medical service. The environment of medical treatment has been improved and city peoples' health consciousness also been strengthened. The organizing pattern has the character of multi-level and vertical management.The results of analysis of system structure show that the medical resource structure is inversion with medical resources, that is, eighty percent of medical resources had centralized in the high level hospitals severely while there were only about twenty percent of medical resources in the other hospitals. The allocation of medical resources presents "inverse triangle" condition. The organization and administration structure of U-MDS has the characters of the macro management mechanism with "centralization", the lack of elasticity of the flat organizing structure, without encourage and restrict regulation to the managers of hospitals, the hospitals' seek of max advantage under the compound economy compensation policy and the low harmony in hospitals.The results of analysis of SD show that we can confirm the main question of the system structure through meta analysis, which is the conversion of the medical resource structure, the confusion of the function of hospitals and the rapidly increase of the medical expenditure. And we divide the system into three subsystems, which are the Medical subsystem, the Medical and Population subsystem, the Medical and Economy subsystem, the Medical and city subsystem according to the system impact factors. We also divide the system into three levels, which are the high level hospitals, the middle level hospitals and the basic hospitals according to the amount of beds. Then we construct themacro SD model of U-MDS based on the system analysis of U-MDS using the level of community health, the population, the community medical demand and the amount of medical resources within each level as main clues.The results of analysis of simulation show that there are two main reasons restricted the development of U-MDS. One is the lack of interaction within hospitals which leads to the result of vice competition in hospitals and the conversion of medical resource. The other is the question of internal compensate mechanism which cause the increase of medical expenditure. However, the organization pattern of medical institutions, the internal promotion mechanism in hospitals, the selection of city crowds on medical service and the regulation of hospital comment all promote the form of the main question of U-MDS.The policy advices are as follows: Based on the adjustment of urban medical resource structure following by the establishment of interaction mechanism of hospitals and the consummation of compensate regulation, we can re-composite the medical structure in all levels of hospitals and re-orientate their functions so that the equity and efficiency of medical service would be improved and the goal of U-MDS will be in consistent with the goal of society. And then we put forward some policy advices: The first is to definitude the function of the government and strengthen the macro management for U-MDS. The second is to establish the interaction mechanism of hospitals so as to optimize the medical resource structure. The third is to consummate the compensate mechanism of hospitals so that their vigor will be enhanced and the medical expenditure will be reduced.This study set up the Systemic Dynamics model of medical demand as the simulating "Laboratory", simulated the system structure, regulation, health policy and external environment of U-MDS in China, obtained the dynamic behavior characteristics and changing mechanism of it. This research leaded by concept model, centralized by system model, was based on system structure, relyed on the behavior simulation, aimed at the ultimate of the system function. The model make the first simulation system come true in medical industry in...
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