| BACKGROUDSThe National Health Service Investigation result indicates many times that the effective medical demand of our country's city and countryside inhabitant has been dropped gradually and the massive medical need is unable to transform to medical demand. It suggests that potential medical demand does not only exist but also has affected health equity seriously in China directly caused a series of significant social question which taking "to see a doctor difficultly, to see a doctor expensively" as the prominent symptom. Therefore, it is important to solve the transformation question of potential medical demand in China and get its transformation mechanism. It is not only helpful to provide theory and method evidences to nation macro health policy formulation like reasonable disposition of health resources, organization of health service, the level determination of health finances, the reform of compensates way and so on, but also the key to enhance health equity. In addition, it is also helpful to strengthen the populace's confidence to government, relax the contradictory of the society and promote the construction of the harmonious society.This study is the sub-topic funded by the research of "Study on Medical Delivery Management based on Community Health" (No. 70333002) which was a major project of Natural Science Foundation of China and "Model construction and simulation of medical demand in China and Study on structure of Health Delivery System" (No. 70173038) which was a surface project of Natural Science Foundation of China.OBJECTIVESThe study based on the complex science and systems engineering theory, using all kinds of health research techniques synthesis, adopting system dynamics modeling technology mainly, by analyzing on the current situation of potential medical demand in China, know the serious degree and influence factor of potential medical demand in China. The study constructs the conceptual model to determine its boundary and main bodies. The studyconstructs the logical model to explain what the main reason of the question is. The study constructs the system dynamics model, simulate the model and do intervention experiment to get the transformation way and mechanism of the question. In the end, the study proposes the policy suggestion to the question.MATERIALSData used in this study includes the investigation material of earlier period by total topic, data of investigation of medical service in 1993, 1998 and 2003, data of statistic yearbook and bulletin of country during 1995-2005, data in 8 kinds of magazines such as "Chinese Journal of Hospital Administration" > "Chinese Health Economics" ^ "Foreign Medical Sciences" > "Chinese Hospital Management" during 1995-2005, data of focus group discussion.METHODSThe study uses the methods of description statistical analysis, logic analysis and system analysis to analyze the current situation and influence factors of potential medical demand in China. The study uses entity - relation method to construct conceptual model. The study uses the methods of multi- factor analysis, system archetype analysis, system thinking and brain storming to construct logical model. The study uses all kinds of the methods include system dynamics, econometrics, statistics, brain storming, scene investigation and so on to construct system dynamics model. Then the study uses system dynamics software platform-Vensim to do simulation and intervention experiment.RESULTSThe study analyzes the current situation of potential medical demand in China indicates that potential medical demand in China has been increased large and stays at a high level after 1990. Oppositely, the medical utility continues to drop displaying the abnormal phenomenon that "the supplies increase, the demands drop". It affects equity seriously of health delivery system in China. The main influence factors of potential medical demand in China mainly divide into three kinds. Firstly, demand factor. Disease degree is slight is the main cause of the relative untransformed potential medical demand. Economical difficulty is the main causes of the relative transformable potential medical demand don't go to hospital. Self- treatment has become the substitutiontreatment method if people don't go to see the doctor. Secondly, supply factor. One factor is the excessive high health expense which cause by external and internal reason. The external reasons refer to the ageing of society and the increasing in chronic non-communicable diseases which lead to the broad application of new drugs, new materials and the complication of health technology. The internal reasons refer to the unreasonable health resources disposition, the unreasonable compensation mechanism of medical institution, the unreasonable formulation mechanism of medical price and lacks of effective supervising and managing in health delivery system. The other factor is that health service is not available. Thirdly, medical ensure system factor. The main performance is that the coverage of medical ensure is not high and personal health expense proportion is excessively high.The results of analysis of conceptual model and logical model show that the question has four main bodies: medical service need, medical service provider, government and medical safeguard organization. The logical model explains what the main reason of the question is. That is under the transformation period of highly indefinite complex environment in China, health investment of the government drop, health delivery system aim to reach the goal to expand the scale and to grow technology, medical institution has function dislocation under the inversion resources structure of system, medical institution take the main compensates way by the service charge to the market, the medical safeguard system has low coverage fraction, health supervisor is lack of management. What mentioned above promotes mutually and affects together which lead to massive appearances of potential medical demand in the city and countryside inhabitant. At the same time, logical model also show the transformation mechanism of potential medical demand. The core is reconstructing resources structure of the system, the key is formulating necessary policy and improving the safeguard system.Systems-dynamics model simulation analysis result shows that in the invariable existing condition, the rate of who-should- be-hospitalized would increase the contradictory resources structure between the community and hospital would be more and more serious, the system simulation result will not be good.Intervention experiment of systems-dynamics model result shows that the basic reason of the transformation of potential medical demand is the contradictory resources structure between the community and hospital. In addition, potential medical demand would transform better in the time when the resources structure (fixed assessment) proportion reach 1.1:1 between the community and hospital.The policy advices of the transformation of potential medical demand are as follows: This is a systems engineering. First of all, the government should develop community health service of the city and strengthen basic medical institution of the countryside, construct the two levels structure which takes the community as the main body of health delivery system. Secondly, based of the structure foundation, the government should carry on the reasonable system arrangement includes establishing the perfect compensation mechanism of the medical institution and reasonable health service price, improving medical safeguard system to enhance the coverage fraction and reduce the proportion of self-pays, constructing mutually turns mechanism between hospital and community, strengthening the supervise and management of the system.Before this research, study of potential medical demand basically is in the blank and lacks of the quantification experiment tool. This study carries on the system theory and the experimental study of potential medical demand for the first time and has obtained the model system of potential medical demand in China which filled the blank of quantification experiment tool of potential medical demand and has provided the advanced quantification analysis simulation tool for the macro health policy formulation.This research is the first attempt used the method of systems dynamics in transformation question of potential medical demand. Because the model involves a lot of data and operates a lot of equations, the load work is huge. The next step we will strengthen the scene investigation and data acquisition, carry on the improvement to the model, enable it greatest degree to approach the realistic system.
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