Study On Chinese Public Health System Simulation And Policy Intervention

In the 20th century most important progress on humanity health should give credit to the development of public health, and not only this viewpoint internationally obtained mutual recognitions of many national, also obtained the full proof in the various countries' health and in the development practice of healthy. Public Health System (PHS) takes realizing the function of public health service and enhancing the benefit of public health resources as a goal, whose purpose is promotion to the crowd health and prevention to the diseases. But since the thought about"the emphasizing medical service and neglecting prevention"has an effect and PHS has problems about compensation mechanism and so on in our country, these all limited the function of PHS. Specially in 2003, the SARS affairs has token the painful experiences and the lessons to us, and left many painful ponders to us, which has caused the government, the society and the populace to pay widespread attentions to PHS. Premier Wen Jiabao explicitly set the goal of PHS in the national working conference about preventing and controlling SARS affairs:"Striving in about three years, establish and perfect Emergency Management System of Public Health, Disease Control and Prevention System and Health Inspection and Supervision System. And in a longer period, consummate Rural Health Delivery System, Urban Medical Delivery System, Health Science Propaganda System and Financial Funds Safeguard System."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.PHS is an extremely complex large-scale system, and the intuitions and the subjective judgments to this kind system are unreliable. The practical tests is not nearly feasible, thus we need seek help from computer simulation which bases on the systems dynamics.This study reviews the historical development of PHS, and in the foundation with analyzing the current situation of demand, resources organizational structure as well as service utility and so on descriptively, diagnoses and the analyzes PHS, which focus on the imperfect structure system of organization manages of PHS, the low efficiency of system function, insufficient input of the government and the unreasonable resources structure and so on. Adopt all kinds of the methods including health economics, the econometrics and the complex systems science modeling technology statistics to construct the conceptual model, the logical model and the SD model of PHS in turn. The SD model is used in making the quantitative analysis, simulating the behavior and doing intervention experiments. Analyzing and establishing the system boundary and the system main body of PHS, we conduct simulating the complex behavior of PHS behavior to obtain its behavior characteristic, carry on the policy intervention experiment of PHS, propose the related policy suggestion, and provide the supporting theory for the policy research of public health.Data used in this study includes the investigation material of earlier period by total topic, data of three nation health service investigation documents in 1993, 1998 and 2003, data of and the statistics bulletins of Nation Ministry of Public Health during 1995-2005, data in 10 kinds of magazines such as , , , , , , , during 1997-2006, as well as national documents related with PHS and so on.Research methods: According to the general research frame of chief project, through analysis to the current situation and the system structure, adopt descriptive study and systems dynamics method to analyze main structural issues of PHS. Adopting meta analysis, confirm the main problems of PHS. Adopt system analysis method to construct conceptual model of PHS. Adopt the methods of multi- factor analysis, system analysis and connection analysis to construct logical model of PHS. Adopt all kinds of the methods include system dynamics, econometrics, statistics, expert consultation and scene investigation to construct system dynamics model. Then the study uses system dynamics software Vensim as the SD platform to do simulation experiments and intervention experiments. And put forward the PHS development policy proposal in this foundation.Main research results are listed here:The results of the current situation analysis: The PHS in China has passed through the period of near 60 years which has developed from the initiation stage, the function consummation stage, the reform stage and the latter SARS stage, has completed gradually from the foundation period, development period to the transition period. But in the current reforming time of the market economy system which experience from initial establishment to the perfect system, and along with the continual readjustment to country industrial structure and the quickening advancement of health service industrial, Health Delivery System has experienced from"emphasizing prevention"to"emphasizing medical service", from the low cost to the high tech and the higher cost, and its movement mechanism has experienced from the pattern with"emphasizing prevention primarily"into the pattern with"emphasizing medical service and neglecting prevention". The performance is the imperfect structure system of organization manages of PHS, insufficient input of the government and the unreasonable resources structure and so on.The results of qualitative logic analysis: Internal main body of PHS in China is composed with the government, the public health service organization and the crowd. The exterior main body of the system includes urban medical delivery organization, community health service organization, rural health delivery organization and so on. The public health service organization has mutual relatedness with them in the structure and the function, and they affect mutually. The finance of the public health service organization main origin from the government's financial investment and the compensated service income, and the fund is used in purchasing and maintaining the outside resources and the inside resources. At present the government's compensation mainly is according to the personnel wages which is used in the public health service organization, and is not based on public production quantity which public health service organization provides, so it creates interior insufficient stimulation in PHS. In the scope with the policy permission, in order to compensate gap between the revenue and the expenditure, the public health service organization enlarges the compensated service unceasingly. Then it causes the function of the public health service organization to be low and cases free service with difficulty, and PHS cannot promote the crowd health effectively.The results of systems-dynamics model analysis: The SD model index of PHS has the public product rate and the public production output. We explain those from two parts which are the Disease Control and Prevention Subsystem and the Health Inspection and Supervision Subsystem.The results of model simulation and intervention experiment of systems-dynamics model: The results of systems-dynamics model simulation show: The behavior characteristic of PHS providing public production primarily both has the general health characteristic and has own problems of uncompleted PHS in China. Under the structure condition which presents"emphasizing the medical and neglecting prevention"in the macroscopic system, PHS mainly performance the difficult condition which is the deficient of the system resources and the difficulty of the function realization. The results of intervention experiment of systems-dynamics model show: The government's investment changes to PHS affect greatly the system public product rate. The compensation level to workers who are engaging in the free service affects greatly the public product rate of Disease Control and Prevention System. The enlarging compensation level which the government inputs to the workers of PHS, can increase achievements of PHS. In the system, the standard compensation to different category workers should be different according to the work nature. The policy advices of the development of PHS including: Enlarging government finance investment to PHS, controlling compensated service charge of public health, straightening out operational mechanism of the supervision and law enforcement to the public health.Through constructing the conceptual model this study determines the object, the category and the boundary of the composition and the main problems of PHS, through logical model qualitatively analyzes this system behavior characteristic and formulation reasons and mechanisms of the main problems, through SD model quantitatively analyzes and simulates behavior rule and makes the intervention experiments, and obtains its policy solutions. These series of model constructions and the simulations is making in turn, and has the theory and the data. It may consummate unceasingly through refining the model, and provide the powerful theory, the data support and the help for the government policy-makers to formulate the macroscopic health policy as'policy laboratory'.This study focus the imperfect structure system of organization manages of PHS, the low efficiency of system function, insufficient input of the government and the unreasonable resources structure and so on. The study begins from two aspects about the supplies and the demand, and it takes the complexity of system internal structure as the key point, which has conducted comprehensive fundamental research to the complex system structure of PHS in China. This study set up the Systemic Dynamics model of PHS as the simulating"Laboratory", simulated the system structure, regulation, health policy and external environment of PHS in China, obtained the dynamic behavior characteristics and changing mechanism of it. This kind of method bases on the model construction dynamic policy research under the system thinking, and changes primarily tradition methods in the past which is statistical, static, qualitative. It provides the advanced quantizing analysis and simulation tools for the research of the public health policy, is the first time attempt in the domain of PHS.PHS is a complicated system. This study is the first attempt used the method of SD in PHS. Because of the PHS has the character of multi-input, multi-output, non-linearity and converse-frank and its function relates more factors, and there are also much more influence factors and complexity relationship. The SD model involves a lot of data and operates a lot of equations, the load work is huge. And because of the limited academic level, time and energy of the author, at present the completed behavior simulations and policy interventions are only based on the established main structure and the established logical relations of PHS. The SD model we built needs further to refine, and the logical relations and the functional relations need to revise unceasingly, and the behavior characteristic of the main body needs further to consummate. The next step we will strengthen data acquisition, continue to refine each kind of variable, complete the debugging and refinement of the model, and enable it greatest degree to approach the realistic Public Health System.