Study On Chinese Community Health Service System Modeling And Related Policy

Central government repeatedly stressed that "The development of community and health services is the important point to optimize allocation of health resources, effectively ease the problem that people seeking medical treatment is difficult and expensive , as well as the intersection to spur up and promote the comprehensive reform of health, "bearing the transition period for reform, protect the livelihood of the people and to promote the importance of harmony, and introduced a series of policies encouraging the development of community health services. But through literature review and on-site investigations, Research shows that the status of urban community health services and the level of development is still not satisfactory pace, public health network hasn't played the end of the basement or basic medical role. Therefore find urban community health service constraints, access to the rule of its development and internal drive mechanism, explore high sensitivity and workable "highly leveraged" policy solution ,it also can provide theoretical and methodological basis for optimizing regional community health service resources, the government level and means of supporting and developing policies to, can promote community health services faster and better, improve health service, with a strong practical and academic value.Research by funding of key projects in the National Natural Science Foundation "population-based health services management in the medical research" (item approved: 70333002).Based on health policy and management, complex science, system dynamics theory, qualitative research and quantitative research. We apply description research and analytical studies of the combination of statistical methods , single factor analysis and multivariate methods, Meta-analysis, empirical analysis, complex scientific modeling techniques to survey the scene, existing data and information on the use of expert advice, based on the urban community health service system analysis of the situation clear their development status and factors influencing, summed up the major problem; By building urban community health service system conceptual model of clear and the main border; By building urban community health service system logic model systems thinking, problem revealed the structural factors behind; By building urban community health services SD model and simulation, experimental intervention, a clear trend in the future development system, access to its development mechanism and laws, and explore valuable policy interventions and strength, and corresponding policy recommendations. The main sources of information are the national scene 95 counties (districts) in the 2000-2005 range of services volume, quality, health costs and health resources index; population and health services demand and use of indicators; supplementary sample survey of 12,000 people, 47 health institutions including survey, , More than 100 expert advice and interviews questionnaire, more than 30 times the feasibility studies.Existing data collection and use, including in 1993, 1998 and 2003 three times the national health services survey analysis; 1995-2006, the National Statistics Year book and more than 400 copies of the information statements health reform documents; domestic and international inspection of the community health services, general medical (physician), health education, medical insurance, micro-distribution of health resources, complex scientific research and system dynamics modeling of the various documents more than 500 articles and summarized analysis.Study Methods: Applying descriptive statistics, analysis and logic analysis, Analysis urban community health service system status and the factors, and related domestic and international comparison. Using entity-relationship to construct conceptual model of urban community health service system; construct logic model of urban community health service system by multi-factor analysis, correlation analysis and association analysis; integrated use of System Dynamics. Econometrics, statistics, expert advice, on-site research and other methods, a complex scientific research "restored" as a guide, build a community health service system SD model , use Vensim software simulation and experimental intervention and model software.The main findings are as follows:Current Status: 1. China's urban community health service development for the six models, which are suitable for cities with different levels of health resources allocation. 2. Community health services system is incomplete, inadequate system resources. Community health services develop slowly, the issue what people seeking medical treatment is difficult and expensive remain outstanding, and crowd can not effectively meet the needs of the community health service. 3. Community health service institutions function is not perfect and lack of competitiveness. Community health service agencies often prominent medical function weakened public health services and make their own convergence to the purely medical institutions, inefficient system without health system as a whole basement.Analysis result of concept model and logical model: clear system as providers to the main crowd, community health service, the government and medical protection agency, the main inter-linked with the role of the combined effects development and existence of community health service system, explain the underlying reasons for system 1. Overall system is inadequate 2. Within the system, health resource allocation is unscientific, 3. The residents'trust of community health services was low. Logic model reveals the problems with the way the conversion and mechanism, within the main driving factors and related circuit, SD model for building a systematic distinction between reasonable modules.Simulation results of SD model: The simulation results more intuitive picture of the USA after the establishment of the slow development of the situation, proven system of health resources "inverted triangle" of the status quo. suggest community health service system with "structure determines function," the basic law in the regulation system, structure and the level of investment under the same circumstances, CHS development to be restrained, limiting the treatment of community residents to choose; Meanwhile System keen on the rich enjoy quasi-public services to affordability of the services sub-groups, system causing the effective coverage of the crowd gradually dwindled. For advance public health services into weak, unable to take up the public health system, the end of the network, the supply of medical services gap is too large, system unable to meet common diseases and chronic diseases clinics demand.Intervention results of SD model: 1. Government increase input (capital and financial health resources) and the expansion of Medicare-based assessment of the effective means of intervention: The government community health service system annual inputs (capital and financial health resources) to 100 billion Yuan a wide margin. 2. Raising Medicare coverage of community health services for sustainable development is of great significance to three. For policy means, such as the strengthening of institutional control and monitoring of community health service quality personnel system reforms and Drugs payments assessed two lines needed further study.Promoting urban community health services, rapid development of the policy recommendations: 1. Adhere to community health services for the benefit of nature, perfect service functions. 2. Taken a number of means, and get rid of social capital to enter the industry barriers, efforts to increase investment in community health. 3. Strengthening community health services in property management. 4. Social health insurance and community health services leveraging each other's development trend.Before this study, using complex science research tools for modeling urban community health services is in the development gaps. This is the first of our urban community health services in the macro health policy experimental study from the urban community health service system model and software ( "Simulation Laboratory") filled the macro-policy community health service gaps in the experimental tools, macro health policy for the development of advanced simulation tools for quantitative analysis.In this study, it's the first time for System dynamics to try modeling of urban community health service system, as huge data, lots of equation large ,enormous workload; and health services to communities throughout the disparities in the level of development, influencing factors and data screening fold, the next step will strengthen research data collection, the model improvements make it close to the maximum extent practical system.