The Study On System Dynamics Of Community Health Service Institutions Under The Background Of Essential Medicine System

Objective Based on the survey of the implementation of NEMS(National Essential Medicine System) on the community health service institutions of Shandong province, using the questionnaire designed by our research teams, this study systematically analyses the impact of NEMS on the community health service institutions with a combination of quantitative and qualitative method, which include the human resources, the financing, the level of charge and so on. Using SD(system dynamics) to predict the development trend of NEMS on the community health service institutions in above aspects;the strategy analysis method is applied to find the operation of community health service institutions under the background of NEMS on the community health service institutions. On this basis, proposing targeted advice to improve relevant policy and further promote the implementation of NEMS on the community health service institutions.Method A questionnaire was designed based on the information derived from literature review, in-depth interview and focus group discussion, and it was improved through the pre-investigation. Using descriptive analyis(Mean, Constituent Ration), we described the basic case of the community health services under the background of NEMS, including the human resource, financial revenue and expenditure, service function and so on. SD was used to construct mathematical models and predict the trend of human, financial and service function of the community health services in the future. According to the “run behind one’s expenses” problem of the community health services under the background of NEMS, we analyzed the influence of each part of the income on expenditure by using the method of panel data. On this basis, scenario analysis was used to identify the situation of the community health services under the background of NEMS, so as to put forward countermeasures and suggestions with the help of management science, policy science and economics related knowledge.Results Under the background of the implementation of NEMS, there is a little effect on expertise team construction in community health service institutions, and the problems of deficiency staffs,lower-degree,lower professional title and the aging of personal had not been changed yet. After the implementation of NEMS, the total amount of community health services staff will change little in the future with the increasing of the workload, working pressure and work difficulty. In financial terms, financial condition of community health service institutions varied widely after the implementation of NEMS. There was an obvious decrease in medicine revenues, and the total revenues increased, but the deficit was gradually increasing. By simulating the future trends, we find that income will be greater than expenditure in the future of community health service institutions. The outpatient income and financial investment were statistically significant to expenditure by panel date analysis. In service function, after the implementation of NEMS, the two main basic medical services, which are Community Health Services and Public Health Services, had changed significantly. Under the "zero error rate" policy of NEMS, the community health service institutions’ patients are increasing, but the restriction of NEMS list as well as the inadequate of medicine supply and delay can reduce the types of medicines available. What’s worse, government subsidy of the "zero error rate" is very little, as a result, the community health service institutions’ basic medical burden is heavy and the basic medical services function is weakening. Basic medical’s high workload and low income make some of community health service institutions focus their energy on public health services, so public health services’ workload increases and its’ function gets much more attention, and the function of community health service institutions’ basic medical service and public health service are losing their balance.Conclusions After the implement of NEMS, the quantity and quality of staff in community health service institutions needs to be further improved. The phenomenon that expenditure is more than income is more serious, so balance of payments structure needs further adjustment. The function of community health service institutions in the "six in one" can not effectively play. Through the comprehensive verification of qualitative and quantitative data analysis, we find that the operation of community health service institutions in Shandong Province under the background of NEMS is still at the scene without mutation, and there are some problems in the implementation process of the system, which needs more attention of the relevant departments. Otherwise, it will be harmful to the healthy and orderly operation of community health service institutions. Therefore, based on the results of the study, with the help of management science, policy science and economics related knowledge; we put forward some countermeasures and suggestions to promote the sustainable development of community health service institutions under the background of NEMS from three aspects that is human, financial and service function.