The System Dynamic Model And Policy Intervention Experiments Of Integrated Healthcare Delivery System In China

The construction of an integrated healthcare service system with quality services and people’s satisfaction is an important decision to implement the "Health China" strategy.With the rise in consumption levels,the incidence of chronic diseases such as cardiovascular and cerebrovascular diseases and immune system diseases continues to grow,posing new challenges to the integration of healthcare services.Although China has been committed to developing a collaborative healthcare service system since the new healthcare reform,the problem of fragmentation of healthcare services has yet to be significantly improved.So,what are the dilemmas facing the integration of healthcare service systems at this stage? What are the factors that affect the construction of an integrated healthcare service system? What are the causal and logical relationships between the various factors? How might the implementation of key integration intervention strategies in the construction process change the system? This study attempts to develop a system dynamics model to find potential explanatory pathways for these questions,and to provide scientific evidence to support the full implementation of health service integration practices in China.In view of this,this study compares the evolution of policies related to health service integration through literature analysis,understands the construction model of integrated service system and local practices,and analyses the structure of system components and internal and external influencing factors;using system dynamics modelling method,it firstly establishes a visual system logic model to reveal the causal feedback relationship of each sub-system factor;then constructs a physical model based on causal loop analysis,combines with The physical model is then constructed based on causal loop analysis,combined with hierarchical analysis expert scoring to calculate the weights of qualitative variables in the model and establish the equation of system functional relationship;finally,the trend of system behaviour changes after the implementation of the intervention strategy is simulated through simulation experiments to support the effectiveness and feasibility of the integrated intervention strategy.The study found that(1)different regions have different patterns and levels of integration,but the dimensions and elements of integration are similar,and there are resource structure,organisational structure and management structure barriers to the integration of health care delivery systems.(2)Factors affecting integration can be classified as supply-side governance regulation,professional service synergy mechanism,resource allocation,value norms,information technology construction,benefit incentives,demand-side perceptions and cognition,income level,health status,and external environmental factors such as political,economic and demographic factors;(3)Based on the causal loop diagram and SD diagram,four interventions were identified: benefit incentives,information technology construction,resource allocation,and perceptions and cognition(3)Four intervention targets were identified based on the causal loop diagram and SD diagram: benefit incentives,information construction,resource allocation,and perception and cognition.(4)From the simulation results,both reasonable single-strategy and mixed-strategy measures can promote the construction and development of an integrated health care service system to varying degrees after implementation.When the benefit incentive level is raised to 2,the primary care consultation rate will reach 70%(about 53% in the original scenario)and the upward and downward referral rates will be close to 20%,saving 197.62 billion yuan in direct medical costs by 2025,while after the benefit incentive level is raised to 3,the primary care first consultation rate and two-way referral rate continue to increase,but the total number of hospital and primary care consultations rebound,and the cost control effect is not as good as in scenario 2;when the information technology construction When the level of information technology construction is raised to 2,the primary care consultation rate can reach 64% by2025,saving RMB 150.46 billion in medical costs;when the level of perception and resource allocation is raised to 2,the primary care consultation rate will reach 62% and 56%respectively,but the increase in the upward and downward transfer rates will be smaller,reducing direct medical costs by RMB 203.05 billion and RMB 61.04 billion respectively by2025.Based on the findings of the previous study,the following policy recommendations are put forward for reference: firstly,optimise the mechanism to promote synergy of interests and coordination of incentives for adaptation,so as to inject "stabilisers" into the implementation of integration work;secondly,enhance the capacity of digital information application and deep nesting with health services;thirdly,co-ordinate the allocation of resources,strive to narrow the regional gap,promote Thirdly,we should co-ordinate the allocation of resources,strive to narrow the regional gap,promote the expansion and sinking of quality resources,and continuously enhance the capacity of primary health services.Lastly,efforts should be made to resolve the conceptual and cognitive difficulties and to properly grasp the value of integration.