Modeling Health Care Systems - An Approach Using Routine Health Care Data

摘要

Routine health care data are one source of information for models of health care systems. They are particularly important when parameterization from peer-reviewed literature and expert knowledge alone is not possible. In this work we describe a model of extramural health care and its reimbursement. It is agent-based, object-oriented, and includes two different agent types: patients and medical providers. Patients develop medical problems, whereas the model includes several different chronic diseases. As a result of their medical problems the patients consult medical providers, and this leads to provision of services and furthermore to reimbursement according to an exchangeable reimbursement system. Several parameters were estimated from available routine care data, for example prevalence of diseases, incidence rates, and mortality rates. The paper presents this approach and shows also which assumptions were made that lead to emerging treatment pathways, where only frequency distributions of health service need per medical problem and medical provider service portfolios serve as input.