Assessing the Economic Performance of Health Service Systems.

摘要

A method for assessing the economic performance of health service systems is explained through the presentation of two models. Two requirements are considered necessary for economic assessment: the method must be able to deal with the complex set of relationships between a system's structural and behavioral characteristics, and the method must be able to deal with changes that occur in a system as it adapts to demands. Examples of structural characteristics would include the method of payment for services and the availability resources, and an example of behavioral characteristics would be the number of patient services provided per unit of time by a particular resource. The 'system dynamics' techniques described involved simulation modelling with a specialized computer simulation language called DYNAMO. The ambulatory care system (ACS) model represents a generic ACS. Individual ACS's can be represented by changing the array of structural attributes. There are two emphases, physician decisionmaking and workload. The major elements are general practitioners, internists, and specialists. The comprehensive health planning model includes acute and long-term inpatient and and home health care for each of several regions within a State. The model allows different combinations of actual resources to be evaluated through simulations. Charted illustrations are provided.