社区卫生服务未来发展趋势的建模与仿真研究

Model Building and Simulation of the Development Trend of Community Health Services in China

目的探索社区卫生服务的未来发展规律和变化趋势。方法本研究围绕社区卫生服务功能的提升,根据社区卫生服务的特点及发展情况,运用系统动力学仿真理论和方法,确定社区卫生服务系统发展中的核心变量,从系统内部结构着手建立政策模拟的仿真模型及变量方程,采用系统动力学仿真软件Vensim,对社区卫生服务的未来发展趋势进行模拟和预测。结果确立社区卫生服务正常运行中的医疗服务、人力资源、医疗设备及经济状况四个子系统,确定诊疗人数与住院人数为医疗服务子系统的核心变量,卫生技术人员数为人力资源子系统的核心变量,万元以上设备价值总额为医疗设备子系统的核心变量,机构收支差为经济状况子系统的核心变量。最终得到2020年诊疗人数、住院人数、卫生技术人员数、万元以上设备总价值、收支差的预测值分别为222 711.0万人次、1 397.6万人次、728 185.0万人、9 470 150万元、-197 499万元。结论未来社区卫生服务机构的诊疗人数、住院人数、卫生技术人员数、万元以上设备总价值呈逐步上升的趋势;收支差有波动,但是波动幅度不是很大,保持着收支平衡的客观规律。

Objective To explore the pattern and trend of the future development of community health services（ CHS）.Methods The study focused on the promotion of ＂ six- in- one＂ function of CHS.Based on the characteristics and development status of CHS and using the simulation theory and method of system dynamics,the kernel variables of the development of CHS system were determined,and the policy simulation models and variable equation were established within the inner structure of the system.By using the simulation software Vensim,the simulation and prediction of the future development trend of CHS were made.Results Four subsystems of the normal function of CHS were established,including medical services,human resources,medical equipment and medical equipments.The number of people receiving diagnosis and treatment and the number of people being hospitalized are the kernel variables of the subsystem of medical resources; the number of health workers is the kernel variable of the subsystem of human resources; the total value of equipment worth more ten thousand yuan is the kernel variable of subsystem of medical equipment; the gap between revenues and expenditures is the kernel variable of the subsystem of economic system.The number of people receiving diagnosis and treatment,the number of people being hospitalized,the number of health workers,the total value of equipment worth more ten thousand yuan and the gap between revenues and expenditures in 2020 are 2 227.11 million,13.976 million,7 281.85 million,94 701.5 million and- 1 974.99 million.Conclusion The number of people receiving diagnosis and treatment,the number of people being hospitalized,the number of health workers and the total value of equipment worth more ten thousand yuan have been increasing.The gap between revenues and expenditures has up and downs,while the fluctuation is not distinct,which is common due to the objective law of balance between income and payment.