应用系统动力学仿真方法预测卫生费用的发展趋势

Predicting the Development Trend of Health Expenditure Based on Methods of System Dynamics Simulation

目的:探索运用系统动力学方法分析卫生总费用影响因素,预测卫生总费用发展趋势,并提出相应对策。方法:根据文献查阅和专家咨询,得出人口数量、老年人口数量、GDP、政府卫生支出、药品费用和每千人口卫生技术人员数量是影响卫生总费用的重要因素,将这些影响因素纳入卫生总费用系统动力学模型,并进行仿真模拟。结果:经检验,模型预测值与历史数据(2002—2014)和官方预测值(2015—2020)吻合度较高,表明模型具有较好的稳定性与可靠性。仿真结果显示卫生总费用会平稳增长,预计在2025年将达到74 571.2亿元。结论:运用系统动力学模型预测卫生费用的发展具有可行性与可靠性,优于其他预测方法。为了控制卫生费用不合理增长,提出如下建议:增加预防投入,降低慢性病发病率;继续推动公立医院改革,完善基本药物制度;改变医院绩效考核导向,体现医务人员劳动价值。

Objective： To explore the usage of system dynamics analyzing the influencing factors of total health expenditure（THE）, forecast the trends of total health expenditure based on the method of System Dynamics and put forward relative countermeasures. Methods- According to the literature and expert consultation, the population, elderly, GDP, government health expenditures, drug costs and the number of health workers per thousand population were the important factors for THE. These factors were incorporated into system dynamics model for total health expenditure and conducted the simulation. Results： Based on the examination, the simula- tion results highly corresponded to historical data （2002--2014） and the official forecast （2015--2020）, which showed that the model had good stability and reliability. The simulation results showed that steadily increasing total health expenditure would reach 7 457.12 billion yuan in 2025. Conclusion： The system dynamics approach had superior characteristics to other projection methods in terms of stability and reliability. In order to control the irrational growth of total health expenditure, it needed to increase the prevention invest- ment, decrease the incidence of chronic diseases; sustainably improve the reform of public, hospitals, implement the basic drug system; change the income-oriented performance appraisal to realize the labor value of medical staffs.