Macro-level healthcare system model?

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This forum supports discussion on topics of specific interest to the Health Policy Special Interest Group of the System Dynamics Society. It is currently unmoderated, and anybody who is signed in may post to the forum.
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J. Chris White
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Joined: Wed Feb 11, 2009 4:20 pm

Macro-level healthcare system model?

Post by J. Chris White » Wed May 06, 2009 10:13 am

I am doing some research on models of the overall healthcare system for the U.S., including high-level interactions among patients, insurance companies, care providers, policies, etc. They do not necessarily have to be SD models. Are there any "commonly accepted" models that I should be aware of? Or, any models at all? So far, I have only found models that focused on one or two elements of the total system or models that look at one specific issue (e.g., flow of patients through an emergency room). Any guidance would be greatly appreciated.

Thanks,
J. Chris White
viaSim
972-722-9255
jcwhite@viasimcorp.com

Etiënne Rouwette
Posts: 20
Joined: Sun Feb 22, 2009 9:59 am

Re: Macro-level healthcare system model?

Post by Etiënne Rouwette » Thu May 07, 2009 6:03 am

Chris,

Some references that might be interesting are:

Hirsch, G. B., & Homer, J. B. (2004, July 25-29). Modeling the Dynamics of Health Care Services for Improved Chronic Illness Management. Paper presented at the 22nd International Conference of the System Dynamics Society, Oxford, England.
Ratanawijitrasin, S. (1993). The Dynamics of Healthcare Finance : A Feedback View Of System Behavior. Unpublished PhD. Dissertation, State University of New York at Albany, Albany, N.Y.
Verburgh, L. D., Gubbels, J. W., Post, D., & Vennix, J. A. M. (1990). Model-Based Analyses of the Dutch Health Care System. Paper presented at the System Dynamics ‘90: Proceedings of the 1990 International Systems Dynamics Conference, Chestnut Hill, Mass.
Verburgh, L. D. (1994). Participative Policy Modelling : Applied to the Health Care Insurance Industry. Unpublished Ph.D. Dissertation, Nijmegen University, Netherlands.

Best regards,

Etiënne Rouwette
Radboud University Nijmegen

James Thompson
Posts: 44
Joined: Sun Jan 11, 2009 11:41 am
Location: Farmington, CT USA

Re: Macro-level healthcare system model?

Post by James Thompson » Thu May 07, 2009 8:28 am

Chris,
In my WPI Health Care Dynamics course (SS 590), we develop a macro-level health care system model. Throughout the course, we read about health care sectors and issues, simplify the issues into a few loopsets, formulate and simulate. The goal is to tie all of the sectors together and test policies to observe how changes in one part of the system ripple or cascade through the whole system. The emphasis is on utilisation; cost and price elasticity are secondary considerations in this model form.

To provide the class with a problem focus, we study the U.S. health care system, but students in other countries have found the principles to be the same. That is, the issues and structure are very familiar and the model is configurable. The sectors include population, demand and utilisation management, capacity dynamics, technologies and the like. Parameters are developed from publicly-available datasets.

The classroom version of the model is scaled down from larger policy testing and predictive models that I developed for commercial use. The larger models include much more on payer economics (including effects of actuarial assumptions and funding mechanisms), effects of medical errors and malpractice insurance, and so on. The forecasting version was ‘built along side’ the policy testing version and includes options to feed in some limited datasets such as the pharmaceuticals approval pipeline.

There is a somewhat dated description of the models and how they were developed in a 2006 Nijmegen conference paper: http://www.systemdynamics.org/conferenc ... OMP384.pdf
Regards,
Jim Thompson
+1 860 676 8152
jpthompson@wpi.edu
james.thompson@strath.ac.uk
Jim Thompson
jimthompson@live.com
jpthompson@wpi.edu
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John Rodat
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Joined: Wed May 20, 2009 10:40 pm

Re: Macro-level healthcare system model?

Post by John Rodat » Wed May 20, 2009 10:55 pm

Chris

Though it would certainly not fit the category of "generally accepted," I did one in the 1990s that I'm still comfortable with. At the annual meeting in Quebec (whatever year that was), I presented part of it that focused on regulators and and behaviors in response. The core model included three types of coverage status for the population (uncovered, having indemnity or service coverage or managed care coverage). The model also included economic responses to coverage including both price and service use, their effects on premiums, and, closing the loop, the subsequent effects on coverage.

The early, more generic versions, were lost in a fire, but I have some others. They were done in iThink. I'd be glad to discuss offline if you like.

Best regards

John W. Rodat

Geoff McDonnell
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Joined: Tue Jan 13, 2009 2:38 pm
Location: Sydney Australia

Re: Macro-level healthcare system model?

Post by Geoff McDonnell » Mon Jun 29, 2009 4:30 pm

I dont believe there are any accepted models. The WHO Health Systems Performance Framework http://www.who.int/health-systems-performance/ is a good place to start.
More recently, a systems of systems approach is emerging, with the healthcare system located within a wider social context which include the social determinants of health.
http://www.who.int/social_determinants/en/

With my colleagues Mark Heffernan, Keith Masnick and John Dewdney I have been compiling some material and models on this.
I will try to upload a simpler picture (or contact me)
HealthCare System.png
HealthCare System.png (27.89 KiB) Viewed 18028 times

James Thompson
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Joined: Sun Jan 11, 2009 11:41 am
Location: Farmington, CT USA

Re: Macro-level healthcare system model?

Post by James Thompson » Tue Jun 30, 2009 7:45 am

Regarding "the overall healthcare system for the U.S., including high-level interactions among patients, insurance companies, care providers, policies, etc. ", Karim Chichakly blogged on the structure of the model used in the WPI Health Care Dynamics course, SS 590. See http://blog.iseesystems.com/stories-fro ... rchically/

At one time, Millennium Institute's Threshold 21 model had a medical care sector, but I haven't looked at that model in 10 years and the sector may have been changed. The original was written by Bob Eberlein and could be calibrated with World Bank publicly available datasets.
Jim Thompson
jimthompson@live.com
jpthompson@wpi.edu
+1 860.796.2428

Geoff McDonnell
Posts: 26
Joined: Tue Jan 13, 2009 2:38 pm
Location: Sydney Australia

Re: Macro-level healthcare system model?

Post by Geoff McDonnell » Mon Jun 21, 2010 6:18 pm

A paper explaining the diagram previously posted on this thread has been published online
Masnick K and McDonnell G. A model linking clinical workforce skill mix planning to health and health care dynamics http://www.human-resources-health.com/content/8/1/11

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