Biomedical Engineering, Vol. 36, No. 6, 2002, pp. 344-347. Translated from Meditsinskaya Tekhnika, Vol. 36, No. 6, 2002, pp. 40-44.Original article submitted March 21, 2002.

0006-3398/02/3606-0344$27.00 2002 Plenum Publishing Corporation344

Systems Analysis and Simulation of Regional Health ServiceManagement

Ufa State Aviation Technical University, Ufa, Russia; E-mail:buharbaeva@asu.ugatu.ac.ru

L. Ya. Bukharbaeva

Public health service is a complicated social systemfor protection of peoples health. According to the WHO,the efficiency of public health service is one of the mainfactors determining the general state of health of apopulation. Its contribution to the general state of healthof a population is assessed at 10-15%; other majorfactors are the way of life (50-55%), environmental factors(20-25%), and heredity (20%). A diagram shown in Fig.1illustrates the interrelation between the factors deter-mining the state of health.

On the other hand, public health service is a com-plicated sector of the national economy involving bothhealthcare expenditure and profits due to restorationof the ability to work.

Thus, public health service can be attributed to aclass of complicated systems possessing the propertiesof memory, heredity, and delayed aftereffects [5]. Theseproperties are mainly due to human factor and theyaffect such areas of public health service as investment,control, stimulation measures, etc.

The theory of control systems can be used forimproving the structure and efficiency of the system ofhealth service management [1]. Health can be consid-ered as one of the main factors determining the effi-ciency of social production. Development of this eco-nomical sector sets the following urgent problems:

development of models for assessing the resourcepotential of health service;

development of methods for mathematical simu-lation of the health service system (for the purpose ofoptimization of the management system).

As a preliminary stage to solution of these prob-lems, systems analysis of health service managementshould be performed. The goal of systems analysis isto determine the optimal ways of development of thehealth service system providing maximal social andmedical efficiency and minimal expenditure of all typesof resources (physical, manpower, intellectual, innova-tional, financial, information, etc.).

Cognitive structuring (one of the methods of systemsanalysis) is a useful method for imaging and analysis ofsystems [1]. It is a modification of the graph theory methodfor simulation of problematic situations in socioeconomicsystems. The goal of cognitive structuring is to generateand refine hypotheses concerning functioning of the objectunder consideration. The object is considered as a com-plicated system involving various elements, subsystems,factors, variables, etc. A structural diagram of cause-and-effect relations is constructed to analyze the func-tioning of the complicated socioeconomic system.

The diagram shown in Fig. 1 can be considered asa cognitive map representing the cause-and-effect re-lations between various factors. If the contributions oftwo factors are directly proportional to one another,the link between them is labeled with +; if inverselyproportional, . The cognitive map includes severalloops: some of them (positive feedback loop) enhancefactor divergence, while other loops (negative feedbackloop) reduce it. The majority of feedback loops arepositive, which shows that the system under consider-ation is unstable and constantly developing.

Under conditions of centrally planned economy, statebudget was the main source providing funding of thepublic health service. Crisis of national economy andbudget deficiency resulted in financial and economiccrisis of the public health service. This crisis can be

Economics and Organization

345Simulation of Regional Health Service Management

roteH

resolved only by reforming the economic relations, partialprivatization of state property, and wide introduction ofinsurance medicine. The budget-insurance model offunctioning of regional public health service determinesthe following four finance sources for public health:

budget; republic foundation for obligatory medical insur-

ance (FOMI); voluntary insurance foundations (VIF); private means of people (commercial medicine).The first source (budget) provides 70% of the fi-

nancing; VIF, 3-4%; the contribution of commercialmedicine is 1.5% of the total financing amount [6].

The cognitive map shown in Fig. 2 can be used forthe analysis of the financial infrastructure of publichealth service management. The multicomponent sys-tem of financial management of public health serviceincludes finance sources and other functional subsystemsand consists of a number of positive and negative feed-back loops. The problem of optimization of the financ-ing system is one of the most urgent problems of re-gional public health service.

The problem of optimization of relationship betweendifferent sources of funding and effective use of eachsource of funding under conditions of funding cuts is aserious problem of the republic level of responsibility.

Public health service is a subsystem of the commu-nity, the main purpose of which is to preserve andimprove public health by providing medical service,hygienic and sanitation control, lecturing, etc. Theexperience of many countries showed that marketeconomy alone (i.e., without state support) was unableto provide effective functioning of public health servicesystems [6]. For example, hygienic and sanitationcontrol, prevention of infectious diseases, epidemiologi-cal control, etc. are not social commodities. It is obviousthat such services should be managed and funded by thestate. Such measures are usually implemented in largeterritory and funded by budgets of different levels.

Effective management of budget funding is a suffi-ciently complicated and important problem. Limitedbudget resources make it necessary to optimize fundingdistribution between medical organizations to attain themaximum social effect. The multilevel organization of

Fig. 1. System of factors determining the general state of health of a population.

346 Bukharbaeva

the budget system makes it necessary to take into accountthe interests of various sides in public health planning.

In this work we considered optimization models ofbudget funding management in public health. Thesewere models of optimal planning of public healthprograms.

As noted above, public health service measuresshould be managed and funded by the state. Usually,the public health service measures of that type are fundedby budgets of different levels and managed by specialmanaging organs.

To construct optimization models of budget fund-ing management in public health, let us introduce thefollowing definitions:

M1, ..., Mi, ..., Mr is the list of measures that canbe implemented in a given territory; Bi is the cost ofthe ith measure; P1, ..., Pj, ..., Pn are the budget rep-resentatives interested in implementation of givenmeasures; R are the financial resources of the manag-ing organ itself; Y = (y1, y2, ..., yr) is the vector ofpriority of managing organ.

Let the program of measures be determined as thefollowing vector: g = (g1, ..., gi, ..., gr), where

1, if the ith measure is included in the programgi = 0, otherwise

Under conditions of limited resources there is aproblem of selection of an optimal set of measures fromthe list of possible measures in order to provide optimalfunding of all sides under conditions of limited resources.

Model 1 (minimum rights of budget representatives)

Let us introduce the following additional defini-tions:

Wj is the funding provided by each representative

to implement the program of measures;Xj = (xj1, ..., xji, ..., xjr) is the vector of priority of

the jth representative;Qj is the priority of each representative defined by

Eq. (1):

(1)

It is necessary to compile the program capable ofproviding the maximum extent of satisfaction of allparticipants and managing organ with resources:

Under conditions of limitation:

(2)

It follows from Eq. (2) that the problem of optimi-zation of the program of measures is a problem of

Fig. 2. Cognitive map illustrating the financial infrastructure of public health service management.

{

1: xWi

ijj =

.= jj

WW

Q

.max gy gxQi

iii

iijj

j +

. +i

jii

i R W Bg

Simulation of Regional Health Service Management 347

linear integer programming. The rights of the repre-sentatives in this problem are reduced to a minimallevel.

Model 2 (significant rights of budget representatives)

In this variant, budget representatives exert a sig-nificant effect on program formation through the maxi-mum volume of the funding allocated to implement eachmeasure. The managing organ distributes its own fundsover deficient programs.

Let Sij be the maximum volume of funding allocatedto measure Mi by representative Pj

where V1 is the deficiency of the ith program.If Vi = 0 then gi = 1, i.e., the measure is included

in the program.Md is the set of measures, in which Vi > 0.Therefore, own funds should be allocated as fol-

lows:

In case of limitation (3)

the funds of the managing organ belonging to the setM should be allocated as to take into account the interestsof the managing organ (3). It follows from Eq. (3) thatit is a problem of linear integer programming.

Depending on specific conditions, one or anothermodel can be used.

Thus, the process of the use of budget funds andformation of program is rather a complicated problemassociated with distribution of financial resources underconditions of limited funding. This problem can besolved using the optimization models described above.These models proved to be particularly effective in theRepublic of Bashkiria, which includes more than 50

.max:

gY i M M i

idi

R Vg i M M i

idi

:

administrative districts and 14 towns. These republicsubjects are able to provide funding of various sani-tation-epidemiological measures, e.g., against tic en-cephalitis and hemorrhagic fever, which are quitecommon in this region.

A model of the process of medical service priceformation with regard for the risk factor was developed[3]. This model is presently implemented as a part ofthe information system for management of the Dentalout-patient clinic, Bashkir State Medical University.

The model of financial flow management is the mostimportant element of the system for public health ser-vice management by VIF [2]. This model is used bythe Sotsinvest insurance company in the Republic ofBashkiria.

A model for optimizing the relationship between thefinancial flows of regional FOMI and VIF is currentlyunder development [4]. In the Republic of Bashkiriathese financial flows are separated, which makes itespecially important to provide their optimal correla-tion.

Thus, systems analysis of the financial infrastruc-ture of the regional public health service revealed severalimportant problems, such as the problem of simulationof financial flows for each of the four financial sourcesand determination of their optimal correlation. Imple-mentation of the developed models allows the efficiencyof public health service to be improved. Scientific andapplied research into these problems is performed atthe Laboratory for Simulation of Biological andBiotechnical Systems, Ufa State Aviation TechnicalUniversity.

REFERENCES

1. L. Ya. Bukharbaeva and R. V. Nasyrov, ManagementSystems: Manual [in Russian], Ufa (1999).

2. L. Ya. Bukharbaeva, Yu. S. Kabalnov, A. V. Glushchenko,and A. V. Kirillov, in: Complex System Management[in Russian], Ufa (1999), pp. 181-192.

3. L. Ya. Bukharbaeva, L. M. Bakusov, R. V. Nasyrov, etal., Med. Tekh., No. 3, 44-48 (2001).

4. L. Ya. Bukharbaeva, M. V. Tanyukevich, and M. E.Kolpakova, in: Abst. Sci.-Meth. Conf. on EconomicsAdministration: Methods, Models, and Technologies, Vol.3, Ufa (2001), pp. 85-90.

5. B. S. Razumikhin, Stability of Hereditary Systems [inRussian], Moscow (1998).

6. I. M. Sheiman, Reform of Public Health Service Man-agement and Financing [in Russian], Moscow (1998).

(3)

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=

otherwise,0

0if,

S B S B V j

ijjj

ijji