Abstract/Summary

This dissertation describes the development and assessment of a new model for the analysis and design of healthcare systems. Motivated by a need to better address the challenges still facing the provision of adequate healthcare services, it offers a model that can explain how healthcare functions as a whole system, and supports predicting the outcomes of policy interventions. Determining what model would satisfy the requirements of such a system is decomposed as (i) a design question asking how to construct the model,(ii) a theoretic question asking how healthcare functions as a system, and (iii) an evaluative question asking how well the implemented model answers the first two. Support in the literature is found in (i) existing models, in both healthcare and broader areas of economics; (ii) model theory providing clarity on representation of explanation and prediction; (iii) systems science providing constructs, a taxonomy and a dedicated language with which to describe healthcare systemically; (iv) a broad corpus of publications in the healthcare literature providing a data set of qualitative and theoretical observations for content analysis. The methodology applies Model Based Systems Engineering to the construction of a model, using a template adapted from model theory. Three versions of the model are developed to satisfy theoretic, systemic and epistemic requirements respectively. The results are reported as three related versions of a core representation of healthcare as a system; as a system composed of three familiar global systems: (i) the LifeCourse system captures how people live lives in which their health status is occasionally impaired by illness for which they may receive treatment to offset that impairment; (ii) the Provision Network, in which individuals and organizations with clinical skills and resources collectively and separately provide treatments needed in the population; (iii) in the Payment Exchange, where funds are exchanged to compensate those providers for the services they provide. Assessed against the original criteria, that the model represent healthcare as a dynamic causal system, the systems model that emerges satisfies the requirements of a scientific model. Boundary conditions qualify the scope of each evaluation. The prototype simulation comparing the model’s predicted outputs under three scenarios to historical trends of selected indicators observed in the healthcare system of the Netherlands is qualitatively comparable to the findings reported in the literature. This research extends healthcare knowledge, provides a reproducible methodology and creates an exploratory instrument to conduct simulated experiments in healthcare economics and health policy. Incorporation of boundary conditions points the way to future enhancements aimed at reducing those limitations and expanding the predictive capabilities of the model.