基于系统动力学方法的医疗费用过快增长问题建模与控制研究
|
摘要
一、研究目的和意义
当前,中国社会围绕着日益增长的医疗费用使得许多家庭面临着经济困扰,以及由此引发的“看病难”等问题成为我国最近一段时期医疗卫生领域存在的突出问题。新医改方案中明确提出“有效减轻居民就医费用负担,切实缓解‘看病难、看病贵’问题”。但是如何认清医疗费用过快发展态势,明确医疗费用增长影响因素及作用机制,明确费用控制策略,成为有效控制医疗费用过快增长迫切需要解决的问题。
然而,国内目前对医疗费用增长机制与控制的研究,多数缺乏全面、系统地审视医疗卫生系统,忽略了医疗卫生系统的整体性、动态性、系统与外部环境之间以及系统内部的结构和功能联系,多局限对焦点问题进行横断面的研究,把医疗费用的增长作为孤立、静止的系统,未深入分析带来卫生总费用或医疗费用过快增长的主要原因和根源,问题和根源掩盖下的利益相关者为追求利益诉求相互博弈的过程,由此研制的医疗费用的控制策略在局部往往存有效果,但从长期和整体来看,多存在顾此失彼的情况。
研究集成系统动力动力学、卫生宏观模型、利益相关者分析、系统论等多种理论与方法,通过聚焦医疗费用过快增长问题的系统主体并且明确主体关联,定性定量分析医疗费用过快增长作用机制,明确医疗费用过快增长问题发展态势及危害,寻找医疗费用过快增长控制关键要素,研制促进医疗费用与社会经济均衡发展的策略思路,为有效控制医疗费用过快增长和解决广大居民看病贵等突出问题,实现国家深化医药卫生体制改革的总体目标提供科学的依据。
二、材料与方法
本研究运用系统论和利益相关者分析方法,确定医疗费用过快增长问题系统的主体及作用关系；运用定性定量多重论证法论证医疗费用过快增长问题系统现况及作用机制；运用系统动力学建模方法建立医疗费用过快增长数学模型,明确医疗费用过快增长的发展态势,确定控制费用过快增长的主要影响因素,模拟论证控制策略及效果。
资料收集方法包括文献归纳分析、居民意向调查、卫生人员意向调查和基本情况调查、二级资料提取等。采用多阶段分层整群随机抽样的方法,对山东、江苏常州、上海嘉定三地居民进行调查,收集居民对医疗费用过快上涨问题的看法。二级资料主要包括1991-2008年的中国统计年鉴、中国人口统计年鉴、卫生事业经费决算资料。
三、主要研究结果
(一)明确我国医疗费用过快增长问题系统主体及相互作用关系
研究通过文献及政策分析,系统搜寻医疗费用过快增长问题相关的利益团体,从搜集的医疗卫生领域政策归类的利益相关者中,通过焦点小组法明确在中国现行行政组织结构框架下,医疗费用利益相关者包括：中央及各级地方政府、卫生部门、物价部门、财政部门、医保部门、药品监管部门、中医药管理部门、发展计划部门、工商行政管理部门、人事部门、教育部门、民政部门、农业部门、人口和计划生育部门、建设(规划)部门、医疗机构、药品供应商、医疗器械供应商、商业保险公司、卫生技术人员、消费者、非政府组织、媒体等。
运用利益相关者分析理论,利用米切尔评分表法,经过20名专家评分,聚焦医疗费用相关的关键利益团体为：(1)政府部门：包括中央及各级地方政府,主要政府职能部门为卫生部门、财政部门、医保部门、药监部门及物价部门；(2)医疗机构；(3)药品供应商；(4)消费者(患者)。
明确医疗费用相关利益团体的利益诉求,例如政府关心社会稳定,担忧看病贵问题危及社会和谐稳定；医疗机构关心政府财政投入,担心政府筹资职能萎缩对自身生存的影响；医保关注收支平衡、担心收支失衡；患者关注费用负担及服务质量；药品关心自身利润的获得等。
进一步通过907篇文献计量分析以及华东地区3省(市)、12县(市、区)、49乡镇的卫生服务机构的3494名卫生人员的意向调查论证对医疗费用过快增长问题的产生与关键主体之间的关系进行综合分析,可知：政府对医疗机构财政投入不足,医疗机构将注意力转向了增加业务收入上。而政府物价部门对医疗服务定价方面采取了严控的对策。医疗收费标准不随物价变动,而且常规项目收不抵支,新的高精尖项目一般收大于支,另外允许有15%的处方药品差价。医疗机构认为在目前政府财政投入不足以及对医疗服务定价不合理的情况下,获取药品进销差价和收取高额检查费是自身生存与发展的主要出路。卫生行政部门从本系统的生存和发展利益出发,对医院行为采取默许。医疗费用快速增长,远超社会经济和工资收入增长速率,给医保部门带来了收支平衡风险,也给居民带来了极高的就医经济风险。作为降低居民就医经济风险的医保系统却未能有效发挥作用,其存在的“医疗保障覆盖率较低,病人自负比例高,导致大部分人群呈现低层次服务、低利用或不堪负担甚至因病致贫而医疗费用的过快增长则给居民带来了极高的就医经济风险”成为社会指责的关键问题之一。医疗费用的持续上涨,再加之医保的不完善,使得需方负担日益加重,医疗费用过快增长下“看病贵”问题亦成为社会反响强烈的焦点问题。
(二)预测医疗费用系统未来发展,明确问题态势及危害
1、医疗机构财政投入萎缩且日益严重
不论是基于按1991年的财政补助、以政府财政支出的8%或是以政府财政支出占卫生总费用比例在40%为理想投入标准,模拟明显可见存在财政投入萎缩情况,并且随着年份的增加,财政投入萎缩日益严重。
其中,基于按1991年的财政补助水平(55.76%),政府财政对医务人员工资的补足,对医疗机构实际与理想投入进行模拟,按1991年的财政补助水平,2008年理想财政投入为671.7亿元,实际财政投入493.3亿元,2008年一年的财政缺口有178.4亿元,2020、2021年财政投入缺口分别为2199.0亿元、2683.0亿元。以不同财政投入缺口测算标准研究中,以政府承诺的卫生支出占财政支出的8%,以及国际经验推荐的政府财政支出占卫生总费用比例在40%左右为宜为投入理想标准,模拟发现2015年对医疗机构政府应承担6665.0-7339.0亿元的责任,与预测的政府实际财政投入2654.0亿元相比,存在缺口4011.0-4685.0亿元。而2020年存在财政投入缺口将达9191.0-10143.0亿元。
2、物价严控下收益率日益下降
业务收入的收益率呈现逐年下降的趋势,模拟显示1991-2021年期间收益率范围在7.0%-12.5%之间。医疗机构需要(1/收益率)倍的财政投入萎缩值的业务收入,收益率越低,意味着需要更多的业务收入弥补财政投入的不足。
3、财政与物价作用下医疗费用呈现过快增长
基于按1991年的财政补助水平,模拟显示2021年医疗费用达72419.0亿元,其中合理费用为18740.0亿元,因财政投入不足而增加的医疗费用达53680.0亿元。因财政投入不足而带来的医疗费用增长超出合理的医疗费用,并且随着年份的增加,超出越明显。而不同理想财政投入标准测算缺口下,在目前的财政与物价作用下,模拟显示,2010-2021年的医疗费用增加6988.0-43387.0亿元。并且医疗费用年均增长高于社会经济(GDP)增长率,医疗费用呈现出过快增长的势头。
4、“多开药、多做检查”成为医疗机构主要行为趋向
模拟显示由于医疗服务收益极低并呈现负值,医疗服务多做多亏。医疗机构四大类收费来源——医务人员劳务收费、社会必需常规服务项目、高新服务项目和药品中,仅有高新项目和处方药品可盈利。模拟显示医疗机构增加业务收入主要依赖药品收入的增加。同时根据业务收入为因变量,药品、检查化验和劳务收入作自变量,回归分析发现,药品收入和检查化验收入对业务收入的增长贡献较大,劳务收入所起作用甚微。反映出,现行的财政与物价作用下,为弥补收益,医疗机构倾向于“多开点药,多做点检查”行为。
5、医疗费用过快增长加重居民就医负担、恶化公平性
在目前医保制度尚不完善的情况下,医疗费用的过快增长对居民就医负担及费用公平性影响较大。以基于政府投入补足医务人员工资的财政投入缺口计算的模型模拟为例,2015年、2021年的年医疗费用负担分别达0.0982,0.1091；其中因财政投入不足而带来的医疗费用负担增加分别为0.0657、0.0809。2015年、2020年的家庭灾难性卫生支出发生率为0.1316、0.1469,而合理的家庭灾难性卫生支出为0.1214、0.1262。实际家庭灾难性卫生支出发生率远超出合理灾难性家庭发生率。医疗机构业务收入过快上涨,大幅增加居民的医疗费用负担,也加大了灾难性家庭发生率。
(三)医疗费用过快增长作用机制
在医疗费用的不合理增长中,对财政、物价、医院自身作用进行模拟发现,财政和物价起着决定性作用,财政承担40.0%-71.6%；物价承担40.8%-66.7%,扣除财政和物价影响后,医疗机构因素在医疗费用增长中所起的作用一直为12.0%至-38.3%。表现出为应付物价增长和财政萎缩,不得不追求净收益的增加。虽有一定追求自身利益的倾向,但与财政和物价相比,其本身行为并不是医疗费用过快增长的最主要原因。
结合统计资料数据定性定量论证方法以及系统动力学模型论证了医疗费用过快上涨引发看病贵等问题的多方作用互动过程：(1)经济发展优先,政府忽视医疗卫生发展,并改变了服务的福利性质：(2)财政对医疗卫生服务筹资职能逐步弱化,要求资金自筹、自收自支,迫使医疗卫生机构直接通过服务收费增加收入；(3)物价部门严守医疗服务低收费政策,改革前的降价和改革后限价,导致收费标准扭曲,以药养医、多做检查等,成为医疗机构缓解自身困境的被动策略；(4)卫生部门亦步亦趋,拓展医疗机构的服务收费补偿渠道；(5)医疗机构顺应宏观政策,摸索形成了一整套“通过服务收费多收一点”的具体途径和方法；(6)医药用品业无序混乱,形成“高价医药用品容易销售导向,医药用品业投资少、见效快和获利高,百业经营医药品”等三大畸形景观,为看病贵等问题推波助澜；(7)医疗保险总体不健全,呈现覆盖率低、结付水平低,为了收支平衡支付和控费方式僵硬等问题,进一步使得看病贵成为社会关注问题。
(四)控制医疗费用过快增长政策策略及效果
运用系统动力学方法构建的SD模型,利用Vensim软件构建仿真平台,筛选政策干预靶点,改变系统状况的行为如政府投入、物价收益率的调整、总额预算、医保报销比例及覆盖率调整等,以观察阳性实验结果的需方的改变情况,为研制优化策略提供依据。干预结果表明,财政投入改变引起的总体次均费用变化是医保作用的1.03-2.38倍,而收益率改变作用是医保作用的1.18-1.42倍。加大政府对医疗服务的投入力度、提高业务收入收益率实现医疗费用的大幅度降低,可有效控制医疗费用的过快增长。
进一步根据博弈均衡理论分析明确系统优化方向,确保医疗费用与社会经济发展同步为着眼点,实现将医疗费用增长纳入社会经济可承受范围之内。在明确政策干预点的基础上,模拟实现医疗费用与社会经济发展同步的策略,明确适宜的组合策略,并且分析策略效果。
1、若以补足工资为标准,调整医疗服务的财政投入,2015年预计需投入1875.0亿元,2020年投入4617.0亿元。相比目前业务收入增速下的财政投入,2015年、2020年所追加投入分别多出414.0亿元、1444.0亿元。而基于财政支出8%、以政府投入占卫生总费用的40%为理想标准测算缺口模拟,若实现医疗费用增速与GDP齐同,2015年预计需投入3591.0-3610.0亿元,2020年投入8518.0-8887.0亿元。相比目前业务收入增速下的财政投入,2015年、2020年所追加投入分别多出937.0-956.0亿元、1991.0-2360.0亿元。在总额预算基础上,通过完善财政筹资职能,可确保医疗费用与社会经济发展同步。
2、若不增加政府筹资,为弥补财政投入萎缩带来的医疗机构净收益损失,需调整业务收入的收益率。模拟显示,若按政府投入补助医务人员工资收入为标准,总体收益率需从0.0384-0.0525调整至0.0695-0.1060。而以财政支出8%、政府卫生支出能够达到卫生总费用的40%为财政投入理想标准计算缺口下,财政投入总体收益率需调整至0.3108-0.3381。
3、若保留现行的按项目付费方式,则可通过合理化现行收费标准,确保医疗机构能通过劳务和常规检查等社会必需服务项目获得合理补偿。调整收费标准,提高医务人员劳务和常规检查等社会必需项目的收益,合理化药品和高新检查等收益率,通过提高业务收入含金量增加了医疗机构的净收入,相应(1/收益率)降低业务收入增长。或者如果变当前的按项目付费为按服务单元付费,即合理设立按服务单元服务收费标准,实行每次就诊付费的“包干”,并规定结余归己,通过引导医疗机构主动降低成本而提高收益率即净收入,必然大幅度降低社会费用负担。
4、通过优化策略实施可实现医疗费用的增长从2015年的25433.0减为19069.0亿元,相比财政投入调整前业务收入减少25.0%；2020年从71920.0亿元降至41275.0亿元,下降了42.6%。2010-2021年次均费用也可节省17.4%-53.4%,家庭灾难性卫生支出发生率至2021年可减缓8.0%。
四、研究创新之处
(一)方法创新
运用系统分析方法、卫生系统宏观模型来进行医疗费用增长规律进行把握,运用利益相关者分析方法明确系统主体及相互关系；数学模型构建中,运用SD建模方法对时间序列数据、增量、存量进行分析与模拟：医疗费用控制策略研制中将运用系统动力分析方法作为指导,针对性研制解决医疗费用问题的控制策略,促使系统均衡发展。
(二)结果创新
1、运用系统论和利益相关者分析方法明确医疗费用过快增长问题形成的主体及相互作用关系,为厘清纷繁复杂的系统内部关系提供思路。
2、运用定性定量论证方法分析了医疗费用过快增长主体作用机制,并且运用系统动力方法探讨其产生的根源和影响因素,明晰医疗费用过快增长作用机制,为解决看病贵问题提供有力依据。
3、使用Vensim软件对模型进行检验,并通过仿真和政策干预对现实情况进行动态模拟。实现首次系统预测医疗费用的未来发展,揭示了在不加干预情况下医疗费用过快增长的态势及危害。
4、通过对系统内相关各方的互动与协调进行研究,运用系统动力学方法进行政策干预模拟,明确现实费用控制策略,模拟论证确保医疗费用与社会经济协调发展策略效果等,为我国医疗卫生体制改革提供科学的借鉴。
1. Study Objectives and Significances
At present, rising health costs make many families facing economic distress, and the difficulty of getting medical treatment becomes a prominent social problem in China. The new medical reform program is to reduce medical expense burden and solve the problem of the difficulty in seeing a doctor and the high cost of getting a treatment. But how to recognize medical expense situation, figure out the mechanism and develop the control strategies? That is an urgent issue to solve.
However, current strategies and researches merely revolve around one or several issues in medical care expenditure, rather than systematic and comprehensive analysis. Most of the researches have ignored the internal contact between the structure and function of system. Thus, current policies achieve few results.
Therefore, the research aims to focus on the behavior characteristics of organizations in medical care expenditure system, define the influential factors and mechanism, analyze the abnormal development tendency of medical care expenditure, propose strategies for harmonious development of health care, and provide scientific basis for further health system reform. Research methods and theories include integrated theory of complex system, modeling technique of system dynamics, health macroscopic models and stakeholder analysis.
2. Materials and Methods
Theories of complex system and stakeholder analysis were used to define the relations between stakeholder's interests and issues, as well as defining the behavior characteristics of organizations in medical care expenditure system. Qualitative and quantitative mechanism models of over-increasing medical care expenditure were applied to demonstrate the formation mechanism.Modeling technique of system dynamics was utilized to construct SD model and build policy experiment platform of medical care expenditure system.
Varied data-collection methods were employed in this study, including literature review, opinion survey of residents and health personnel, the second hand data collection, etc. Multiple stratified Chester sampling method was used to investigate people's views on over-increasing medical care expenditure in Shandong, Changzhou Jiangsu and Jiading Shanghai. The data used in the study was collected mainly from statistics including China Statistical Yearbook, China Population Statistics Yearbook and health accounts funding information of the year from 1991 to 2008.
3. Main results
(1) Define the Stakeholders and interaction of the Medical Care Expenditure system.
Based on the literature and policy analysis, the research collected all the stakeholders related to medical care expenditure, such as the central and local governments, public health departments, the price department, financial department, health care providers, Food and Drug Administration, the Chinese medicine management department, development planning department, the administrative department for industry and commerce, education department, hr department, civil affairs departments, agriculture department, population and family planning department, construction department and medical institutions, pharmaceutical suppliers, medical equipment suppliers, commercial insurance company, hygienic and technical personnel, consumers, non-governmental organizations, mass media, etc.
Subsequently, through Meta analysis and Mitchell score-based approach, the study demonstrated that the key stakeholders in pharmaceutical field included government departments, health departments, financial department, health care sector, Food and Drug Administration, the price department, hospital, pharmaceutical suppliers, and consumers.
The demands of those interests were discussed, such as the government was concerned on the social harmony and stability;medical institutions focused on the government financial investment; medical insurance concerned on the balance of payments while worried about payments imbalances; patients paid close attention to service quality and the expense; pharmaceutical supplier cared about its own profit, etc.
By methods of metrological analysis on 907 literatures and intention surveys of 3494 health personnel, the result showed that the government financial investment of medical institutions was insufficient, the price department adopted a distorted standard of prices on medical service pricing, the medical institutions depended on more prescription drugs and more medical examinations to compensate for deficit of health investment, which led to an over-increase of medical expenditure. In the absence of a social safety net, residents bear the high cost of a greater risk.Medical insurance Department suffered problems of unbalance between financing and expenditure. In such circumstances, the high cost of obtaining medical service became a focusing problem of social public concern.
(2) Predict future development of medical expenses system; diagnose the problem situation and the harmfulness
1) Seriously inadequate government subsidies
Lack of financial investment had led to over-increasing medical care expenditure, more serious social burdens and the waste of medical resources. The analyzing results suggest that the government subsidies dropped year by year since 1978. According to the financial aid standard on 1991 level, the ideal financial input was 67.17 billion yuan, while actual financial investment was 49.33 billion yuan, so there was a 17.84 billion yuan fiscal gap in 2008. It was estimated that the fiscal gap might top 268.30 billion yuan by 2021.The study on financial investment gap in different measuring standard found that the government shall bear the liability with 6665.0-7339.0 yuan in 2015.And compared to the forecast actual financial input, there would be a 919.10-1014.30 billion yuan gap in 2020.
2) The return rates of operating revenue decreased according to the price control
Yields on the business income had been declined for years. The model showed the rate of return was at 7.0% to 12.5% during year 1991 to 2021 respectively. It was demanded that the operating revenue would be 1/yields times that of the financial investment atrophy. Other things being equal, the lower the yields, the more business income would be need for. Under the distorted standard of prices, the medical institutions depended on more operating revenue to compensate for deficit of health investment.
3) Medical care expenditure revealed a trend of fast increase across the board
By using the SD models, simulations suggest that medical expenses might amount to 7241.90 billion yuan by 2021, of which 1874.00 billion yuan was reasonable expense. And the rest of medical expense was 5368.00 billion yuan for deficit of health investment. According to different standards of ideal financial input, it led to an over-increasing of medical expenditure to 698.80-433.87 billion yuan from 2010 to 2021. Over the years, the medical care expenditure had experienced a continuously rapid growth which was far higher than the GDP growth rate.
4) The medical institutions depended on more prescription drugs and more medical examinations
The simulation results showed that more medical services would create more losses since revenue was extremely low and presented negative. The revenue sources of medical institutions included the fee for diagnosis, the routine service items, and high-tech service project and prescription drugs. However, only high-tech projects and prescription drugs could be profitable. The simulation indicated that medical institutions relied on drug income to amplify their returns. Simultaneously, the research on the influencing factors was conducted in regression model, while the revenue sources were referred as dependent variables. The percentage contributions of various revenue sources to operating revenue were calculated.Regression analysis showed that the growth of revenue owed mostly to the contribution from income of drugs and medical examinations, while Service revenue had little effect. This finding reflect that the medical institutions depended on more prescription drugs and more medical examinations for deficit of health investment under the distorted standard of prices.
5) Over-increasing medical care expenditure pressed too heavy an economic burden on the civic people and the equity deteriorated
In the condition that medical security system had yet to be improved, the rapid growth would have significant effects on the economic burden and impartiality of medical expenditure especially. Based on the model which calculated fiscal gap by financial aid standard on 1991 level, the economic burden would reach 0.0982 in 2015 and 0.1091 in 2020. And with regard to the lack of government subsidies, it gained an additional 0.0657-0.0809 of the burden of medical care expenditure. Catastrophic payments for health care happened in 13.16 percent of families in 2015, and that the reasonable quantity was 12.14 percent. Results stated clearly that the incidence of catastrophic health payments was far more than it should be. Thus, the economic burden and the head count of family catastrophic payments for health care were increased due to the rapid rise of medical care expenditure.
(3)The Mechanism of Over-Increasing Medical Care Expenditure
SD model simulation was used to interpret the responsibility of the financial, the commodity prices and the medical institution for the excessive growth of medical expenditure. It showed that, the financial and commodity prices bore the primary responsibility due to attribution analysis, the responsibility amount to 40.0%-71.6% and 40.8%-66.7% or more separately. Medical institutions conduct "more prescription drugs, more medical examinations" to make up for the lackage of financial investment and the strict control of commodity prices.
The study simulated dynamics action characteristic and mechanism of over-increasing medical care expenditure system using SD model combined with qualitative and quantitative methods. It was founded that the course of over-increasing medical care expenditure was controlled by the intrinsic properties. And the interactive mechanism among the numerous factors was complicated in the medical care expenditure system.
—The central government had been giving priority to the economic development, while neglecting health care and changing the nature of welfare.
—Since government subsidies dropped year by year, the medical institutions was demanded the way that funds raised by oneself. Consequently, they leant on operating revenue.
—The policies of price cutting and fixing that price department always persisted in differed from the environment of macroeconomic reform and the adjustment fiscal function. They deviated from the cost of the medical services, and resulted in an abnormality in the charge standard of medical services.
—It induced the health department to explore new sources of profit for hospitals.
—And it stimulated the hospitals to set up more high-tech or new services, do more inspections, and over dose, etc, which became the main method for hospitals to reply the self-financing policy.
—Tacit understanding between medical agencies and pharmaceutical companies helped develop the drug market chaos:too expensive drug, production structure more imbalance, production lever lower, more repeated production.
—Moreover, the imperfect medical insurance with low coverage, limited access to health insurance and limited benefit package caused "overly expensive medical services" as a universal social issue.
(4)Give suggestions on medical expense control and evaluate the effects
Simulation platform was build to screen policy intervention targets by system dynamics methods, using Vensim software. The experiments changed the behavior of system conditions such as government subsidies, price adjustment of the total yields, Global budget, medicare reimbursement rates and coverage, etc, in order to observe positive results. After intervention, it had been found that the change of fee per time caused by financial investment adjustment was 1.03-2.38 times more than medical insurance function, while the effect of yield change was 1.18-1.42 times as great. As the study showed, Strategies, such as increasing the government investment or bumping up business income yield could effectively control the rapid increase of the medical expense.
In accordance with the game theory, the paper deduced that medical expenditure should be in proportion to the level of social and economic development, which meant social affordability. On the basis of policy intervention targets, simulations were carried out to realize economic development synchronization. At the same time, appropriate combination strategies were put forward and policy effects were analyzed as follows:
◆Firstly, it was possible to solve a package of the existing major problems and ensure the synchronism of medical expenditure and social economic development by increasing Government subsidies. Financial investment of medical services in 2015 was expected to 187.50 billion yuan, and 461.70 billion yuan by 2020. Compared to the financial investment under current business income growth, there would be 41.40 and 144.40 billion yuan additional investment in 2015 and 2020. And based on the standard of the government investment account for 8% in financial expenditure or takes up 40% of total health expenses, the research expected the total government subsidies to be 851.80-888.70 billion yuan in 2020.
◆Then, it was necessary to make some adaptations in terms of the return rates of operating revenue to compensate the loss unless increasing government subsidies. It showed that the return rates of operating revenue should rise from 0.0384-0.0525 to 0.0695-0.1060.
◆Furthermore, under the "fee for service" payment, the irrational price criterion needed to be improved. So as to ensure medical institutions gain reasonable compensation through regular examinations and social necessary services. Or through changing the post payment to prepayment, such as service unit payment. To pursue revenue maximization, the hospitals had to adopt the way "less prescription drugs, less expensive drugs", "less examinations, less sophisticated examinations" to increase revenues. In accordance with purchasing the lowest price drugs, replacing expensive drugs with cheap drugs within the same kind, replacing sophisticated examinations with conventional examinations.
◆At last, the growth of medical care expenditure would remit through optimization strategy. Total operating revenue would fall by almost a quarter compared with the same period in 2015 to 1906.90 billion. Result showed that not only operating revenue could be saved, but also 17.4 to 53.4 percent of fee per time could be saved. Besides, the implementation of the optimization strategy would lead to a decline of 8.0 percent of catastrophic payments for health care by 2021.
4. Research Innovations
(1) Methods Innovations
The method of system analysis and the macro module special for health system were also employed to understand the inner laws of medical care expenditure growth.
The stakeholder theory was used to analyze the stakeholders and interaction of the medical care expenditure system.
The logic model and SD model of over-increasing medical care expenditure were constructed to evaluate the main variable and function relation by agent action analysis based on VENSIM software.
Simulation and policy intervention research were carried out to illuminate the mechanism and put forward correlative policy suggestions by applying synthetically system dynamics and computer simulation technique.
(2) Results innovations
By using theories of system and stakeholders to analyze the interests of all stakeholders, relationship between stakeholders and the process of expenditure growth, thus suggest a kind of new thinking about how to clarify internal relations in the complicated system
Use of quantitative and qualitative methods to explain the formation of key issues, and reveal the root causes and the mechanisms by System Dynamics methods, in order to develop policy ideas for solving the problem of the difficulty in seeing a doctor and the high cost of getting a treatment.
Some simulation trials with Vensim software are made, and the results prove that the model can perfectly simulate the dynamics of the medical care expenditure system. The SD model is used for the simulation and verifying platform for the whole processes. By means of predicting the future development of medical expense, results reveal the high speed growth and its damage in the absence of government intervention.
The study put forward the policy suggestions of solving the focus problem by policy intervention experiment. At the same time, policy effects are analyzed. It turns out that strategies such as increasing the government investment or bumping up business income yield can effectively control the rapid increase of the medical expense. Thus, provide a reference outline for our country health system reform and the development.
当前,中国社会围绕着日益增长的医疗费用使得许多家庭面临着经济困扰,以及由此引发的“看病难”等问题成为我国最近一段时期医疗卫生领域存在的突出问题。新医改方案中明确提出“有效减轻居民就医费用负担,切实缓解‘看病难、看病贵’问题”。但是如何认清医疗费用过快发展态势,明确医疗费用增长影响因素及作用机制,明确费用控制策略,成为有效控制医疗费用过快增长迫切需要解决的问题。
然而,国内目前对医疗费用增长机制与控制的研究,多数缺乏全面、系统地审视医疗卫生系统,忽略了医疗卫生系统的整体性、动态性、系统与外部环境之间以及系统内部的结构和功能联系,多局限对焦点问题进行横断面的研究,把医疗费用的增长作为孤立、静止的系统,未深入分析带来卫生总费用或医疗费用过快增长的主要原因和根源,问题和根源掩盖下的利益相关者为追求利益诉求相互博弈的过程,由此研制的医疗费用的控制策略在局部往往存有效果,但从长期和整体来看,多存在顾此失彼的情况。
研究集成系统动力动力学、卫生宏观模型、利益相关者分析、系统论等多种理论与方法,通过聚焦医疗费用过快增长问题的系统主体并且明确主体关联,定性定量分析医疗费用过快增长作用机制,明确医疗费用过快增长问题发展态势及危害,寻找医疗费用过快增长控制关键要素,研制促进医疗费用与社会经济均衡发展的策略思路,为有效控制医疗费用过快增长和解决广大居民看病贵等突出问题,实现国家深化医药卫生体制改革的总体目标提供科学的依据。
二、材料与方法
本研究运用系统论和利益相关者分析方法,确定医疗费用过快增长问题系统的主体及作用关系；运用定性定量多重论证法论证医疗费用过快增长问题系统现况及作用机制；运用系统动力学建模方法建立医疗费用过快增长数学模型,明确医疗费用过快增长的发展态势,确定控制费用过快增长的主要影响因素,模拟论证控制策略及效果。
资料收集方法包括文献归纳分析、居民意向调查、卫生人员意向调查和基本情况调查、二级资料提取等。采用多阶段分层整群随机抽样的方法,对山东、江苏常州、上海嘉定三地居民进行调查,收集居民对医疗费用过快上涨问题的看法。二级资料主要包括1991-2008年的中国统计年鉴、中国人口统计年鉴、卫生事业经费决算资料。
三、主要研究结果
(一)明确我国医疗费用过快增长问题系统主体及相互作用关系
研究通过文献及政策分析,系统搜寻医疗费用过快增长问题相关的利益团体,从搜集的医疗卫生领域政策归类的利益相关者中,通过焦点小组法明确在中国现行行政组织结构框架下,医疗费用利益相关者包括：中央及各级地方政府、卫生部门、物价部门、财政部门、医保部门、药品监管部门、中医药管理部门、发展计划部门、工商行政管理部门、人事部门、教育部门、民政部门、农业部门、人口和计划生育部门、建设(规划)部门、医疗机构、药品供应商、医疗器械供应商、商业保险公司、卫生技术人员、消费者、非政府组织、媒体等。
运用利益相关者分析理论,利用米切尔评分表法,经过20名专家评分,聚焦医疗费用相关的关键利益团体为：(1)政府部门：包括中央及各级地方政府,主要政府职能部门为卫生部门、财政部门、医保部门、药监部门及物价部门；(2)医疗机构；(3)药品供应商；(4)消费者(患者)。
明确医疗费用相关利益团体的利益诉求,例如政府关心社会稳定,担忧看病贵问题危及社会和谐稳定；医疗机构关心政府财政投入,担心政府筹资职能萎缩对自身生存的影响；医保关注收支平衡、担心收支失衡；患者关注费用负担及服务质量；药品关心自身利润的获得等。
进一步通过907篇文献计量分析以及华东地区3省(市)、12县(市、区)、49乡镇的卫生服务机构的3494名卫生人员的意向调查论证对医疗费用过快增长问题的产生与关键主体之间的关系进行综合分析,可知：政府对医疗机构财政投入不足,医疗机构将注意力转向了增加业务收入上。而政府物价部门对医疗服务定价方面采取了严控的对策。医疗收费标准不随物价变动,而且常规项目收不抵支,新的高精尖项目一般收大于支,另外允许有15%的处方药品差价。医疗机构认为在目前政府财政投入不足以及对医疗服务定价不合理的情况下,获取药品进销差价和收取高额检查费是自身生存与发展的主要出路。卫生行政部门从本系统的生存和发展利益出发,对医院行为采取默许。医疗费用快速增长,远超社会经济和工资收入增长速率,给医保部门带来了收支平衡风险,也给居民带来了极高的就医经济风险。作为降低居民就医经济风险的医保系统却未能有效发挥作用,其存在的“医疗保障覆盖率较低,病人自负比例高,导致大部分人群呈现低层次服务、低利用或不堪负担甚至因病致贫而医疗费用的过快增长则给居民带来了极高的就医经济风险”成为社会指责的关键问题之一。医疗费用的持续上涨,再加之医保的不完善,使得需方负担日益加重,医疗费用过快增长下“看病贵”问题亦成为社会反响强烈的焦点问题。
(二)预测医疗费用系统未来发展,明确问题态势及危害
1、医疗机构财政投入萎缩且日益严重
不论是基于按1991年的财政补助、以政府财政支出的8%或是以政府财政支出占卫生总费用比例在40%为理想投入标准,模拟明显可见存在财政投入萎缩情况,并且随着年份的增加,财政投入萎缩日益严重。
其中,基于按1991年的财政补助水平(55.76%),政府财政对医务人员工资的补足,对医疗机构实际与理想投入进行模拟,按1991年的财政补助水平,2008年理想财政投入为671.7亿元,实际财政投入493.3亿元,2008年一年的财政缺口有178.4亿元,2020、2021年财政投入缺口分别为2199.0亿元、2683.0亿元。以不同财政投入缺口测算标准研究中,以政府承诺的卫生支出占财政支出的8%,以及国际经验推荐的政府财政支出占卫生总费用比例在40%左右为宜为投入理想标准,模拟发现2015年对医疗机构政府应承担6665.0-7339.0亿元的责任,与预测的政府实际财政投入2654.0亿元相比,存在缺口4011.0-4685.0亿元。而2020年存在财政投入缺口将达9191.0-10143.0亿元。
2、物价严控下收益率日益下降
业务收入的收益率呈现逐年下降的趋势,模拟显示1991-2021年期间收益率范围在7.0%-12.5%之间。医疗机构需要(1/收益率)倍的财政投入萎缩值的业务收入,收益率越低,意味着需要更多的业务收入弥补财政投入的不足。
3、财政与物价作用下医疗费用呈现过快增长
基于按1991年的财政补助水平,模拟显示2021年医疗费用达72419.0亿元,其中合理费用为18740.0亿元,因财政投入不足而增加的医疗费用达53680.0亿元。因财政投入不足而带来的医疗费用增长超出合理的医疗费用,并且随着年份的增加,超出越明显。而不同理想财政投入标准测算缺口下,在目前的财政与物价作用下,模拟显示,2010-2021年的医疗费用增加6988.0-43387.0亿元。并且医疗费用年均增长高于社会经济(GDP)增长率,医疗费用呈现出过快增长的势头。
4、“多开药、多做检查”成为医疗机构主要行为趋向
模拟显示由于医疗服务收益极低并呈现负值,医疗服务多做多亏。医疗机构四大类收费来源——医务人员劳务收费、社会必需常规服务项目、高新服务项目和药品中,仅有高新项目和处方药品可盈利。模拟显示医疗机构增加业务收入主要依赖药品收入的增加。同时根据业务收入为因变量,药品、检查化验和劳务收入作自变量,回归分析发现,药品收入和检查化验收入对业务收入的增长贡献较大,劳务收入所起作用甚微。反映出,现行的财政与物价作用下,为弥补收益,医疗机构倾向于“多开点药,多做点检查”行为。
5、医疗费用过快增长加重居民就医负担、恶化公平性
在目前医保制度尚不完善的情况下,医疗费用的过快增长对居民就医负担及费用公平性影响较大。以基于政府投入补足医务人员工资的财政投入缺口计算的模型模拟为例,2015年、2021年的年医疗费用负担分别达0.0982,0.1091；其中因财政投入不足而带来的医疗费用负担增加分别为0.0657、0.0809。2015年、2020年的家庭灾难性卫生支出发生率为0.1316、0.1469,而合理的家庭灾难性卫生支出为0.1214、0.1262。实际家庭灾难性卫生支出发生率远超出合理灾难性家庭发生率。医疗机构业务收入过快上涨,大幅增加居民的医疗费用负担,也加大了灾难性家庭发生率。
(三)医疗费用过快增长作用机制
在医疗费用的不合理增长中,对财政、物价、医院自身作用进行模拟发现,财政和物价起着决定性作用,财政承担40.0%-71.6%；物价承担40.8%-66.7%,扣除财政和物价影响后,医疗机构因素在医疗费用增长中所起的作用一直为12.0%至-38.3%。表现出为应付物价增长和财政萎缩,不得不追求净收益的增加。虽有一定追求自身利益的倾向,但与财政和物价相比,其本身行为并不是医疗费用过快增长的最主要原因。
结合统计资料数据定性定量论证方法以及系统动力学模型论证了医疗费用过快上涨引发看病贵等问题的多方作用互动过程：(1)经济发展优先,政府忽视医疗卫生发展,并改变了服务的福利性质：(2)财政对医疗卫生服务筹资职能逐步弱化,要求资金自筹、自收自支,迫使医疗卫生机构直接通过服务收费增加收入；(3)物价部门严守医疗服务低收费政策,改革前的降价和改革后限价,导致收费标准扭曲,以药养医、多做检查等,成为医疗机构缓解自身困境的被动策略；(4)卫生部门亦步亦趋,拓展医疗机构的服务收费补偿渠道；(5)医疗机构顺应宏观政策,摸索形成了一整套“通过服务收费多收一点”的具体途径和方法；(6)医药用品业无序混乱,形成“高价医药用品容易销售导向,医药用品业投资少、见效快和获利高,百业经营医药品”等三大畸形景观,为看病贵等问题推波助澜；(7)医疗保险总体不健全,呈现覆盖率低、结付水平低,为了收支平衡支付和控费方式僵硬等问题,进一步使得看病贵成为社会关注问题。
(四)控制医疗费用过快增长政策策略及效果
运用系统动力学方法构建的SD模型,利用Vensim软件构建仿真平台,筛选政策干预靶点,改变系统状况的行为如政府投入、物价收益率的调整、总额预算、医保报销比例及覆盖率调整等,以观察阳性实验结果的需方的改变情况,为研制优化策略提供依据。干预结果表明,财政投入改变引起的总体次均费用变化是医保作用的1.03-2.38倍,而收益率改变作用是医保作用的1.18-1.42倍。加大政府对医疗服务的投入力度、提高业务收入收益率实现医疗费用的大幅度降低,可有效控制医疗费用的过快增长。
进一步根据博弈均衡理论分析明确系统优化方向,确保医疗费用与社会经济发展同步为着眼点,实现将医疗费用增长纳入社会经济可承受范围之内。在明确政策干预点的基础上,模拟实现医疗费用与社会经济发展同步的策略,明确适宜的组合策略,并且分析策略效果。
1、若以补足工资为标准,调整医疗服务的财政投入,2015年预计需投入1875.0亿元,2020年投入4617.0亿元。相比目前业务收入增速下的财政投入,2015年、2020年所追加投入分别多出414.0亿元、1444.0亿元。而基于财政支出8%、以政府投入占卫生总费用的40%为理想标准测算缺口模拟,若实现医疗费用增速与GDP齐同,2015年预计需投入3591.0-3610.0亿元,2020年投入8518.0-8887.0亿元。相比目前业务收入增速下的财政投入,2015年、2020年所追加投入分别多出937.0-956.0亿元、1991.0-2360.0亿元。在总额预算基础上,通过完善财政筹资职能,可确保医疗费用与社会经济发展同步。
2、若不增加政府筹资,为弥补财政投入萎缩带来的医疗机构净收益损失,需调整业务收入的收益率。模拟显示,若按政府投入补助医务人员工资收入为标准,总体收益率需从0.0384-0.0525调整至0.0695-0.1060。而以财政支出8%、政府卫生支出能够达到卫生总费用的40%为财政投入理想标准计算缺口下,财政投入总体收益率需调整至0.3108-0.3381。
3、若保留现行的按项目付费方式,则可通过合理化现行收费标准,确保医疗机构能通过劳务和常规检查等社会必需服务项目获得合理补偿。调整收费标准,提高医务人员劳务和常规检查等社会必需项目的收益,合理化药品和高新检查等收益率,通过提高业务收入含金量增加了医疗机构的净收入,相应(1/收益率)降低业务收入增长。或者如果变当前的按项目付费为按服务单元付费,即合理设立按服务单元服务收费标准,实行每次就诊付费的“包干”,并规定结余归己,通过引导医疗机构主动降低成本而提高收益率即净收入,必然大幅度降低社会费用负担。
4、通过优化策略实施可实现医疗费用的增长从2015年的25433.0减为19069.0亿元,相比财政投入调整前业务收入减少25.0%；2020年从71920.0亿元降至41275.0亿元,下降了42.6%。2010-2021年次均费用也可节省17.4%-53.4%,家庭灾难性卫生支出发生率至2021年可减缓8.0%。
四、研究创新之处
(一)方法创新
运用系统分析方法、卫生系统宏观模型来进行医疗费用增长规律进行把握,运用利益相关者分析方法明确系统主体及相互关系；数学模型构建中,运用SD建模方法对时间序列数据、增量、存量进行分析与模拟：医疗费用控制策略研制中将运用系统动力分析方法作为指导,针对性研制解决医疗费用问题的控制策略,促使系统均衡发展。
(二)结果创新
1、运用系统论和利益相关者分析方法明确医疗费用过快增长问题形成的主体及相互作用关系,为厘清纷繁复杂的系统内部关系提供思路。
2、运用定性定量论证方法分析了医疗费用过快增长主体作用机制,并且运用系统动力方法探讨其产生的根源和影响因素,明晰医疗费用过快增长作用机制,为解决看病贵问题提供有力依据。
3、使用Vensim软件对模型进行检验,并通过仿真和政策干预对现实情况进行动态模拟。实现首次系统预测医疗费用的未来发展,揭示了在不加干预情况下医疗费用过快增长的态势及危害。
4、通过对系统内相关各方的互动与协调进行研究,运用系统动力学方法进行政策干预模拟,明确现实费用控制策略,模拟论证确保医疗费用与社会经济协调发展策略效果等,为我国医疗卫生体制改革提供科学的借鉴。
1. Study Objectives and Significances
At present, rising health costs make many families facing economic distress, and the difficulty of getting medical treatment becomes a prominent social problem in China. The new medical reform program is to reduce medical expense burden and solve the problem of the difficulty in seeing a doctor and the high cost of getting a treatment. But how to recognize medical expense situation, figure out the mechanism and develop the control strategies? That is an urgent issue to solve.
However, current strategies and researches merely revolve around one or several issues in medical care expenditure, rather than systematic and comprehensive analysis. Most of the researches have ignored the internal contact between the structure and function of system. Thus, current policies achieve few results.
Therefore, the research aims to focus on the behavior characteristics of organizations in medical care expenditure system, define the influential factors and mechanism, analyze the abnormal development tendency of medical care expenditure, propose strategies for harmonious development of health care, and provide scientific basis for further health system reform. Research methods and theories include integrated theory of complex system, modeling technique of system dynamics, health macroscopic models and stakeholder analysis.
2. Materials and Methods
Theories of complex system and stakeholder analysis were used to define the relations between stakeholder's interests and issues, as well as defining the behavior characteristics of organizations in medical care expenditure system. Qualitative and quantitative mechanism models of over-increasing medical care expenditure were applied to demonstrate the formation mechanism.Modeling technique of system dynamics was utilized to construct SD model and build policy experiment platform of medical care expenditure system.
Varied data-collection methods were employed in this study, including literature review, opinion survey of residents and health personnel, the second hand data collection, etc. Multiple stratified Chester sampling method was used to investigate people's views on over-increasing medical care expenditure in Shandong, Changzhou Jiangsu and Jiading Shanghai. The data used in the study was collected mainly from statistics including China Statistical Yearbook, China Population Statistics Yearbook and health accounts funding information of the year from 1991 to 2008.
3. Main results
(1) Define the Stakeholders and interaction of the Medical Care Expenditure system.
Based on the literature and policy analysis, the research collected all the stakeholders related to medical care expenditure, such as the central and local governments, public health departments, the price department, financial department, health care providers, Food and Drug Administration, the Chinese medicine management department, development planning department, the administrative department for industry and commerce, education department, hr department, civil affairs departments, agriculture department, population and family planning department, construction department and medical institutions, pharmaceutical suppliers, medical equipment suppliers, commercial insurance company, hygienic and technical personnel, consumers, non-governmental organizations, mass media, etc.
Subsequently, through Meta analysis and Mitchell score-based approach, the study demonstrated that the key stakeholders in pharmaceutical field included government departments, health departments, financial department, health care sector, Food and Drug Administration, the price department, hospital, pharmaceutical suppliers, and consumers.
The demands of those interests were discussed, such as the government was concerned on the social harmony and stability;medical institutions focused on the government financial investment; medical insurance concerned on the balance of payments while worried about payments imbalances; patients paid close attention to service quality and the expense; pharmaceutical supplier cared about its own profit, etc.
By methods of metrological analysis on 907 literatures and intention surveys of 3494 health personnel, the result showed that the government financial investment of medical institutions was insufficient, the price department adopted a distorted standard of prices on medical service pricing, the medical institutions depended on more prescription drugs and more medical examinations to compensate for deficit of health investment, which led to an over-increase of medical expenditure. In the absence of a social safety net, residents bear the high cost of a greater risk.Medical insurance Department suffered problems of unbalance between financing and expenditure. In such circumstances, the high cost of obtaining medical service became a focusing problem of social public concern.
(2) Predict future development of medical expenses system; diagnose the problem situation and the harmfulness
1) Seriously inadequate government subsidies
Lack of financial investment had led to over-increasing medical care expenditure, more serious social burdens and the waste of medical resources. The analyzing results suggest that the government subsidies dropped year by year since 1978. According to the financial aid standard on 1991 level, the ideal financial input was 67.17 billion yuan, while actual financial investment was 49.33 billion yuan, so there was a 17.84 billion yuan fiscal gap in 2008. It was estimated that the fiscal gap might top 268.30 billion yuan by 2021.The study on financial investment gap in different measuring standard found that the government shall bear the liability with 6665.0-7339.0 yuan in 2015.And compared to the forecast actual financial input, there would be a 919.10-1014.30 billion yuan gap in 2020.
2) The return rates of operating revenue decreased according to the price control
Yields on the business income had been declined for years. The model showed the rate of return was at 7.0% to 12.5% during year 1991 to 2021 respectively. It was demanded that the operating revenue would be 1/yields times that of the financial investment atrophy. Other things being equal, the lower the yields, the more business income would be need for. Under the distorted standard of prices, the medical institutions depended on more operating revenue to compensate for deficit of health investment.
3) Medical care expenditure revealed a trend of fast increase across the board
By using the SD models, simulations suggest that medical expenses might amount to 7241.90 billion yuan by 2021, of which 1874.00 billion yuan was reasonable expense. And the rest of medical expense was 5368.00 billion yuan for deficit of health investment. According to different standards of ideal financial input, it led to an over-increasing of medical expenditure to 698.80-433.87 billion yuan from 2010 to 2021. Over the years, the medical care expenditure had experienced a continuously rapid growth which was far higher than the GDP growth rate.
4) The medical institutions depended on more prescription drugs and more medical examinations
The simulation results showed that more medical services would create more losses since revenue was extremely low and presented negative. The revenue sources of medical institutions included the fee for diagnosis, the routine service items, and high-tech service project and prescription drugs. However, only high-tech projects and prescription drugs could be profitable. The simulation indicated that medical institutions relied on drug income to amplify their returns. Simultaneously, the research on the influencing factors was conducted in regression model, while the revenue sources were referred as dependent variables. The percentage contributions of various revenue sources to operating revenue were calculated.Regression analysis showed that the growth of revenue owed mostly to the contribution from income of drugs and medical examinations, while Service revenue had little effect. This finding reflect that the medical institutions depended on more prescription drugs and more medical examinations for deficit of health investment under the distorted standard of prices.
5) Over-increasing medical care expenditure pressed too heavy an economic burden on the civic people and the equity deteriorated
In the condition that medical security system had yet to be improved, the rapid growth would have significant effects on the economic burden and impartiality of medical expenditure especially. Based on the model which calculated fiscal gap by financial aid standard on 1991 level, the economic burden would reach 0.0982 in 2015 and 0.1091 in 2020. And with regard to the lack of government subsidies, it gained an additional 0.0657-0.0809 of the burden of medical care expenditure. Catastrophic payments for health care happened in 13.16 percent of families in 2015, and that the reasonable quantity was 12.14 percent. Results stated clearly that the incidence of catastrophic health payments was far more than it should be. Thus, the economic burden and the head count of family catastrophic payments for health care were increased due to the rapid rise of medical care expenditure.
(3)The Mechanism of Over-Increasing Medical Care Expenditure
SD model simulation was used to interpret the responsibility of the financial, the commodity prices and the medical institution for the excessive growth of medical expenditure. It showed that, the financial and commodity prices bore the primary responsibility due to attribution analysis, the responsibility amount to 40.0%-71.6% and 40.8%-66.7% or more separately. Medical institutions conduct "more prescription drugs, more medical examinations" to make up for the lackage of financial investment and the strict control of commodity prices.
The study simulated dynamics action characteristic and mechanism of over-increasing medical care expenditure system using SD model combined with qualitative and quantitative methods. It was founded that the course of over-increasing medical care expenditure was controlled by the intrinsic properties. And the interactive mechanism among the numerous factors was complicated in the medical care expenditure system.
—The central government had been giving priority to the economic development, while neglecting health care and changing the nature of welfare.
—Since government subsidies dropped year by year, the medical institutions was demanded the way that funds raised by oneself. Consequently, they leant on operating revenue.
—The policies of price cutting and fixing that price department always persisted in differed from the environment of macroeconomic reform and the adjustment fiscal function. They deviated from the cost of the medical services, and resulted in an abnormality in the charge standard of medical services.
—It induced the health department to explore new sources of profit for hospitals.
—And it stimulated the hospitals to set up more high-tech or new services, do more inspections, and over dose, etc, which became the main method for hospitals to reply the self-financing policy.
—Tacit understanding between medical agencies and pharmaceutical companies helped develop the drug market chaos:too expensive drug, production structure more imbalance, production lever lower, more repeated production.
—Moreover, the imperfect medical insurance with low coverage, limited access to health insurance and limited benefit package caused "overly expensive medical services" as a universal social issue.
(4)Give suggestions on medical expense control and evaluate the effects
Simulation platform was build to screen policy intervention targets by system dynamics methods, using Vensim software. The experiments changed the behavior of system conditions such as government subsidies, price adjustment of the total yields, Global budget, medicare reimbursement rates and coverage, etc, in order to observe positive results. After intervention, it had been found that the change of fee per time caused by financial investment adjustment was 1.03-2.38 times more than medical insurance function, while the effect of yield change was 1.18-1.42 times as great. As the study showed, Strategies, such as increasing the government investment or bumping up business income yield could effectively control the rapid increase of the medical expense.
In accordance with the game theory, the paper deduced that medical expenditure should be in proportion to the level of social and economic development, which meant social affordability. On the basis of policy intervention targets, simulations were carried out to realize economic development synchronization. At the same time, appropriate combination strategies were put forward and policy effects were analyzed as follows:
◆Firstly, it was possible to solve a package of the existing major problems and ensure the synchronism of medical expenditure and social economic development by increasing Government subsidies. Financial investment of medical services in 2015 was expected to 187.50 billion yuan, and 461.70 billion yuan by 2020. Compared to the financial investment under current business income growth, there would be 41.40 and 144.40 billion yuan additional investment in 2015 and 2020. And based on the standard of the government investment account for 8% in financial expenditure or takes up 40% of total health expenses, the research expected the total government subsidies to be 851.80-888.70 billion yuan in 2020.
◆Then, it was necessary to make some adaptations in terms of the return rates of operating revenue to compensate the loss unless increasing government subsidies. It showed that the return rates of operating revenue should rise from 0.0384-0.0525 to 0.0695-0.1060.
◆Furthermore, under the "fee for service" payment, the irrational price criterion needed to be improved. So as to ensure medical institutions gain reasonable compensation through regular examinations and social necessary services. Or through changing the post payment to prepayment, such as service unit payment. To pursue revenue maximization, the hospitals had to adopt the way "less prescription drugs, less expensive drugs", "less examinations, less sophisticated examinations" to increase revenues. In accordance with purchasing the lowest price drugs, replacing expensive drugs with cheap drugs within the same kind, replacing sophisticated examinations with conventional examinations.
◆At last, the growth of medical care expenditure would remit through optimization strategy. Total operating revenue would fall by almost a quarter compared with the same period in 2015 to 1906.90 billion. Result showed that not only operating revenue could be saved, but also 17.4 to 53.4 percent of fee per time could be saved. Besides, the implementation of the optimization strategy would lead to a decline of 8.0 percent of catastrophic payments for health care by 2021.
4. Research Innovations
(1) Methods Innovations
The method of system analysis and the macro module special for health system were also employed to understand the inner laws of medical care expenditure growth.
The stakeholder theory was used to analyze the stakeholders and interaction of the medical care expenditure system.
The logic model and SD model of over-increasing medical care expenditure were constructed to evaluate the main variable and function relation by agent action analysis based on VENSIM software.
Simulation and policy intervention research were carried out to illuminate the mechanism and put forward correlative policy suggestions by applying synthetically system dynamics and computer simulation technique.
(2) Results innovations
By using theories of system and stakeholders to analyze the interests of all stakeholders, relationship between stakeholders and the process of expenditure growth, thus suggest a kind of new thinking about how to clarify internal relations in the complicated system
Use of quantitative and qualitative methods to explain the formation of key issues, and reveal the root causes and the mechanisms by System Dynamics methods, in order to develop policy ideas for solving the problem of the difficulty in seeing a doctor and the high cost of getting a treatment.
Some simulation trials with Vensim software are made, and the results prove that the model can perfectly simulate the dynamics of the medical care expenditure system. The SD model is used for the simulation and verifying platform for the whole processes. By means of predicting the future development of medical expense, results reveal the high speed growth and its damage in the absence of government intervention.
The study put forward the policy suggestions of solving the focus problem by policy intervention experiment. At the same time, policy effects are analyzed. It turns out that strategies such as increasing the government investment or bumping up business income yield can effectively control the rapid increase of the medical expense. Thus, provide a reference outline for our country health system reform and the development.
引文
[1]赵存现.陈俊国,陈燕凌,等.医疗费用增长的研究与对策[J].重庆医学,2009,38(1)：10-11.
[2]Hong Wang,Licheng Zhang,William Hsiao. Ill health and its potential influence on household consumptions in rural China [J].Health Policy,2006,78(2):167-177.
[3]Liu YL,Rao KQ,Hsiao W.Medical expenditure and rural impoverishment in China[J].Journal of Health Population and Nutrition,2003,21 (2):216-238.
[4]高强.深化改革加快发展切实解决群众看病难、看病贵的问题[J].中国监察,2005,(22)：10-13.
[5]Wen JB.The Report on the Work of the Government delivered by Premier Wen Jiabao at the Fifth Session of the Tenth National People's Congress [Z].2007-03-05.
[6]胡焕庭,朱有生,刘沛涵.药物资源滥用及控制对策邹议[J].中国卫生经济,1996,15(4)：16-17.
[7]郭秀武,杨永歧.市场经济体制的药品监督管理[J].中国药事,1995,19(1)：11-12.
[8]周圣群.探索基层医疗机构药品管理的长效机制[J].中国药事,2004,18(8)：32-34.
[9]胡善联,张仁伟,高建民.”乡村卫生机构药品购销体制研究”总报告[J].卫生经济研究,2003,(4)：3-5.
[10]陈敏章.在1990年全国卫生厅局长会议上的讲话.中国卫生五十年历程[M].北京：中医古籍出版社,1996：293-298
[11]孙兰香.调整收费结构、减轻患者负担[J].中国卫生经济,2002,21(8)：42.
[12]达复安.引资合作使用医疗仪器的利弊分析[J].中国卫生经济,1998,17(5)：34-35.
[13]郝模,吴延风,王志锋.与社会协调解决问题：卫生事业可持续发展的基石[J].中华医院管理杂志,1998,14(1)：1-5.
[14]郝模,王志锋,吴延风.社会互动：医院补偿机制恶性循环模型逻辑推论[J].中华医院管理杂志,1998,14(1)：6-12.
[15]黄伟震.对我国卫生资源配置和使用几个深层次问题的思索[J].山东医科大学学报(社会科学版),2000,(2)：44-47.
[16]田璇.浅谈新时期医德医风建设[J].医学理论与实践,2005,18(11)：1367-1368.
[17]王怀才.试论当前医德医风存在问题的成因及其对策[J].中国医院管理,1996,16(2)：27-28.
[18]高强.在2005年全国卫生工作会议上的工作报告[EB/OL].www.moh.gov.cn.2005-01-10
[19]卫生部.卫生部关于加强卫生行业作风建设的意见,2004年.[EB/OL].http://www.moh.gov.cn/newshtml/115.htm
[20]刘军民.过度市场化与分权化--中国医疗卫生改革的双重误区[J].卫生经济研究,2005,(12)：3-10.
[21]郑云.推动两个效益实现医药卫生现代化[J].现代医院,2004，4(1)：47-49.
[22]郜习德,温琴如,黄淑英.以病人为中心,深入开展优质服务,提高门诊工作质量[J].实用医院临床杂志,1998,(2)：135-136.
[23]任真年.当前医疗质量管理的难点与对策[J].中国医院管理,1996,16(1)：26-27.
[24]姜福康,苏丽,毛庆来.”医改”后军队医院加大无形资产投入的必要性[J].中国卫生经济,2002,21(9)：32.
[25]沈鸿伟,王钦清.正确认识和处理医疗纠纷促进医患关系正常化[J].前进论坛,2003,(10)：25-26
[26]国务院体改办,国家计委,国家经贸委,财政部,劳动保障部,卫生部,药品监管局,中医药管理局.《关于城镇医药卫生体制改革的指导意见》,2000年[EB/OL]. http://cnki.shsmu.edu.cn/yywsgl/yywsgll/SHYLWS%60GL/BMGZ/BMGZ1068.htm
[27]王陇德.中国卫生体制改革[J].中国行政管理,2004,(8)：26-29.
[28]财政部,国家发展计划委员会,卫生部,中医药管理局.关于完善城镇医疗机构补偿机制落实补偿政策的若干意见(财社[2001]60号)，2000年[EB/OL].http://www.100md.com/Html/Dir0/14/49/32.htm
[29]时空调查.九成人认为医生声望有所下降[J].健康大视野,2005,(12)：7.
[30]尹秀云.走出医患关系认知误区[J].家庭中医药,2004,(12)：10-11.
[31]郑雪倩.医疗纠纷防范与对策[M].广东：汕头大学出版社,2002：1-7.
[32]唐玉兰.再谈医疗卫生事业的地位[J].中国卫生经济,1995,7(14)：5-8.
[33]温家宝.第十届全国人民代表大会第三次会议政府工作报告,2005.http://www.people.com.cn/zgrdxw/zlk/rd/10jie/text03.htm
[34]温家宝.第十届全国人民代表大会第四次会议政府工作报告[EB/OL].http: //www.npc.gov.cn/dbdh/home/index.jsp
[35]胡锦涛.强调建设覆盖城乡居民的基本卫生保健制度,中共中央政治局第三十五次集体学习讲话[EB/OL].:http://cpc.people.com.cn/.2006-10-24
[36]胡锦涛在中共中央政治局第三十五次集体学习时强调,高度关注和不断提高人民群众健康水平,建设覆盖城乡居民的基本卫生保健制度[EB/OL].:http://news.xinhuanet.com/video/2006-10/24/content_5244468.htm.2006-10-24
[37]郝模,吴延风,王志锋.社会互动：医疗费用过快增长的动因[J].中华医院管理杂志,1995,11(9)：565-567.
[38]胡善联.深化医药卫生体制改革的若干问题探讨[J].卫生经济研究,2010,(1)：5-7.
[39]郝模,吴延风,郑树忠.1983-93年上海市医疗费用增长的合理度分析[J].中华医院管理杂志,1995,11(9)：558-561.
[40]中国卫生总费用课题组.中国卫生总费用数据测算工作的进展[J].中国卫生经济,1997,16(12)：38-39.
[41]Appleby J,Boyle S. Blair's billions:where will he find the money for the NHS? [J].BMJ. 2000,320(7238):865-867.
[42]Blendon RJ. The public versus the world health organization on health system performance [J].Health Affairs.2001,20(3):10-20.
[43]Levy D T. The Transactions Cost Approach to Vertical Integration:An Empirical examination [J]. Review of Economics and Statistics,1985,67(3):438-445.
[44]艾自胜,高歌,潘军燕.国际医疗保险支付制度理论研究及对我国的借鉴作用[J].中国农村卫生事业管理,2001,21(1)：40-43.
[45]CDC. Medical care spending:United States [J].JAMA.1994,272(10):764.
[46]杜乐勋.1992年中国医疗费用测算结果和初步分析[J].中国医院管理,2000,20(01)：35-37.
[47]何平平.中国卫生总费用增长因素研究[J].统计与信息论坛,2006,21(1)：37-41.
[48]刘国祥等.中国卫生总费用分配流向测算报告[J].中国卫生经济,2001,20(2)：29-33.
[49]Gilbert,Neil.Transformation of the welfare state [M].New York:Oxford University Press,2002.
[50]Gilbert,Neil,Paul Terrell. Dimensions of social welfare policy (5th Edition) [M].Boston:Allyn and Bacon,2002.
[51]郝模.我国职工医疗保险制度实施中若干问题的思考[J].中华医院管理杂志,2000,16(1)：7-12.
[52]Kumar A.The Market Approach to Health Care [J]. Hospital Management International,1992,(2):122-131.
[53]Zhong L,Goldberg MS,Gao YT,et al. A population-based case control study of lung cancer and green tea consumption among women living in Shanghai,China [J].Epidemiology.2001,12(6):695.
[54]徐勇.我国公共卫生执法的现状、问题及分析[J].中国卫生监督杂志,2000,7(2)：84-86.
[55]Linna M. Measuring hospital cost efficiency with panel data models [J].Health Economics. 1998,7(5):415-427.
[56]Paula Braveman and Eleuther Tarimo. Social inequalities in health within countries:not only an issue for affluent nations [J]. Social Science and Medicine,2002,54(11):1621-1635.
[57]Norton E. C., Staiger D. O. How hospital ownership affects access to care for the uninsured [J].RAND journal of economics.1994,25:171-185.
[58]郝模,王小宁,尹爱田.我国农村三级医疗预防保健网的焦点问题、作用机制、和发展战略研究结果简介[J].中国卫生资源,2000,3(6)：256-259.
[59]G·布罗姆,汤胜蓝.中国政府在农村合作医疗保健制度中的角色与作用[J].中国卫生经济,2002,21(3)：17-21.
[60]陈健生.新型农村合作医疗筹资制度的设计与改进[J].财经科学,2005,(1)：124-131.
[61]程晓明.对中国农村贫困地区合作医疗的政策建议[J].国际医药卫生导报,2003,(9)：17-18.
[62]陈在余.新型农村合作医疗需求不足的经济学分析[J].中国卫生经济,2007,26(3)：54-57
[63]董莹.新型农村合作医疗体系的筹资政策分析[J].甘肃农业,2006,(12)：58-59.
[64]C.米尔,郑秉文.法国社会保障的经验教训与出路--与中国学者的交流[J].国外社会科学,2001，(2)：22-27.
[65]J. E. Foster.J. Greer & Eric Thorbecke. A Class of Decomposable Poverty Measures [J].Econometrica. 1984,52(3):761-766.
[66]郝模,王永龙,周剑萍.论医疗费用合理增长的确定方法[J].中华医院管理杂志,1995,11(9)：554-556.
[67]L. Lindholm. Cost-effectiveness analysis with defined budget:how to distribute resources for the prevention of cardiovascular disease [J].Health Policy.1999, (48):155-170.
[68]Silvia Evers. Predicting the cost of hospital stay for stroke patients:the use of diagnosis related groups [J].Health Policy.2002, (61):21-42.
[69]Emmett B. The changing effects of competition on non-profit and for-profit hospital pricing behavior [J].Journal of Health Economics.1999,(18):69-86.
[70]范文胜.西方国家控制医疗花费的改革[J].国外医学.卫生经济分册,1996,13(3)：121-122.
[71]李银才.构建科学的医疗服务价格体系的思考[J].中国卫生经济,2004,23(10)：55.
[72]Schmeider EC,Liberman T. Publicly disclosed information about the quality of health care:response of the US public [J].Quality in HealthCare.2001,10(1):96-103.
[73]Zaric GS,Brandeau ML. Dynamic resource allocation for epidemic control in multiple populations [J].Math Med Biol.2002,19(4):235-255.
[74]James R,Kwangsoo L. Longitudinal study of health maintenance organization efficiency [J]. Health Services Management Research,2001,14(4):249-262.
[75]郝模,罗力,李海宁.协调发展政策思路--医疗资源最优利用模型分析[J].中华医院管理杂志,1998,14(1)：13-14.
[76]Laska EM,Meisner M,Siegel C. Ratio based and net benefit based approaches to health care resource allocation:proofs of optimality and equivalence [J].Health Econ.1999,8(2):171-174.
[77]Hardorn.David C. Setting health care priorities in Oregon:cost effectiveness meets the role of rescue [J].JAMA.1991,265:2218-2225.
[78]Yasar A 0. Efficiency of hospital services production in local markets:the balance sheet of U.S. medical armament [J]. Socio Econ Plann Sci.1995,29:139-150.
[79]Green A,Ali B,Naeern A,et al. Resource allocation and budgetary mechanisms for decentralized health systems:experiences from Balochistan,Pakistan [J]. Bull World Health Organ.2000,78(8):1024-1035.
[80]Ewa Forsberg. Financial incentives in health care.The impact of performance-base reimbursement [J].Health Policy.2001,(58):243-262.
[81]初炜,贾佩福,刘英伟.我国药品监管实践中存在的法律问题与思考[J].中国药事,2010,24(1)：11-18.
[82]郝模,王志锋.促使药品市场有序发展的政策研究概述[J].中国卫生资源,1998,1(1)：15-19.
[83]Rret C.Essential drugs and lower costs. World Health Forum.1997,(8):345-347.
[84]陈和平.试论我国药业规制的法律界定及其制度要素[J].南京中医药大学学报(社会科学版),2003,4(4)：221-226.
[85]Lanska DJ,Kryscio RJ. In-hospital mortality following carotid en-darterectomy [J].Neurology. 1998,51:440-447.
[86]Van Zon AH,Kommer GJ. Patient flows and optimal healthcare resource allocation at the macro-level:a dynamic linear programming approach [J].Health Care Manage Sci.1999,2(2):87-96.
[87]Wolleswinkel-van den Bosch JH,Looman CW,Van Poppel FW,et al. Cause-specific mortality trends in the Netherlands,1875-1992:a formal analysis of the epidemiologic transition [J].Int J Epidemiol. 1997,26(4):772-81.
[88]Frank R. G.,Salkever D. S.,Mullan F. Hospital ownership and the care of uninsured and Medicaid patients:findings form the National Hospital Discharge Survey 1979-1984 [J].Health policy.1990,14:1-11.
[89]徐渊洪,朱亮真.信息不对称下医患信任的重构[J].中华医院管理杂志,2004,20(3)：167-169.
[90]郝模，刘金锋,马安宁.《医疗卫生产业化范畴界定和策略研究》项目概述[J].中国卫生资源,2004,7(5)：195-197.
[91]Lynch,Janet R,Ozcan,et al. Hospital closure:an efficiency analysis [J]. Hospital & Health Services Administration,1994,39:205-217.
[92]冯显威,黄严.公立医院产权制度改革理论与模式分析[J].医学与哲学,2005,26(5)：18-25.
[93]顾昕.全球性公立医院的法人治理模式变革--探寻国家监管与市场效率之间的平衡[J].经济社会体制比较,2006,(1)：46-55.
[94]顾昕.走向有管理的市场化：中国医疗体制改革的战略性选择[J].经济社会体制比较,2005,(6)：18-29.
[95]赵楠.由科斯定理看我国公立医院产权制度改革[J].当代经济(下半月),2006,(11)：8-9.
[96]郝模.论三项改革联动和公立医院管理体制改革[J].中华医院管理杂志,2002,18(1)：4-11.
[97]郝模,吴延风,华颖.论医院收入构成合理调整的确定方法[J].中华医院管理杂志,1995,11(9)：557.
[98]郝模,陈立今,马安宁.公立医疗机构管理体制改革：策略和障碍[J].中国医院管理,2004,24(1)：2-6.
[99]吴敏.我国医院管理体制改革趋势分析[J].医院管理论坛,2004,(11)：9-14.
[100]Diane D,Maria G,Andrew S. Improving performance in public hospitals:a role for comparative costs [J].Health Policy.2001,57:235-248.
[101]Leape,L. L. Error in Medicine [J].JAMA.1994,272:1851-1857.
[102]Gelijins,A. and R. Nathan.The Dynamics of Technological Change in Medicine [J].Health Affairs. 1994,13(3):28-46.
[103]Prescott P A. Nursing:An important component of hospital survival under a reformed health care system [J].Nursing Economics.1993,11 (4):192-199.:192-199.
[104]柏晶伟.葛延风：中国医疗改革违背了卫生事业发展的基本规律[J].健康大视野,2005,(08)：27-28.
[105]GERDTHAM U.G,LONSSON B.1992."An Econometric Analysis of Health Care Expenditure,A Cross Section Study of OECD Counties" Journal of Health Economics,11(1).
[106]NEWHOUSE.J.P. Medical Care Expenditure:ACross National Survey Journal of Human Resoureces,1977,12(1):115-125.
[107]Newhouse. Medieal Care Costs:How Much welfare Loss? Jounral of Economic PersPectives.1992,6(3):3-21.
[108]Till Baernighausenl,Rainer Sauerbornl,张新平.德国卫生保健系统费用及其控制的宏观分析[J].国外医学社会医学分册,2000,17(2)：68-71.
[109]赵蓉,郝模,吴延风.国外医疗费用控制的方法和理论研究[J].中华医院管理杂志,1995,11(9)：573-576.
[110]Mark V. Pauly.The Economics of Moral Hazard:Comment[J]. American Economics Review, 1968,58(3):531-537.
[111]Michael L.The management of the cost and utilization of pharmaceuticals in the United Kingdom[J].Health Policy,1997,41(1):27-43
[112]R Feldman, B Dowd, and G Gifford.The effect off HMOs on premiums in employment-based health Plans[J].Health Service Research,1993,27(6):799-811.
[113]Rice T.Containing health care costs in the United States[J].Medical Care Review,1993,49(1):19-65.
[114]Blum, M.Spell,C.Workplace characteristics and health care cost containment practice[J]. Journal of Management,1996,22(5):675-701.
[115]ShenY,Ellis R.P.Cost-minimizing risk adjustment[J]Jounal of Health Economics, 2002,21 (3):515-530.
[116]陈蕙.中国医疗费用控制：来自HMO的启示[D].厦门：厦门大学,2007.
[117]Xirasagar,S.and H.C.Lin,Cost Convergence between Public and For-profit Hospitals under Prospective Payment and High Competition in Taiwan,Health Services Research,2004,39:2101-2115.
[118]Alain C. Enthoven.The U.S. health care economy:from guild to market in ten years. Health policy,1987, 7(2):241-251.
[119]Levin G, Hirsch GB, Roberts E. Narcotics andthe community:A system simulation. American Journal of Public Health 1972,62(6):861-873.
[120]Hirsch GB, Bergan TA. Simulating ambulatory care systems:The relationship between structure and behavior. Proceedings of the Summer Computer Simulation Conference.Montreal, Quebec, Canada 1973:877-884.
[121]Barbara Bridgman Perkins. Re-forming medical delivery systems:economic organization and dynamics of regional planning and managed competition. Social Science & Medicine, 1999,48(2):241-251.
[122]Peter C. Smith, Ann van Ackere. A note on the integration of system dynamics and economic models. Economic Dynamics & Control,2002,26(1):1-10.
[123]Marion Sabine Rauner, Michaela-Maria Schaffhauser-Linzatti. Impact of the new Austrian inpatient payment strategy on hospital behavior:a system-dynamics model. Socio-Economic Planning Sciences, 2002,36(3):161-182.
[124]Dietz, T. (2004). Preface to:Mediated Modeling:A System Dynamics Approach to Environmental Consensus Building, Island Press, Washington D.C. ISBN 1-55963-960-1.
[125]World Health Organization,Evaluation of the Strategy for Health for All by the Year 2000[M].,WHO.1987.
[126]胡锦涛.强调建设覆盖城乡居民的基本卫生保健制度,中共中央政治局第三十五次集体学习讲话[EB/OL].http://news.xinhuanet.com/politics/2006-10/24/content_5244094.htm.2006-10-24.
[127]朱秀兰,田平,舒峨,等.“看病贵”的原因及对策[J].中国医院管理,1991,11(8)：38-40.
[128]刘昆明.站在医改风口浪尖的副厅长——访广东省卫生厅副厅长廖新波[J].新经济杂志,2006,(2)：30-33.
[129]新华社.药价虚高重复检查九成城市居民嫌看病太贵[EB/OL]. http://finance.sina.com.cn/xiaofei/shenghuo/20050429/13511563246.shtml. 2005-4-29.
[130]张锦高.“看病难”问题浅析[N].小商品世界报,2005-03-05(006).
[131]胡善联.上海市“看病难、看病贵”成因和对策研究[J].卫生经济研究,2006(2)：21-23.
[132]王文清.中国医疗费用快速上涨问题研究—山西省W县医疗费用状况的调查与思考[D].北京：中央民族大学,2006.
[133]方格.浅议“治病贵”[J].中国医院管理,1990,(3)：49.
[134]黄成礼,马进,自虓.供方支付方式研究及政策建议[J].中国卫生经济,2000,19(1)：8-10.
[135]刘汉卿.如何解决老百姓看病难?[J].中国经济周刊,2005,(33)：26-27.
[136]杜治政.约束大医院无限扩张的冲动建立和谐医患关系的重中之重[J].医学与哲学,2005,26(11)：1-5.
[137]杨俊荣,于润吉.解决机制性深层次矛盾才能缓解看病贵[J].卫生经济研究,2005,(11)：29-30.
[138]刘文海.别把“市场化”当作医疗卫生问题的替罪羊[J].医院领导决策参考,2005,(20)：34-37.
[139]那丽,任苒,赵郁馨.政府卫生事业投入分析.[J]中国卫生资源,2002,5(6)：243-246.
[140]尹爱田,钱东福,等控制医院药品费用过高策略的政府行为[J].中国卫生经济,2004.,23(9)：22-23.
[141]郭永松,徐凌霄.社会医疗保险中需方制约机制的研究[J].中国卫生事业管理,2004,(9)：540-542.
[142]郝模.谁之过？——论“看病贵”问题的成因[J].中国卫生资源,2006,9(1)：3-5.
[143]时培君.遏制医药费用增长过快必须全方位深化改革[J].青岛医药卫生,2001,33(2)：123-124.
[144]孟庆跃.医疗保险支付方式改革对费用控制的影响分析[J].卫生经济研究,2002,(9)：18-21.
[145]赵军,张正华.医疗费用过快增长的动力机制和控制策略谫论[J].中华医院管理杂志,2003,19(8)：449-450.
[146]郑大喜.医疗保险费用支付方式的比较及其选择[J].中国初级卫生保健,2005,19(6)：6-9.
[147]史文璧,黄丞.道德风险与医疗保险风险控制[J].经济问题探索,2005,(2)：60-63.
[148]赵晓光.我国医疗保障制度改革与医疗费用增长的控制[J].世界经济情况,2007,(4)：22-27.
[149]徐文.浅析医疗费用增长过快的原因及对策[J].中国医药指南,2009,7(24)：80-81.
[150]王其藩.复杂大系统综合动态分析与模型体系[J].管理科学学报,1999,2(2)：15-27.
[151]许光清,邹骥.系统动力学方法：原理、特点与最新进展[J].哈尔滨工业大学学报(社会科学版).2006,4：72-77.
[152]陈勇.影响供应链合作伙伴关系的因素研究[J].工业技术经济,2009,28(11)：113-116.
[153]李焕荣.基于SD的战略人力资源管理与企业绩效作用机理[J].工业工程,2009,12(6)：23-27.
[154]刘威,李玉峰,吕巍.组织内部人际信任的系统动力学分析[J].现代管理科学,2009,(10)：39-41
[155]迟英庆,詹强南,杜妍虹.动态环境下持续营销渠道实现的系统动力分析[J].经济问题,2007,(12)：117-118.
[156]周建亨,徐琪.服装业供应链的系统动力学模型分析[J].纺织学报,2008,29(12)：122-125.
[157]吴隽,李杰,张莹.供应链环境下联合库存SD模型研究[J].中国物流与采购,2008,(13)：66-67.
[158]李旭.二级供应链系统库存策略的系统动力学研究[J].系统工程,2009,27(5)：1-6.
[159]程叶青,李同升,张平宇.SD模型在区域可持续发展规划中的应用[J].系统工程理论与实践,2004,(12)：13-18.
[160]赵秀生,魏宏森.综合集成方法及其在区域规划中的应用[J].系统辩证学学报,1994,(1)：63-69.
[161]申碧峰.北京市宏观经济水资源系统动力学模型[J].北京水利,1995,(2)：14-16
[162]陈成鲜,严广乐.我国水资源可持续发展系统动力学模型研究[J].上海理工大学学报,2000,22(2)：154-159.
[163]杨春伟,赵秀生,于素花,等,塔里木河流域水资源调配SD模型及应用[J].农业技术经济,2001,(3)：13-17.
[164]王武科,李同升,等.基于SD模型的渭河流域关中地区水资源调度系统优化[J].资源科学,2008,30(7)：983-989.
[165]李梅,朱丽,王洪波.城市水资源再生利用系统分析及模拟[J].水资源保护,2008,24(1)：31-33.
[166]陈传美,郑垂勇,马彩霞.郑州市土地承载力系统动力学研究[J]河海人学学报,1999,27(1)：53-56.
[167]张晓玲,吴宇哲,关欣.城市化视角下的土地利用变化研究综述[J].农机化研究,2008,(1)：243-245.
[168]刘炳恩,隽志才,贾洪飞.城市土地利用与交通系统关系的动力学模型[J].吉林大学学报(工学版),2008,38(2)：67-70.
[169]王其藩.SD模型在基础设施研究中的应用[J].管理工程学报,1999,(2)：31-35
[170]韩德林,陈正江.运用系统动力学方法研究绿洲经济-生态系统——以玛纳斯绿洲为例[J].地理学报.1994,49(4)：307-316.
[171]符亚明.奥运经济对北京市产业发展直接影响研究[J].中国软科学,2003,(7)：44-47.
[172]施国洪,朱敏.系统动力学方法在环境经济学中的应用[J].系统工程理论与实践,2001,(12)：104-110.
[173]何世有,章文芳,李光久.环境经济系统SD模型的建立[J].江苏理工大学学报：社会科学版,2001,(4)：63-66.
[174]童玉芬.人口变动对干旱区生态环境影响的定量评估模型的应用—以新疆塔里木河流域为例[J].中国人口·资源与环境,2003,13(5)：59-65.
[175]刘桂梅.孙松,王辉.海洋生态系统动力学模型及其研究进展[J].地球科学进展,2003,18(3)：427-431.
[176]张汉雄,张兴昌,邵明安.长城沿线农牧交错带生态环境恢复重建SD模型研究[J].中国生态农业学报.2005,13(1)：173-178.
[177]贾海峰,张岩松,何苗.北京水系多藻类生态动力学模型[J].清华大学学报(自然科学版).2009,49(12)：1993-1996.
[178]李凌,张鹭鹭,杨祖兴,等.潜在医疗服务需求转化逻辑模型构建[J].第二军医大学学报,2005,(26)：1213-1216
[179]卢杨,张鹭鹭,欧崇阳,等.城市医院与社区卫生服务中心互动模式及问题分析[J].中国全科医学,2006,9(17)：1400-1402.
[180]李凌,张鹭鹭,杨祖兴.潜在医疗服务需求转化逻辑模型构建[J].第二军医大学学报,2005,26(11)：1213-1216.
[181]欧崇阳,张鹭鹭,杨祖兴.我国卫生资源投入与利用的系统动力学模型初建及模拟[J].第二军医大学学报,2005,26(11)：1220-1223.
[182]张鹭鹭.转型期医院可持续发展机制实证研究[J].中华医院管理杂志,2003,19(2)：87-89.
[183]卢杨,张鹭鹭,马玉琴.医院与社区互动逻辑建模分析[J].中国初级卫生保健,2008,22(1)：15-17.
[184]欧崇阳,张鹭鹭,杨祖兴,等.我国卫生资源投入与利用的系统动力学模型初建及模拟[J].第二军医大学学报,2005,26(11)：1220-1223.
[185]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统政策干预研究[J].中国全科医学，2010,13(4)：1093-1095.
[186]谢长勇,张鹭鹭,李玲.我国宏观卫生筹资系统模拟与干预结果分析[J].中国卫生经济,2010,29(2)：16-18.
[187]谢长勇,张鹭鹭,李玲,等.基于系统动力学方法的我国宏观卫生等资系统要素分析[J].中国卫生经济,2009,28(3)：8-11.
[188]杨祖兴,张鹭鹭,李凌,等.城市医疗卫生服务系统宏观模型构建[J].第二军医大学学报,2005,26(11)：1217-1219.
[189]张鹭鹭,李凌,欧崇阳.基于人群健康的国家医疗卫生服务系统建模设计[J].第二军医大学学报,2005,26(11)：1209-1212.
[190]马玉琴,张鹭鹭,卢杨.农村医疗卫生服务系统系统动力学模型干预研究[J].中国农村卫生事业管理,2007,27(8)：569-571.
[191]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统政策干预研究[J].中国全科医学,2010,13(4)：1093-1095.
[192]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统的系统动力学模型研究[J].中国初级卫生保健,2009,23(11)：6-8.
[193]张宇,张鹭鹭,马玉琴,等.基于系统动力学的农村人群就医选择行为模型干预研究[J].中国全科医学,2010,13(8)：2474-2476.
[194]张宇,张鹭鹭,马玉琴.“农村人群就医行为选择”建模设计[J].中国农村卫生事业管理,2009,29(11)：812-814.
[195]张宇,张鹭鹭,马玉琴.农村人群就医选择行为逻辑模型构建[J].中国全科医学,2010,13(8)：2467-2470.
[196]朱燕刚,张鹭鹭,贾建国.“药品价格虚高”问题模型构建与模拟[J].管理评论,2007,19(5)：26-33.
[197]王晓燕.社会医疗保险费用控制方案的系统动力学模拟[J].财贸研究,2007,(4)：64-71.
[198]廖晓明,贾清萍.基于系统动力学的新型农村合作医疗系统分析[J].中国行政管理,2007,(9)：66-69.
[199]王玉梅,王丽.基于系统动力学的中医人才成长供应链模型研究[J].青岛科技大学学报(社会科学版),2008,24(4)：69-73.
[200]李丽清,周重刚,肖俊华.流程再造对医院运营效率的反馈关系图分析[J].华中师范大学学报(自然科学版),2008,42(2)：224-228.
[201]蒋军成.试论我国医疗保障体制改革中的政府作用--基于系统动力学的分析[J].宏观经济,2008,(7)：57-59.
[202]许晶晶,汤少梁.系统动力学方法应用于国家基本药物体系研究的探讨[J].中国药业,2009,18(18)：1-2.
[203]肖增敏,申俊龙.不同医疗保险补偿机制的系统动力学比较分析[J].南京中医药大学学报(社会科学版),2009,10(4)：230-233.
[204]余江,臧雷,王卫东,等.大型综合性医院风险防范系统动力学模型的构建[J].中国医院管理,2009,29(6)：15-16.
[205]张志丹,汤少梁.城市贫困人口医疗救助系统模型构建研究[J].南京中医药大学学报(社会科学版),2010,11(3)：166-169.
[206]马蔚姝,张再生.基于利益制衡的三医联动系统良性循环模型构建[J].西安电子科技大学学报(社会科学版),2010,20(1)：98-103.
[207]甘筱青,李红.基于系统动力学的双向转诊“下转难”现象研究[J].中国全科医学,2010,13(10)：3141-3142.
[208]罗力,刘芳,舒蝶.中国公立医院经济补偿规律和成本管制的必然性[J].中国医院管理,2010,30(8)：3-5.
[209]关理.社区卫生服务机构“零差率”药品实际费用比例的系统动力学分析[J].中国卫生经济,2010,29(5)：55-57.
[210]关理.社区卫生服务机构实行收支两条线后收支状况的系统学模拟与分析[J].中国卫生经济,2010,29(4)：40-43.
[211]周绿林,刘石柱,周以林,梅强.我国医疗费用趋势预测研究[J].中国卫生经济,2008,27(5)：16-18
[212]Avi Yacar Ellencweig. Analyzing Health Systems:a modular approach. Oxford:Oxford University Press, 1sted,1992:243-248
[213]Avi Yacar Ellencweig.Analyzing Health Systems:a modular approach.Oxford:Oxford University Press, 1992:17.
[214]郝模.我国农村卫生发展的关键问题政策研究[D].上海：复旦大学，2003.
[215]梁军,赵勇.系统工程导论[M].北京：化学工业出版社,2005：2-3
[216]Blair M.M.and Stout L.A. Response to Peter C1Kostant's Exit,Voice and Loyalty in the Course of Corporate Governance and Counsel's Changing role[J] 1 Journal of Socio n Economics,1999,28(3):251-253.
[217]Mitchell. Aland Woodl Toward a Theory of Stakeholder Identification and Salience:Defining the Principle of Who and What Really Counts [J]. The Academy of Management Review,1997,22(4):853-886.
[218]Thayer C.E.and Fine A.H.Evaluation and Outcome Measurement in the Non Profit Sector:Stakeholder Participation[J].Evaluation and Program Planning,2001,24 (1):103-108.
[219]贾生华,陈宏辉.利益相关者界定方法述评[J].外国经济与管理,2002,24(5)：15-18.
[220]World Health Organization. Equity in health and health care, a WHO/SIDA initiative. WHO, Geneva, 1996
[221]黄如欣.卫生事业与经济社会发展的关系[J].中国医院管理,2003,23(9)：6-7
[222]梁万年.卫生事业管理学[M].北京：人民卫生出版社,2003,311-355
[223]吴筱.我国医疗卫生领域中的政府职能演变：回顾与展望[J].中国卫生政策研究,2008,12(1)：27-31
[224]蔡立辉.西方国家政府绩效评估的理念及其启示[J].清华大学学报(哲学社会科学版),2003,18(1)：76-84.
[225]梁万年.卫生事业管理学.北京：人民卫生出版社,2003：385-399
[226]刘立善.构建和谐医保之我见[J].卫生职业教育.2006,24(13)：125-126
[227]董伟.我国医疗费用过快增长作用机制定量研究[D].上海：复旦大学,2010.
[228]郝模,王永龙,王金承,等.论医疗费用合理增长的确定方法[J].中华医院管理杂志,1995,11(9)：554-556.
[229]王志锋,尹爱田,张勇.运用医疗费用合理增长率测算方法评价我国医疗费用增长状况[J].中国医院管理,2002,22(9)：36-38.
[230]中国人民共和国卫生部.卫生部关于我国农村实现"2000年人人享有卫生保健”的规划目标(试行)[EB/OL]. http://law.lawtime.cn/d527813532907.html/pos=0.1990-03-15.
[231]孙梅,陈文,郝模,等.半个世纪的降价和限价政策,导致了医院的畸形收费[J].中国卫生资源,2007,10(3)：109-111.
[232]陈敏章.在1993年全国卫生厅局长会议上的讲话[R].中国卫生五十年历程.北京：中医古籍出版社，1996：369-376.
[233]郝模,吴延风,王志锋,等.社会互动：医疗费用过快增长的动因[J].中华医院管理杂志,1995,11(9)：565-567.
[234]苌凤水,吕军,王颖,等.中国医疗费用增长有失合理.中国卫生资源,2011,14(1)：48-49.
[235]励晓红，梁鸿,郝模,等.宏观改革政策和财政职能变化,医院成为逐利的“经济实体”[J].中国卫生资源,2007,10(3)：104-108.
[236]曾雁冰,王颖,吕军,等.扭曲的补偿机制困扰医疗机构发展30年[J].中国卫生资源,2011,14(1)：50-51.
[237]曹岳兴,袁汇亢,周莹.公立医院医疗服务价格补偿机制研究[J]卫生经济研究，,2009,(2)：24-26
[238]谭申生,范理宏,周晓辉.医疗资源纵向整合的实践与体会[J].中华医院管理志,2006,22(12)：761-762
[239]卫生部,财政部.关于医院工作人员的工资全部由国家预算开支的通知[EB/OL]. http://www. gzsdfz. org. cn/gzsz/10B/cs/sz10cs02070602. htm.2007-03-28.
[240]钟永光,钱颖,于庆东,等.系统动力学在国内外的发展历程与未来发展方向[J].河南科技大学学报：自然科学版,2006,(8)：101-105
[241]许光清,邹骥.系统动力学方法：原理、特点与最新进展[J].哈尔滨工业大学学报(社会科学版).2006,4：72-77
[242]郝模.医院补偿机制恶性循环和资源最优利用模型定量论证方法[J].中华医院管理杂志.1998,14(1)：21-28
[243]王柯.江苏省铜山县新型农村合作医疗补偿方案研究[D].江苏：东南大学,2000.
[244]Owen O'Donnell, Eddy van Doorslaer,Adam Wagstaff, Magnus Lidelow Analysing health equity using household survey data:a guide to techniques and their implementation[M]. World Bank, Washington, DC, 2008
[245]王朝昕,王颖,励晓红,等.医疗机构净收入与业务收入关系是医改求得突破的技术基础[J].中国卫生 资源,2011,14(1)：62-64.
[246]郝模,林尚立,刘俊.解决看病贵等技术非常成熟,关键是政府的决心[J].中国卫生资源,2007,10(3)：132-134.
[247]郝模.医改：“总额预算”可作为选择[J].医院领导决策参考.2006,(8)：37-40.
[248]冯蕾,张文燕,总额预付拧紧费用之阀,管窥台湾全民健保[J].中国医院院长,2010,(5)：46-48.
[249]曹俊山.上海医疗保障事业可持续发展的环境分析[J].中国卫生资源,2007,10(1)：11-13
[250]王颖,励晓红,吕军,等.从改变支付方式入手,求得医改的突破(2)——析“总额预算+按服务单元付费”组合支付方式[J].中国卫生资源,2011,14(1)：13-15.
[251]章滨云,罗力,郝模.医疗费用“总量控制、结构调整”政策的国内研究进展[J].中国医院管理,2002,21(9)：5-8
[252]周文燕,顾海DRGs对我国医疗保险付费方式的启示与应用前景[J].上海医药,2007,(3)：20-22
[253]王桂榕,范淑萍.我国推广应用ICD中的问题与对策[J].中国病案,2002,(3)：47-48.
[254]沈玉景,张命良.按人头付费式的医疗保险在中国是否可行?[J].中国药物经济学,2006,(1)：9-12
[255]罗力.医保包干、按服务量付费与医疗费用控制[J].中国卫生资源，2006,(1)：42-44
[256]王晓京,朱士俊.医疗费用支付方式的比较[J].中华医院管理杂志.2006,22(7)：481-483
[257]官旭华,卢祖沟.我国现阶段卫生筹资政策分析[J].中国卫生经济,2004,23(1)：55-56
[258]颜爱华.三明市医疗保险基金赤字原因分析及相应对策[J].三明学院学报.2005,22(4)：478-480
[259]程晓明.医疗保险学[M].上海：复旦大学出版社,2003：25-26
[1]许光清,邹骥.系统动力学方法：原理、特点与最新进展[J].哈尔滨工业大学学报(社会科学版).2006,4：72-77
[2]王其藩.复杂大系统综合动态分析与模型体系[J].管理科学学报,1999,2：15—20
[3]FORRESTER J W. Industrial Dynamics:A Breakthrough for Decision Makers [J].Harvard Business Review,1958,36(4):37-66.
[4]FORRESTER J W. Industrial Dynamics [M].Cambridge MA:Productivity Press,1961.
[5]FORRESTER J W. Principles of Systems [M].Cambridge MA:Productivity Press,1968
[6]FORRESTER J W. Urban Dynamics [M].Cambridge MA:Productivity Press,1969.
[7]MASS N J. Readings in Urban Dynamics Vol Ⅰ [M].Cambridge MA:Productivity Press,1974
[8]SCHROEDER W W,SWEENEY R E, ALFELD L E. Readings in Urban Dynamics Vol Ⅱ [M].Cambridge MA:Productivity Press,1975.
[9]ALFELD L E, GRAHAMAK.Introduction to Urban Dynamics [M].Cambridge MA:Productivity Press,1976
[10]FORRESTER J W. World Dynamics[M].2 ed. Cambridge MA:Productivity Press,1973.
[11]MEADOWS D H,MEADOWS D L, J BEHRENS III.The Limits to Growth:A Report for the Club of Rome's Project on the Predicament of Mankind [M].NewYork:Universe Books,1972.
[12]MEADOWS D L,MEADOWS DH,Toward Global Equilibrium:Collected Papers [M].Cambridge MA:Productivity Press,1974.
[13]STERMAN JOHN D.Business Dynamics,Systems Thinking and Modeling for a Complex World[M].NewYork:Irwin McGraw-Hill,2000:41-79.
[14]NAILL R F.A System Dynamics Model for National Energy Policy Planning[J].System Dynamics Review,1992,8(1):1-19.
[15]NAILL R F. An Analysis of the Cost Effectiveness of U.S. Energy Policies to Mitigate Global Warming[J].System Dynamics Review,1992,8(2):111-128.
[16]ABDELMONEIM ALI IBRAHIM.A system dynamics approach to african urban problems:a case study from the Sudan [D]. Kent State University,1989.
[17]KOPAINSKY, BIRGIT URSULA.A system dynamics analysis of socioeconomic development in lagging Swiss regions [D].ETH,2005.
[18]ANDREW FORD.Modeling the environment:an introduction to system dynamics models of environmental systems [M].Island Press, Washington DC,1999.
[19]BRIAN DYSON, NI-BIN CHANG.Forecasting municipal solid waste generation in a fast-growing urban region with sys-tem dynamics modeling [J].Waste Management,2002,25(7):669-679.
[20]STERMAN J D. Modeling Managerial Behavior:Misperceptions of Feedback in a Dynamic Decision Making Experiment [J].Management Science,1989,35(3):321-339.
[21]DISNEY S M, POTTER A T, GARDNER B M.The Impact of Vendor Managed Inventory on Transport Operation[J].Transportation Research E,2003,39(5):363-380.
[22]Pierreval H, Bruniaux R, Caux C.A continuous simulation approach for supply chains in the automotive industry[J].Simulation Mod-elling Practice and Theory,2007,15(2):185-198.
[23]Kamath N B, Roy R.Supply chain structure design for a short lifecycle product:a loop dominance based analysis[C]//Proceed-ings of the 38th Hawaii International Conference on System Sciences,2005.
[24]Rabeloa L, Eskandari H.Value chain analysis using hybrid simulation and HP[J].International Journal of Production Economics,2007,105 (2):536-547.
[25]Higuchi T,Troutt M D.Dynamic simulation of the supply chain for a short life cycle product—Lessons from the Tamagotchi case[J].Computers&Operations Research,2004,31 (7):1097-1114.
[26]Stave K A. Using system dynamic to improve public participation in environmental decisions [J]. System Dynamic Review,2002,18 (2):139-167.
[27]Stavo K A. A system dynamics model to facilitate public understanding of water management options in Las Vegas, Nevada [J]. Environmental Management,2003,67(4):303-313.
[28]Janssen M A,Walker B H, Langridge J. An adaptive agent model for analyzing co-evolution of management and policies in a complex range land system [J]. Ecological Modelling,2000, 131(2-3):249-268.
[29]Janssen MA.An exploratory integrated model to assess management of lake utrophication[J]. Ecological Modelling,2001,140(1):111-124.
[30]Guneralp B, Barlas Y. Dynamic modelling of a shallow freshwater lake for ecological and economic sustainability[J].Ecological Modelling,2003,167(1-2):115-138.
[31]Saysel A K, Barlas Y, Orhan Y. Environmental sustainability in an agricultural development project; a system dynamics approach[J].Environmental Management,2002,64(3):247-260.
[32]COOPER K G. Naval ship production:Claim Settled and a Framework Built [J].Interfaces,1980,10(6):20-36.
[33]ABDEL-Hamid T K,MADNICK S E. Software Project Dynamics:An Integrated Approach[M].Englewood Cliffs NJ:Prentice Hall,1991.
[34]Robert H.Pantell, Catherine C.Lewis. Measuring the impact of medical care on children[J]. J Chron Dis, 1987,40(1):99-108.
[35]Jac A.M. Vennix. Knowledge elicitation in conceptual model building:A case study in modeling a regional Dutch health care system[J]. European Journal of Operational Research,1992,59(1):85-101.
[36]Barbara Bridgman Perkins. Re-forming medical delivery systems:economic organization and dynamics of regional planning and managed competition[J]. Social Science & Medicine, 1999,48(2):241-251.
[37]Ahmed wali khwaja.Health insurance,habits and health outcomes:a dynamic stochastic model of investment in health,university of minnesota,2001.
[38]Peter C. Smith, Ann van Ackere. A note on the integration of system dynamics and economic models[J]. Economic Dynamics & Control,2002,26(1):1-10.
[39]Marion Sabine Raunera, Michaela-Maria Schaffhauser-Linzatti. Impact of the new Austrian inpatient payment strategy on hospital behavior:a system-dynamics model[J]. Socio-Economic Planning Sciences, 2002,36(3):161-182.
[40]Marna Hoard. Systems modeling in support of evidence-based disaster planning for rural areas [J]. International Journal of Hygiene and Environmental Health.2005,208(1-2):117-125.
[41]H Grundmann, B Hellriegel. Mathematical modelling:a tool for hospital infection control [J]. Lancet Infect Dis,2006,6(1):39-45.
[42]Elly J. Breedveld, Bert R. Meijboom, Aad A. de Roo. Labour supply in the home care industry:A case study in a Dutch region [J]. Health Policy,2006,76(2):144-155.
[43]M Smits. Impact of policy and process design on the performance of intake and treatment processes in mental health care:a system dynamics case study [J]. Journal of the Operational Research Society.2010, 61(10):1437-1445.
[44]王其藩.SD模型在基础设施研究中的应用[J].管理工程学报,1999(2)：31-35
[45]赵秀生,魏宏森.综合集成方法及其在区域规划中的应用[J].系统辩证学学报,1994(1)：63-69.
[46]韩德林,陈正江.运用系统动力学方法研究绿洲经济-生态系统——以玛纳斯绿洲为例[J].地理学报.1994,49(4)：307-316.
[47]符亚明.奥运经济对北京市产业发展直接影响研究[J].中国软科学,2003(7)：44-47.
[48]程叶青,李同升,张平宇.SD模型在区域可持续发展规划中的应用[J].系统工程理论与实践,2004,12：13-18.
[49]孙晓华.产业集聚效应的系统动力学建模与仿真[J].科学学与科学技术管理,2008,(4)：71-75.
[50]高丽,石学云.教育与经济互动关系的系统动力学分析及其启示[J].陕西师范大学学报(哲学社会科学版),2008，,37(2)：98-101.
[51]傅明明,吕靖.基于系统动力学的港口-区域经济关系研究[J].大连海事大学学报,2009,35(4)：43-46.
[52]谭玲玲.电力行业煤炭需求系统动力学模型[J].系统工程理论与实践,2009,29(7)：55-63.
[53]苏屹,李柏洲.大型企业原始创新支持体系的系统动力学研究[J].科学学研究，2010,28(1)：141-147.
[54]吴二娇,刘璟.广州工业竞争力系统动态预测及政策模拟研究[J].华东经济管理,2010,24(1)：44-48.
[55]侯剑.基于系统动力学的港口经济可持续发展[J].系统工程理论与实践,2010,30(1)：56-61.
[56]申碧峰.北京市宏观经济水资源系统动力学模型[J].北京水利,1995(2)：14-16
[57]陈成鲜，严广乐.我国水资源可持续发展系统动力学模型研究[J].上海理工大学学报,2000,22(2)：154-159.
[58]杨春伟,赵秀生,于素花,等,塔里木河流域水资源调配SD模型及应用[J].农业技术经济,2001(3)：13-17
[59]王武科,李同升,等.基于SD模型的渭河流域关中地区水资源调度系统优化[J].资源科学,2008,30(7)：983-989.
[60]李梅,朱丽,王洪波.城市水资源再生利用系统分析及模拟[J].水资源保护,2008,24(1)：31-33.
[61]牛志强,王延辉,刘明珠.河南省水资源承载能力系统动力学模型及其应用[J].水电能源科学,2009,27(1)：48-50.
[62]童玉芬.北京市水资源人口承载力的动态模拟与分析[J].资源与环境.2010,20(9)：42-47.
[63]封金利,杨维,王贵东.基于SD模型的水资源承载力模拟研究[J].辽宁化工,2010,39(12)：1259-1262.
[64]文雅,宋桂琴,李锐,等,系统动力学仿真方法在土地生态设计中的应用——以渭北高原沟壑区长武县为例[J].土壤侵蚀与水土保持学报,1996,2(3)：48-55.
[65]陈传美,郑垂勇,马彩霞.郑州市土地承载力系统动力学研究[J].河海人学学报,1999,27(1)：53-56.
[66]赵涛.城市土地利用优化配置分析应用[J].地球信息科学,2004(2)：53-57.
[67]张晓玲,吴宇哲,关欣.城市化视角下的土地利用变化研究综述[J].农机化研究,2008,(1)：243-245.
[68]刘炳恩,隽志才,贾洪飞.城市土地利用与交通系统关系的动力学模型[J].吉林大学学报(工学版),2008,38(2)：67-70.
[69]迟英庆,詹强南,杜妍虹.动态环境下持续营销渠道实现的系统动力分析[J].经济问题,2007,(12)：117-118.
[70]周建亨,徐琪.服装业供应链的系统动力学模型分析[J].纺织学报,2008,29(12)：122-125.
[71]吴隽,李杰,张莹.供应链环境下联合库存SD模型研究[J].中国物流与采购,2008,(13)：66-67.
[72]李旭.二级供应链系统库存策略的系统动力学研究[J].系统工程,2009,27(5)：1-6.
[73]郭滕达,李向阳.顾客退货与价值链增值的系统动力学模拟[J].系统管理学报,2009,18(2)：153-157.
[74]汤卫克,姜大立,甘明.基于系统动力学的短生命周期产品供应链牛鞭效应研究[J].物流科技，,2009(12)：77-80.
[75]汪洋,郝红雨.基于系统动力学的供应链物流资金供求平衡[J].工业工程,2009,12(1)：46-50.
[76]刘秉镰,杨明.城市物流园区需求预测的系统动力学模型构建[J].城市交通,2009,7(5)：21-27.
[77]刘秋生,蒋国耀.基于系统动力学的供应链中牛鞭效应的研究[J].中国管理信息化,2009,12(6)：72-75.
[78]于洪洋,周艳山,滕春贤.基于系统动力学的供应链库存仿真研究基于系统动力学的供应链库存仿真研究基于系统动力学的供应链库存仿真研究[J].物流科技,2009,(1)：110-113.
[79]汪洋,黄雯雯.港口群/腹地区域供应链系统物流财务管理的国民经济动态性分析[J].工业工程,2010,13(1)：36-41.
[80]李剑锋,陈燕,等.港口供应链系统动力仿真模型研究[J].计算机工程与应用,2010,46(35)：18-22.
[81]杭文,吉万军,毛海军.基于顾客-销售商互动反馈的库存控制策略仿真[J].系统仿真学报,2010,22(12)：2973-2978.
[82]方艳,邓文博.基于系统动力学的短生命周期产品供应链利润分析[J].物流工程与管理,2010,32(3)：69-72.
[83]廖诺,吴菊华.多级供应链系统动力学建模与仿真研究[J].管理学刊,2010,23(4)：53-55.
[84]何云飞.城市商业区中小零售企业配送联盟研究—基于系统动力学视角[J].物流技术,2010，(10)：18-20.
[85]周三元,胡贵彦.产品回收再生动态行为分析[J].中国流通经济，,2011(1)：31-34.
[86]王继峰,陆化普,彭唬.城市交通系统的SD模型及其应用[J].交通运输系统工程与信息,2008,8(3)：84-89.
[87]张毅媚,张谊.城市交通拥挤的系统动力学模型仿真研究[J].交通与计算机,2008,26(2)：94-101.
[88]孙广林,王健,胡晓伟.城市公交价格组合策略的系统动力学建模与仿真[J].交通运输系统工程与信 息,2010,10(6)：121-127.
[89]FULAI HUANGA,FENG WANG.A system for early-warning and forecasting of real estate development [J].Automation in Construction,2005,14:333-342.
[90]王晓鸣,汪洋,等.城市发展政策决策的系统动力学研究综述[J].科技进步与对策，,2009,26(22)：197-200.
[91]刘汝良,贾仁安,董秋仙.江西省农村人口的仿真模拟预测[J].安徽农业科学,2007,35(28)：8783-878.
[92]贺晟晨,王远,等.城市经济环境协调发展系统动力学模拟[J].长江流域资源与环境,2009,18(8)：698-703.
[93]王红涛,童玉芬.北京市未来劳动力供需状况的政策模拟与分析[J].西北人口,2009,30(5)：56-64.
[94]谢英亮,刘贻玲,张友锋.东江源区寻乌县经济环境协调发展系统动态仿真模型研究[J].安徽农业科学,2009,37(8)：3831-3833.
[95]刘兴华.广西北部湾经济区经济社会可持续发展研究——基于系统动力学的视角[J].广西民族大学学报(哲学社会科学版),2009,31(5)：92-96.
[96]金丽.国际旅游城市形成发展的动力机制与发展模式研究[J].天津商业大学学报.2010,30(3)：55-59.
[97]陈书忠,周敬宣,李湘梅,等.城市环境影响模拟的系统动力学研究[J].生态环境学报2010,19(8)：1822-1827.
[98]赵妍,田强,尚金城.城市生态工业系统模拟、优化调控方法研究[J].生态环境学报2010,19(6)：1416-1421.
[99]沈玉志.中国能源发展的决策模型研究[D].辽宁工程技术大学,2004.Shen Y Z. The research on the strategy model of Chinese energy development(D]. Liaoning Technical University,2004.
[100]谭志豪.基于SD模型的中国能源需求预测[J].消费导刊,2008,(6)：42.
[101]于谨凯,林逢珠.海洋不可再生资源可持续开发的系统动力学机制研究——以海洋石油资源为例[J].中国科技论坛,2010,(7)：106-117.
[102]艾德春,程伟,韩可琦.基于系统动力学的我国煤炭生产总量预测研究[J].煤炭技术,2010,29(5)：7-9.
[103]刘志斌,王君.基于系统动力学的油价预测[J].工业技术经济,2009,28(5)：98-101.
[104]唐旭,张宝生,邓红梅,冯连勇.基于系统动力学的中国石油产量预测分析[J].系统工程理论与实践,2010,30(2)：207-212.
[105]陈海涛.基于系统动力学的中国石油需求系统模型及预测[J].统计与决策,，2010,(20)：98-101.
[106]施国洪,朱敏.系统动力学方法在环境经济学中的应用[J].系统工程理论与实践,2001(12)：104-110.
[107]何世有,章文芳,李光久.环境经济系统SD模型的建立[J].江苏理工大学学报：社会科学版,2001(4)：63-66
[108]杨春伟,赵秀生,于素花,等.塔里木河流域水资源调配SD模型及应用[J].农业技术经济,2001(3)：13-17.
[109]童玉芬.人口变动对干旱区生态环境影响的定量评估模型的应用—以新疆塔里木河流域为例[J].中国人口·资源与环境,2003,13(5)：59-65.
[110]陈兴鹏,戴芹.系统动力学在甘肃省河西地区水上资源承载力中的应用[J].干旱区地理,2002,25(4)：377-382.
[111]刘桂梅,孙松,王辉.海洋生态系统动力学模型及其研究进展[J].地球科学进展,2003,18(3)：427-431.
[112]刘振乾,段舜山,李爱芬,等,湿地蓄水量动态SD仿真研究——以三江平原沼泽湿地为例[J].地理与地理信息科学,2004,20(1)：54-56.
[113]张汉雄,张兴昌,邵明安.长城沿线农牧交错带生态环境恢复重建SD模型研究[J].中国生态农业学报.2005,13(1)：173-178.
[114]贾海峰,岩松,苗.北京水系多藻类生态动力学模型[J].清华大学学报(自然科学版).200949(12)：1993-1996.
[115]蔡玲如,曾伟,王红卫.环境污染博弈问题的系统动力学模型[J].计算机应用研究,2009,26(7)：2465-2468.
[116]李阳,张兆同.基于系统动力学的水污染问题研究[J].安徽农业科学,2010,38(34)：19491-1949.
[117]贺德方,谢科范.国家科技基础条件平台的系统动力学分析[J].中国软科学,2006,(12)：52-57.
[118]李焕荣.基于SD的战略人力资源管理与企业绩效作用机理[J].工业工程,2009,12(6)：2-27.
[119]陈勇.影响供应链合作伙伴关系的因素研究[J].工业技术经济,2009,28(11)：113-116.
[120]刘威,李玉峰,吕巍.组织内部人际信任的系统动力学分析[J].现代管理科学,2009，,(10)：39-41.
[121]关军,马靖忠.产业集群核心创新网络运行的系统动力学模型构建[J].商业时代,2010,(15)：67.
[122]李凌,张鹭鹭,杨祖兴,等.潜在医疗服务需求转化逻辑模型构建[J].第二军医大学学报，2005,26(11)：1213-1216
[123]卢杨,张鹭鹭,欧崇阳,等.城市医院与社区卫生服务中心互动模式及问题分析[J].中国全科医学,2006,9(17)：1400-1402.
[124]欧崇阳，张鹭鹭,杨祖兴.我国卫生资源投入与利用的系统动力学模型初建及模拟[J].第二军医大学学报,2005,26(11)：1220-1223.
[125]张鹭鹭.转型期医院可持续发展机制研究[J].中华医院管理杂志,2003,19：87-89
[126]卢杨,张鹭鹭,马玉琴.医院与社区互动逻辑建模分析[J].中国初级卫生保健,2008,22(1)：15-17.
[127]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统政策干预研究[J].中国全科医学,2010,13(4)：1093-1095.
[128]谢长勇,张鹭鹭,李玲.我国宏观卫生筹资系统模拟与干预结果分析[J].中国卫生经济,2010,29(2)：16-18.
[129]谢长勇,张鹭鹭,等.基于系统动力学方法的我国宏观卫生筹资系统要素分析[J].中国卫生经济,2009,28(3)：8-11.
[130]张鹭鹭,李凌,欧崇阳.基于人群健康的国家医疗卫生服务系统建模设计[J].第二军医大学学报,2005,26(11)：1209-1212.
[131]马玉琴,张鹭鹭,卢杨.农村医疗卫生服务系统系统动力学模型干预研究[J].中国农村卫生事业管理,2007,27(8)：569-571.
[132]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统政策干预研究[J].中国全科医学,2010,13(4)：1093-1095.
[133]田伟,美娜,张鹭鹭.我国公共卫生服务系统的系统动力学模型研究[J].中国初级卫生保健,2009,23(11)：6-8.
[134]张宇,张鹭鹭,马玉琴,等.基于系统动力学的农村人群就医选择行为模型干预研究[J].中国全科医学，,2010,13(8)：2474-2476.
[135]张宇,张鹭鹭,马玉琴.“农村人群就医行为选择”建模设计[J].中国农村卫生事业管理,2009,29(11)：812-814.
[136]张宇,张鹭鹭,马玉琴.农村人群就医选择行为逻辑模型构建[J].中国全科医学,2010,13(8)：2467-2470.
[137]朱燕刚,张鹭鹭,贾建国.“药品价格虚高”问题模型构建与模拟[J].管理评论,2007,19(5)：26-33.
[138]马蔚姝,张再生.基于利益制衡的三医联动系统良性循环模型构建[J].西安电子科技大学学报(社会科学版),2010,20(1)：98-103.
[139]鲁翔,许年珍,袁永根,等.大型医院医疗流程和资源配置的仿真决策系统研究[J].中国医院管理,2005,25(1)：10-13.
[140]李丽清,周重刚,肖俊华.流程再造对医院运营效率的反馈关系图分析[J].华中师范大学学报(自然科学版),2008,42(2)：224-228.
[141]余江,臧雷,王卫东,等.大型综合性医院风险防范系统动力学模型的构建[J].中国医院管理,2009,29(6)：15-16.
[142]罗力,刘芳,舒蝶.中国公立医院经济补偿规律和成本管制的必然性[J].中国医院管理,2010,30(8)：3-5.
[143]李湘君.基于系统动力学的医院系统集成平台建设分析[J].卫生软科学,2010,24(4)：349-351.
[144]王晓燕.社会医疗保险费用控制方案的系统动力学模拟[J].财贸研究,2007,(4)：64-71.
[145]廖晓明,贾清萍.基于系统动力学的新型农村合作医疗系统分析[J].中国行政管理,2007,(9)：66-69.
[146]肖增敏,申俊龙.不同医疗保险补偿机制的系统动力学比较分析[J].南京中医药大学学报(社会科学版),2009,10(4)：230-233.
[147]贾清萍,贾仁安,甘筱青.江西新型农村合作医疗制度实施效应反馈仿真分析[J].系统工程理论与实践,2010,30(5)：888-898.
[148]梁鑫,伯生,寿伟.海城镇职工养老保险可持续发展对策研究[J].统计与决策,2010,(13)：150-152.
[149]蒋军成.试论我国医疗保障体制改革中的政府作用——基于系统动力学的分析[J].宏观经济,2008,7：57-59.
[150]张志丹,汤少梁.城市贫困人口医疗救助系统模型构建研究[J].南京中医药大学学报(社会科学版),2010,11(3)：166-169.
[151]温晓雪,王林.系统动力学思维在药物发现过程中的应用[J].国际药学研究杂志,2009,36(3)：219-223.
[152]许晶晶,少梁.系统动力学方法应用于国家基本药物体系研究的探讨[J].中国药业,2009，18(18)：1-2.
[153]蔡雨阳,施莉莉,H imanshu Ardawatia,等HIV/AIDS国家模型促进艾滋病健康教育探索[J].上海交通大学学报(医学版),2010,30(8)：914-918.
[154]陈书忠,周敬宣,等.城市环境影响模拟的系统动力学研究[J].生态环境学报2010,19(8)：1822-1827.
[155]王继峰,陆化普,彭唬.城市交通系统的SD模型及其应用[J].交通运输系统工程与信息,2008,8(3)：84-89.
[156]张毅媚,张谊.城市交通拥挤的系统动力学模型仿真研究[J].交通与计算机,2008,26(2)：94-101.
[157]刘炳恩,隽志才,贾洪飞.城市土地利用与交通系统关系的动力学模型[J].吉林大学学报(工学版),2008,38(2)：67-70.
[158]贺晟晨,王远,等.城市经济环境协调发展系统动力学模拟[J].长江流域资源与环境,2009,18(8)：698-703.
[159]于谨凯,林逢珠.海洋不可再生资源可持续开发的系统动力学机制研究——以海洋石油资源为例[J].中国科技论坛,2010,(7)：106-117.
[160]MEADOWS D L,MEADOWS DH,Toward Global Equilibrium:Collected Papers [M].Cambridge MA:Productivity Press,1974.
[2]Hong Wang,Licheng Zhang,William Hsiao. Ill health and its potential influence on household consumptions in rural China [J].Health Policy,2006,78(2):167-177.
[3]Liu YL,Rao KQ,Hsiao W.Medical expenditure and rural impoverishment in China[J].Journal of Health Population and Nutrition,2003,21 (2):216-238.
[4]高强.深化改革加快发展切实解决群众看病难、看病贵的问题[J].中国监察,2005,(22)：10-13.
[5]Wen JB.The Report on the Work of the Government delivered by Premier Wen Jiabao at the Fifth Session of the Tenth National People's Congress [Z].2007-03-05.
[6]胡焕庭,朱有生,刘沛涵.药物资源滥用及控制对策邹议[J].中国卫生经济,1996,15(4)：16-17.
[7]郭秀武,杨永歧.市场经济体制的药品监督管理[J].中国药事,1995,19(1)：11-12.
[8]周圣群.探索基层医疗机构药品管理的长效机制[J].中国药事,2004,18(8)：32-34.
[9]胡善联,张仁伟,高建民.”乡村卫生机构药品购销体制研究”总报告[J].卫生经济研究,2003,(4)：3-5.
[10]陈敏章.在1990年全国卫生厅局长会议上的讲话.中国卫生五十年历程[M].北京：中医古籍出版社,1996：293-298
[11]孙兰香.调整收费结构、减轻患者负担[J].中国卫生经济,2002,21(8)：42.
[12]达复安.引资合作使用医疗仪器的利弊分析[J].中国卫生经济,1998,17(5)：34-35.
[13]郝模,吴延风,王志锋.与社会协调解决问题：卫生事业可持续发展的基石[J].中华医院管理杂志,1998,14(1)：1-5.
[14]郝模,王志锋,吴延风.社会互动：医院补偿机制恶性循环模型逻辑推论[J].中华医院管理杂志,1998,14(1)：6-12.
[15]黄伟震.对我国卫生资源配置和使用几个深层次问题的思索[J].山东医科大学学报(社会科学版),2000,(2)：44-47.
[16]田璇.浅谈新时期医德医风建设[J].医学理论与实践,2005,18(11)：1367-1368.
[17]王怀才.试论当前医德医风存在问题的成因及其对策[J].中国医院管理,1996,16(2)：27-28.
[18]高强.在2005年全国卫生工作会议上的工作报告[EB/OL].www.moh.gov.cn.2005-01-10
[19]卫生部.卫生部关于加强卫生行业作风建设的意见,2004年.[EB/OL].http://www.moh.gov.cn/newshtml/115.htm
[20]刘军民.过度市场化与分权化--中国医疗卫生改革的双重误区[J].卫生经济研究,2005,(12)：3-10.
[21]郑云.推动两个效益实现医药卫生现代化[J].现代医院,2004，4(1)：47-49.
[22]郜习德,温琴如,黄淑英.以病人为中心,深入开展优质服务,提高门诊工作质量[J].实用医院临床杂志,1998,(2)：135-136.
[23]任真年.当前医疗质量管理的难点与对策[J].中国医院管理,1996,16(1)：26-27.
[24]姜福康,苏丽,毛庆来.”医改”后军队医院加大无形资产投入的必要性[J].中国卫生经济,2002,21(9)：32.
[25]沈鸿伟,王钦清.正确认识和处理医疗纠纷促进医患关系正常化[J].前进论坛,2003,(10)：25-26
[26]国务院体改办,国家计委,国家经贸委,财政部,劳动保障部,卫生部,药品监管局,中医药管理局.《关于城镇医药卫生体制改革的指导意见》,2000年[EB/OL]. http://cnki.shsmu.edu.cn/yywsgl/yywsgll/SHYLWS%60GL/BMGZ/BMGZ1068.htm
[27]王陇德.中国卫生体制改革[J].中国行政管理,2004,(8)：26-29.
[28]财政部,国家发展计划委员会,卫生部,中医药管理局.关于完善城镇医疗机构补偿机制落实补偿政策的若干意见(财社[2001]60号)，2000年[EB/OL].http://www.100md.com/Html/Dir0/14/49/32.htm
[29]时空调查.九成人认为医生声望有所下降[J].健康大视野,2005,(12)：7.
[30]尹秀云.走出医患关系认知误区[J].家庭中医药,2004,(12)：10-11.
[31]郑雪倩.医疗纠纷防范与对策[M].广东：汕头大学出版社,2002：1-7.
[32]唐玉兰.再谈医疗卫生事业的地位[J].中国卫生经济,1995,7(14)：5-8.
[33]温家宝.第十届全国人民代表大会第三次会议政府工作报告,2005.http://www.people.com.cn/zgrdxw/zlk/rd/10jie/text03.htm
[34]温家宝.第十届全国人民代表大会第四次会议政府工作报告[EB/OL].http: //www.npc.gov.cn/dbdh/home/index.jsp
[35]胡锦涛.强调建设覆盖城乡居民的基本卫生保健制度,中共中央政治局第三十五次集体学习讲话[EB/OL].:http://cpc.people.com.cn/.2006-10-24
[36]胡锦涛在中共中央政治局第三十五次集体学习时强调,高度关注和不断提高人民群众健康水平,建设覆盖城乡居民的基本卫生保健制度[EB/OL].:http://news.xinhuanet.com/video/2006-10/24/content_5244468.htm.2006-10-24
[37]郝模,吴延风,王志锋.社会互动：医疗费用过快增长的动因[J].中华医院管理杂志,1995,11(9)：565-567.
[38]胡善联.深化医药卫生体制改革的若干问题探讨[J].卫生经济研究,2010,(1)：5-7.
[39]郝模,吴延风,郑树忠.1983-93年上海市医疗费用增长的合理度分析[J].中华医院管理杂志,1995,11(9)：558-561.
[40]中国卫生总费用课题组.中国卫生总费用数据测算工作的进展[J].中国卫生经济,1997,16(12)：38-39.
[41]Appleby J,Boyle S. Blair's billions:where will he find the money for the NHS? [J].BMJ. 2000,320(7238):865-867.
[42]Blendon RJ. The public versus the world health organization on health system performance [J].Health Affairs.2001,20(3):10-20.
[43]Levy D T. The Transactions Cost Approach to Vertical Integration:An Empirical examination [J]. Review of Economics and Statistics,1985,67(3):438-445.
[44]艾自胜,高歌,潘军燕.国际医疗保险支付制度理论研究及对我国的借鉴作用[J].中国农村卫生事业管理,2001,21(1)：40-43.
[45]CDC. Medical care spending:United States [J].JAMA.1994,272(10):764.
[46]杜乐勋.1992年中国医疗费用测算结果和初步分析[J].中国医院管理,2000,20(01)：35-37.
[47]何平平.中国卫生总费用增长因素研究[J].统计与信息论坛,2006,21(1)：37-41.
[48]刘国祥等.中国卫生总费用分配流向测算报告[J].中国卫生经济,2001,20(2)：29-33.
[49]Gilbert,Neil.Transformation of the welfare state [M].New York:Oxford University Press,2002.
[50]Gilbert,Neil,Paul Terrell. Dimensions of social welfare policy (5th Edition) [M].Boston:Allyn and Bacon,2002.
[51]郝模.我国职工医疗保险制度实施中若干问题的思考[J].中华医院管理杂志,2000,16(1)：7-12.
[52]Kumar A.The Market Approach to Health Care [J]. Hospital Management International,1992,(2):122-131.
[53]Zhong L,Goldberg MS,Gao YT,et al. A population-based case control study of lung cancer and green tea consumption among women living in Shanghai,China [J].Epidemiology.2001,12(6):695.
[54]徐勇.我国公共卫生执法的现状、问题及分析[J].中国卫生监督杂志,2000,7(2)：84-86.
[55]Linna M. Measuring hospital cost efficiency with panel data models [J].Health Economics. 1998,7(5):415-427.
[56]Paula Braveman and Eleuther Tarimo. Social inequalities in health within countries:not only an issue for affluent nations [J]. Social Science and Medicine,2002,54(11):1621-1635.
[57]Norton E. C., Staiger D. O. How hospital ownership affects access to care for the uninsured [J].RAND journal of economics.1994,25:171-185.
[58]郝模,王小宁,尹爱田.我国农村三级医疗预防保健网的焦点问题、作用机制、和发展战略研究结果简介[J].中国卫生资源,2000,3(6)：256-259.
[59]G·布罗姆,汤胜蓝.中国政府在农村合作医疗保健制度中的角色与作用[J].中国卫生经济,2002,21(3)：17-21.
[60]陈健生.新型农村合作医疗筹资制度的设计与改进[J].财经科学,2005,(1)：124-131.
[61]程晓明.对中国农村贫困地区合作医疗的政策建议[J].国际医药卫生导报,2003,(9)：17-18.
[62]陈在余.新型农村合作医疗需求不足的经济学分析[J].中国卫生经济,2007,26(3)：54-57
[63]董莹.新型农村合作医疗体系的筹资政策分析[J].甘肃农业,2006,(12)：58-59.
[64]C.米尔,郑秉文.法国社会保障的经验教训与出路--与中国学者的交流[J].国外社会科学,2001，(2)：22-27.
[65]J. E. Foster.J. Greer & Eric Thorbecke. A Class of Decomposable Poverty Measures [J].Econometrica. 1984,52(3):761-766.
[66]郝模,王永龙,周剑萍.论医疗费用合理增长的确定方法[J].中华医院管理杂志,1995,11(9)：554-556.
[67]L. Lindholm. Cost-effectiveness analysis with defined budget:how to distribute resources for the prevention of cardiovascular disease [J].Health Policy.1999, (48):155-170.
[68]Silvia Evers. Predicting the cost of hospital stay for stroke patients:the use of diagnosis related groups [J].Health Policy.2002, (61):21-42.
[69]Emmett B. The changing effects of competition on non-profit and for-profit hospital pricing behavior [J].Journal of Health Economics.1999,(18):69-86.
[70]范文胜.西方国家控制医疗花费的改革[J].国外医学.卫生经济分册,1996,13(3)：121-122.
[71]李银才.构建科学的医疗服务价格体系的思考[J].中国卫生经济,2004,23(10)：55.
[72]Schmeider EC,Liberman T. Publicly disclosed information about the quality of health care:response of the US public [J].Quality in HealthCare.2001,10(1):96-103.
[73]Zaric GS,Brandeau ML. Dynamic resource allocation for epidemic control in multiple populations [J].Math Med Biol.2002,19(4):235-255.
[74]James R,Kwangsoo L. Longitudinal study of health maintenance organization efficiency [J]. Health Services Management Research,2001,14(4):249-262.
[75]郝模,罗力,李海宁.协调发展政策思路--医疗资源最优利用模型分析[J].中华医院管理杂志,1998,14(1)：13-14.
[76]Laska EM,Meisner M,Siegel C. Ratio based and net benefit based approaches to health care resource allocation:proofs of optimality and equivalence [J].Health Econ.1999,8(2):171-174.
[77]Hardorn.David C. Setting health care priorities in Oregon:cost effectiveness meets the role of rescue [J].JAMA.1991,265:2218-2225.
[78]Yasar A 0. Efficiency of hospital services production in local markets:the balance sheet of U.S. medical armament [J]. Socio Econ Plann Sci.1995,29:139-150.
[79]Green A,Ali B,Naeern A,et al. Resource allocation and budgetary mechanisms for decentralized health systems:experiences from Balochistan,Pakistan [J]. Bull World Health Organ.2000,78(8):1024-1035.
[80]Ewa Forsberg. Financial incentives in health care.The impact of performance-base reimbursement [J].Health Policy.2001,(58):243-262.
[81]初炜,贾佩福,刘英伟.我国药品监管实践中存在的法律问题与思考[J].中国药事,2010,24(1)：11-18.
[82]郝模,王志锋.促使药品市场有序发展的政策研究概述[J].中国卫生资源,1998,1(1)：15-19.
[83]Rret C.Essential drugs and lower costs. World Health Forum.1997,(8):345-347.
[84]陈和平.试论我国药业规制的法律界定及其制度要素[J].南京中医药大学学报(社会科学版),2003,4(4)：221-226.
[85]Lanska DJ,Kryscio RJ. In-hospital mortality following carotid en-darterectomy [J].Neurology. 1998,51:440-447.
[86]Van Zon AH,Kommer GJ. Patient flows and optimal healthcare resource allocation at the macro-level:a dynamic linear programming approach [J].Health Care Manage Sci.1999,2(2):87-96.
[87]Wolleswinkel-van den Bosch JH,Looman CW,Van Poppel FW,et al. Cause-specific mortality trends in the Netherlands,1875-1992:a formal analysis of the epidemiologic transition [J].Int J Epidemiol. 1997,26(4):772-81.
[88]Frank R. G.,Salkever D. S.,Mullan F. Hospital ownership and the care of uninsured and Medicaid patients:findings form the National Hospital Discharge Survey 1979-1984 [J].Health policy.1990,14:1-11.
[89]徐渊洪,朱亮真.信息不对称下医患信任的重构[J].中华医院管理杂志,2004,20(3)：167-169.
[90]郝模，刘金锋,马安宁.《医疗卫生产业化范畴界定和策略研究》项目概述[J].中国卫生资源,2004,7(5)：195-197.
[91]Lynch,Janet R,Ozcan,et al. Hospital closure:an efficiency analysis [J]. Hospital & Health Services Administration,1994,39:205-217.
[92]冯显威,黄严.公立医院产权制度改革理论与模式分析[J].医学与哲学,2005,26(5)：18-25.
[93]顾昕.全球性公立医院的法人治理模式变革--探寻国家监管与市场效率之间的平衡[J].经济社会体制比较,2006,(1)：46-55.
[94]顾昕.走向有管理的市场化：中国医疗体制改革的战略性选择[J].经济社会体制比较,2005,(6)：18-29.
[95]赵楠.由科斯定理看我国公立医院产权制度改革[J].当代经济(下半月),2006,(11)：8-9.
[96]郝模.论三项改革联动和公立医院管理体制改革[J].中华医院管理杂志,2002,18(1)：4-11.
[97]郝模,吴延风,华颖.论医院收入构成合理调整的确定方法[J].中华医院管理杂志,1995,11(9)：557.
[98]郝模,陈立今,马安宁.公立医疗机构管理体制改革：策略和障碍[J].中国医院管理,2004,24(1)：2-6.
[99]吴敏.我国医院管理体制改革趋势分析[J].医院管理论坛,2004,(11)：9-14.
[100]Diane D,Maria G,Andrew S. Improving performance in public hospitals:a role for comparative costs [J].Health Policy.2001,57:235-248.
[101]Leape,L. L. Error in Medicine [J].JAMA.1994,272:1851-1857.
[102]Gelijins,A. and R. Nathan.The Dynamics of Technological Change in Medicine [J].Health Affairs. 1994,13(3):28-46.
[103]Prescott P A. Nursing:An important component of hospital survival under a reformed health care system [J].Nursing Economics.1993,11 (4):192-199.:192-199.
[104]柏晶伟.葛延风：中国医疗改革违背了卫生事业发展的基本规律[J].健康大视野,2005,(08)：27-28.
[105]GERDTHAM U.G,LONSSON B.1992."An Econometric Analysis of Health Care Expenditure,A Cross Section Study of OECD Counties" Journal of Health Economics,11(1).
[106]NEWHOUSE.J.P. Medical Care Expenditure:ACross National Survey Journal of Human Resoureces,1977,12(1):115-125.
[107]Newhouse. Medieal Care Costs:How Much welfare Loss? Jounral of Economic PersPectives.1992,6(3):3-21.
[108]Till Baernighausenl,Rainer Sauerbornl,张新平.德国卫生保健系统费用及其控制的宏观分析[J].国外医学社会医学分册,2000,17(2)：68-71.
[109]赵蓉,郝模,吴延风.国外医疗费用控制的方法和理论研究[J].中华医院管理杂志,1995,11(9)：573-576.
[110]Mark V. Pauly.The Economics of Moral Hazard:Comment[J]. American Economics Review, 1968,58(3):531-537.
[111]Michael L.The management of the cost and utilization of pharmaceuticals in the United Kingdom[J].Health Policy,1997,41(1):27-43
[112]R Feldman, B Dowd, and G Gifford.The effect off HMOs on premiums in employment-based health Plans[J].Health Service Research,1993,27(6):799-811.
[113]Rice T.Containing health care costs in the United States[J].Medical Care Review,1993,49(1):19-65.
[114]Blum, M.Spell,C.Workplace characteristics and health care cost containment practice[J]. Journal of Management,1996,22(5):675-701.
[115]ShenY,Ellis R.P.Cost-minimizing risk adjustment[J]Jounal of Health Economics, 2002,21 (3):515-530.
[116]陈蕙.中国医疗费用控制：来自HMO的启示[D].厦门：厦门大学,2007.
[117]Xirasagar,S.and H.C.Lin,Cost Convergence between Public and For-profit Hospitals under Prospective Payment and High Competition in Taiwan,Health Services Research,2004,39:2101-2115.
[118]Alain C. Enthoven.The U.S. health care economy:from guild to market in ten years. Health policy,1987, 7(2):241-251.
[119]Levin G, Hirsch GB, Roberts E. Narcotics andthe community:A system simulation. American Journal of Public Health 1972,62(6):861-873.
[120]Hirsch GB, Bergan TA. Simulating ambulatory care systems:The relationship between structure and behavior. Proceedings of the Summer Computer Simulation Conference.Montreal, Quebec, Canada 1973:877-884.
[121]Barbara Bridgman Perkins. Re-forming medical delivery systems:economic organization and dynamics of regional planning and managed competition. Social Science & Medicine, 1999,48(2):241-251.
[122]Peter C. Smith, Ann van Ackere. A note on the integration of system dynamics and economic models. Economic Dynamics & Control,2002,26(1):1-10.
[123]Marion Sabine Rauner, Michaela-Maria Schaffhauser-Linzatti. Impact of the new Austrian inpatient payment strategy on hospital behavior:a system-dynamics model. Socio-Economic Planning Sciences, 2002,36(3):161-182.
[124]Dietz, T. (2004). Preface to:Mediated Modeling:A System Dynamics Approach to Environmental Consensus Building, Island Press, Washington D.C. ISBN 1-55963-960-1.
[125]World Health Organization,Evaluation of the Strategy for Health for All by the Year 2000[M].,WHO.1987.
[126]胡锦涛.强调建设覆盖城乡居民的基本卫生保健制度,中共中央政治局第三十五次集体学习讲话[EB/OL].http://news.xinhuanet.com/politics/2006-10/24/content_5244094.htm.2006-10-24.
[127]朱秀兰,田平,舒峨,等.“看病贵”的原因及对策[J].中国医院管理,1991,11(8)：38-40.
[128]刘昆明.站在医改风口浪尖的副厅长——访广东省卫生厅副厅长廖新波[J].新经济杂志,2006,(2)：30-33.
[129]新华社.药价虚高重复检查九成城市居民嫌看病太贵[EB/OL]. http://finance.sina.com.cn/xiaofei/shenghuo/20050429/13511563246.shtml. 2005-4-29.
[130]张锦高.“看病难”问题浅析[N].小商品世界报,2005-03-05(006).
[131]胡善联.上海市“看病难、看病贵”成因和对策研究[J].卫生经济研究,2006(2)：21-23.
[132]王文清.中国医疗费用快速上涨问题研究—山西省W县医疗费用状况的调查与思考[D].北京：中央民族大学,2006.
[133]方格.浅议“治病贵”[J].中国医院管理,1990,(3)：49.
[134]黄成礼,马进,自虓.供方支付方式研究及政策建议[J].中国卫生经济,2000,19(1)：8-10.
[135]刘汉卿.如何解决老百姓看病难?[J].中国经济周刊,2005,(33)：26-27.
[136]杜治政.约束大医院无限扩张的冲动建立和谐医患关系的重中之重[J].医学与哲学,2005,26(11)：1-5.
[137]杨俊荣,于润吉.解决机制性深层次矛盾才能缓解看病贵[J].卫生经济研究,2005,(11)：29-30.
[138]刘文海.别把“市场化”当作医疗卫生问题的替罪羊[J].医院领导决策参考,2005,(20)：34-37.
[139]那丽,任苒,赵郁馨.政府卫生事业投入分析.[J]中国卫生资源,2002,5(6)：243-246.
[140]尹爱田,钱东福,等控制医院药品费用过高策略的政府行为[J].中国卫生经济,2004.,23(9)：22-23.
[141]郭永松,徐凌霄.社会医疗保险中需方制约机制的研究[J].中国卫生事业管理,2004,(9)：540-542.
[142]郝模.谁之过？——论“看病贵”问题的成因[J].中国卫生资源,2006,9(1)：3-5.
[143]时培君.遏制医药费用增长过快必须全方位深化改革[J].青岛医药卫生,2001,33(2)：123-124.
[144]孟庆跃.医疗保险支付方式改革对费用控制的影响分析[J].卫生经济研究,2002,(9)：18-21.
[145]赵军,张正华.医疗费用过快增长的动力机制和控制策略谫论[J].中华医院管理杂志,2003,19(8)：449-450.
[146]郑大喜.医疗保险费用支付方式的比较及其选择[J].中国初级卫生保健,2005,19(6)：6-9.
[147]史文璧,黄丞.道德风险与医疗保险风险控制[J].经济问题探索,2005,(2)：60-63.
[148]赵晓光.我国医疗保障制度改革与医疗费用增长的控制[J].世界经济情况,2007,(4)：22-27.
[149]徐文.浅析医疗费用增长过快的原因及对策[J].中国医药指南,2009,7(24)：80-81.
[150]王其藩.复杂大系统综合动态分析与模型体系[J].管理科学学报,1999,2(2)：15-27.
[151]许光清,邹骥.系统动力学方法：原理、特点与最新进展[J].哈尔滨工业大学学报(社会科学版).2006,4：72-77.
[152]陈勇.影响供应链合作伙伴关系的因素研究[J].工业技术经济,2009,28(11)：113-116.
[153]李焕荣.基于SD的战略人力资源管理与企业绩效作用机理[J].工业工程,2009,12(6)：23-27.
[154]刘威,李玉峰,吕巍.组织内部人际信任的系统动力学分析[J].现代管理科学,2009,(10)：39-41
[155]迟英庆,詹强南,杜妍虹.动态环境下持续营销渠道实现的系统动力分析[J].经济问题,2007,(12)：117-118.
[156]周建亨,徐琪.服装业供应链的系统动力学模型分析[J].纺织学报,2008,29(12)：122-125.
[157]吴隽,李杰,张莹.供应链环境下联合库存SD模型研究[J].中国物流与采购,2008,(13)：66-67.
[158]李旭.二级供应链系统库存策略的系统动力学研究[J].系统工程,2009,27(5)：1-6.
[159]程叶青,李同升,张平宇.SD模型在区域可持续发展规划中的应用[J].系统工程理论与实践,2004,(12)：13-18.
[160]赵秀生,魏宏森.综合集成方法及其在区域规划中的应用[J].系统辩证学学报,1994,(1)：63-69.
[161]申碧峰.北京市宏观经济水资源系统动力学模型[J].北京水利,1995,(2)：14-16
[162]陈成鲜,严广乐.我国水资源可持续发展系统动力学模型研究[J].上海理工大学学报,2000,22(2)：154-159.
[163]杨春伟,赵秀生,于素花,等,塔里木河流域水资源调配SD模型及应用[J].农业技术经济,2001,(3)：13-17.
[164]王武科,李同升,等.基于SD模型的渭河流域关中地区水资源调度系统优化[J].资源科学,2008,30(7)：983-989.
[165]李梅,朱丽,王洪波.城市水资源再生利用系统分析及模拟[J].水资源保护,2008,24(1)：31-33.
[166]陈传美,郑垂勇,马彩霞.郑州市土地承载力系统动力学研究[J]河海人学学报,1999,27(1)：53-56.
[167]张晓玲,吴宇哲,关欣.城市化视角下的土地利用变化研究综述[J].农机化研究,2008,(1)：243-245.
[168]刘炳恩,隽志才,贾洪飞.城市土地利用与交通系统关系的动力学模型[J].吉林大学学报(工学版),2008,38(2)：67-70.
[169]王其藩.SD模型在基础设施研究中的应用[J].管理工程学报,1999,(2)：31-35
[170]韩德林,陈正江.运用系统动力学方法研究绿洲经济-生态系统——以玛纳斯绿洲为例[J].地理学报.1994,49(4)：307-316.
[171]符亚明.奥运经济对北京市产业发展直接影响研究[J].中国软科学,2003,(7)：44-47.
[172]施国洪,朱敏.系统动力学方法在环境经济学中的应用[J].系统工程理论与实践,2001,(12)：104-110.
[173]何世有,章文芳,李光久.环境经济系统SD模型的建立[J].江苏理工大学学报：社会科学版,2001,(4)：63-66.
[174]童玉芬.人口变动对干旱区生态环境影响的定量评估模型的应用—以新疆塔里木河流域为例[J].中国人口·资源与环境,2003,13(5)：59-65.
[175]刘桂梅.孙松,王辉.海洋生态系统动力学模型及其研究进展[J].地球科学进展,2003,18(3)：427-431.
[176]张汉雄,张兴昌,邵明安.长城沿线农牧交错带生态环境恢复重建SD模型研究[J].中国生态农业学报.2005,13(1)：173-178.
[177]贾海峰,张岩松,何苗.北京水系多藻类生态动力学模型[J].清华大学学报(自然科学版).2009,49(12)：1993-1996.
[178]李凌,张鹭鹭,杨祖兴,等.潜在医疗服务需求转化逻辑模型构建[J].第二军医大学学报,2005,(26)：1213-1216
[179]卢杨,张鹭鹭,欧崇阳,等.城市医院与社区卫生服务中心互动模式及问题分析[J].中国全科医学,2006,9(17)：1400-1402.
[180]李凌,张鹭鹭,杨祖兴.潜在医疗服务需求转化逻辑模型构建[J].第二军医大学学报,2005,26(11)：1213-1216.
[181]欧崇阳,张鹭鹭,杨祖兴.我国卫生资源投入与利用的系统动力学模型初建及模拟[J].第二军医大学学报,2005,26(11)：1220-1223.
[182]张鹭鹭.转型期医院可持续发展机制实证研究[J].中华医院管理杂志,2003,19(2)：87-89.
[183]卢杨,张鹭鹭,马玉琴.医院与社区互动逻辑建模分析[J].中国初级卫生保健,2008,22(1)：15-17.
[184]欧崇阳,张鹭鹭,杨祖兴,等.我国卫生资源投入与利用的系统动力学模型初建及模拟[J].第二军医大学学报,2005,26(11)：1220-1223.
[185]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统政策干预研究[J].中国全科医学，2010,13(4)：1093-1095.
[186]谢长勇,张鹭鹭,李玲.我国宏观卫生筹资系统模拟与干预结果分析[J].中国卫生经济,2010,29(2)：16-18.
[187]谢长勇,张鹭鹭,李玲,等.基于系统动力学方法的我国宏观卫生等资系统要素分析[J].中国卫生经济,2009,28(3)：8-11.
[188]杨祖兴,张鹭鹭,李凌,等.城市医疗卫生服务系统宏观模型构建[J].第二军医大学学报,2005,26(11)：1217-1219.
[189]张鹭鹭,李凌,欧崇阳.基于人群健康的国家医疗卫生服务系统建模设计[J].第二军医大学学报,2005,26(11)：1209-1212.
[190]马玉琴,张鹭鹭,卢杨.农村医疗卫生服务系统系统动力学模型干预研究[J].中国农村卫生事业管理,2007,27(8)：569-571.
[191]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统政策干预研究[J].中国全科医学,2010,13(4)：1093-1095.
[192]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统的系统动力学模型研究[J].中国初级卫生保健,2009,23(11)：6-8.
[193]张宇,张鹭鹭,马玉琴,等.基于系统动力学的农村人群就医选择行为模型干预研究[J].中国全科医学,2010,13(8)：2474-2476.
[194]张宇,张鹭鹭,马玉琴.“农村人群就医行为选择”建模设计[J].中国农村卫生事业管理,2009,29(11)：812-814.
[195]张宇,张鹭鹭,马玉琴.农村人群就医选择行为逻辑模型构建[J].中国全科医学,2010,13(8)：2467-2470.
[196]朱燕刚,张鹭鹭,贾建国.“药品价格虚高”问题模型构建与模拟[J].管理评论,2007,19(5)：26-33.
[197]王晓燕.社会医疗保险费用控制方案的系统动力学模拟[J].财贸研究,2007,(4)：64-71.
[198]廖晓明,贾清萍.基于系统动力学的新型农村合作医疗系统分析[J].中国行政管理,2007,(9)：66-69.
[199]王玉梅,王丽.基于系统动力学的中医人才成长供应链模型研究[J].青岛科技大学学报(社会科学版),2008,24(4)：69-73.
[200]李丽清,周重刚,肖俊华.流程再造对医院运营效率的反馈关系图分析[J].华中师范大学学报(自然科学版),2008,42(2)：224-228.
[201]蒋军成.试论我国医疗保障体制改革中的政府作用--基于系统动力学的分析[J].宏观经济,2008,(7)：57-59.
[202]许晶晶,汤少梁.系统动力学方法应用于国家基本药物体系研究的探讨[J].中国药业,2009,18(18)：1-2.
[203]肖增敏,申俊龙.不同医疗保险补偿机制的系统动力学比较分析[J].南京中医药大学学报(社会科学版),2009,10(4)：230-233.
[204]余江,臧雷,王卫东,等.大型综合性医院风险防范系统动力学模型的构建[J].中国医院管理,2009,29(6)：15-16.
[205]张志丹,汤少梁.城市贫困人口医疗救助系统模型构建研究[J].南京中医药大学学报(社会科学版),2010,11(3)：166-169.
[206]马蔚姝,张再生.基于利益制衡的三医联动系统良性循环模型构建[J].西安电子科技大学学报(社会科学版),2010,20(1)：98-103.
[207]甘筱青,李红.基于系统动力学的双向转诊“下转难”现象研究[J].中国全科医学,2010,13(10)：3141-3142.
[208]罗力,刘芳,舒蝶.中国公立医院经济补偿规律和成本管制的必然性[J].中国医院管理,2010,30(8)：3-5.
[209]关理.社区卫生服务机构“零差率”药品实际费用比例的系统动力学分析[J].中国卫生经济,2010,29(5)：55-57.
[210]关理.社区卫生服务机构实行收支两条线后收支状况的系统学模拟与分析[J].中国卫生经济,2010,29(4)：40-43.
[211]周绿林,刘石柱,周以林,梅强.我国医疗费用趋势预测研究[J].中国卫生经济,2008,27(5)：16-18
[212]Avi Yacar Ellencweig. Analyzing Health Systems:a modular approach. Oxford:Oxford University Press, 1sted,1992:243-248
[213]Avi Yacar Ellencweig.Analyzing Health Systems:a modular approach.Oxford:Oxford University Press, 1992:17.
[214]郝模.我国农村卫生发展的关键问题政策研究[D].上海：复旦大学，2003.
[215]梁军,赵勇.系统工程导论[M].北京：化学工业出版社,2005：2-3
[216]Blair M.M.and Stout L.A. Response to Peter C1Kostant's Exit,Voice and Loyalty in the Course of Corporate Governance and Counsel's Changing role[J] 1 Journal of Socio n Economics,1999,28(3):251-253.
[217]Mitchell. Aland Woodl Toward a Theory of Stakeholder Identification and Salience:Defining the Principle of Who and What Really Counts [J]. The Academy of Management Review,1997,22(4):853-886.
[218]Thayer C.E.and Fine A.H.Evaluation and Outcome Measurement in the Non Profit Sector:Stakeholder Participation[J].Evaluation and Program Planning,2001,24 (1):103-108.
[219]贾生华,陈宏辉.利益相关者界定方法述评[J].外国经济与管理,2002,24(5)：15-18.
[220]World Health Organization. Equity in health and health care, a WHO/SIDA initiative. WHO, Geneva, 1996
[221]黄如欣.卫生事业与经济社会发展的关系[J].中国医院管理,2003,23(9)：6-7
[222]梁万年.卫生事业管理学[M].北京：人民卫生出版社,2003,311-355
[223]吴筱.我国医疗卫生领域中的政府职能演变：回顾与展望[J].中国卫生政策研究,2008,12(1)：27-31
[224]蔡立辉.西方国家政府绩效评估的理念及其启示[J].清华大学学报(哲学社会科学版),2003,18(1)：76-84.
[225]梁万年.卫生事业管理学.北京：人民卫生出版社,2003：385-399
[226]刘立善.构建和谐医保之我见[J].卫生职业教育.2006,24(13)：125-126
[227]董伟.我国医疗费用过快增长作用机制定量研究[D].上海：复旦大学,2010.
[228]郝模,王永龙,王金承,等.论医疗费用合理增长的确定方法[J].中华医院管理杂志,1995,11(9)：554-556.
[229]王志锋,尹爱田,张勇.运用医疗费用合理增长率测算方法评价我国医疗费用增长状况[J].中国医院管理,2002,22(9)：36-38.
[230]中国人民共和国卫生部.卫生部关于我国农村实现"2000年人人享有卫生保健”的规划目标(试行)[EB/OL]. http://law.lawtime.cn/d527813532907.html/pos=0.1990-03-15.
[231]孙梅,陈文,郝模,等.半个世纪的降价和限价政策,导致了医院的畸形收费[J].中国卫生资源,2007,10(3)：109-111.
[232]陈敏章.在1993年全国卫生厅局长会议上的讲话[R].中国卫生五十年历程.北京：中医古籍出版社，1996：369-376.
[233]郝模,吴延风,王志锋,等.社会互动：医疗费用过快增长的动因[J].中华医院管理杂志,1995,11(9)：565-567.
[234]苌凤水,吕军,王颖,等.中国医疗费用增长有失合理.中国卫生资源,2011,14(1)：48-49.
[235]励晓红，梁鸿,郝模,等.宏观改革政策和财政职能变化,医院成为逐利的“经济实体”[J].中国卫生资源,2007,10(3)：104-108.
[236]曾雁冰,王颖,吕军,等.扭曲的补偿机制困扰医疗机构发展30年[J].中国卫生资源,2011,14(1)：50-51.
[237]曹岳兴,袁汇亢,周莹.公立医院医疗服务价格补偿机制研究[J]卫生经济研究，,2009,(2)：24-26
[238]谭申生,范理宏,周晓辉.医疗资源纵向整合的实践与体会[J].中华医院管理志,2006,22(12)：761-762
[239]卫生部,财政部.关于医院工作人员的工资全部由国家预算开支的通知[EB/OL]. http://www. gzsdfz. org. cn/gzsz/10B/cs/sz10cs02070602. htm.2007-03-28.
[240]钟永光,钱颖,于庆东,等.系统动力学在国内外的发展历程与未来发展方向[J].河南科技大学学报：自然科学版,2006,(8)：101-105
[241]许光清,邹骥.系统动力学方法：原理、特点与最新进展[J].哈尔滨工业大学学报(社会科学版).2006,4：72-77
[242]郝模.医院补偿机制恶性循环和资源最优利用模型定量论证方法[J].中华医院管理杂志.1998,14(1)：21-28
[243]王柯.江苏省铜山县新型农村合作医疗补偿方案研究[D].江苏：东南大学,2000.
[244]Owen O'Donnell, Eddy van Doorslaer,Adam Wagstaff, Magnus Lidelow Analysing health equity using household survey data:a guide to techniques and their implementation[M]. World Bank, Washington, DC, 2008
[245]王朝昕,王颖,励晓红,等.医疗机构净收入与业务收入关系是医改求得突破的技术基础[J].中国卫生 资源,2011,14(1)：62-64.
[246]郝模,林尚立,刘俊.解决看病贵等技术非常成熟,关键是政府的决心[J].中国卫生资源,2007,10(3)：132-134.
[247]郝模.医改：“总额预算”可作为选择[J].医院领导决策参考.2006,(8)：37-40.
[248]冯蕾,张文燕,总额预付拧紧费用之阀,管窥台湾全民健保[J].中国医院院长,2010,(5)：46-48.
[249]曹俊山.上海医疗保障事业可持续发展的环境分析[J].中国卫生资源,2007,10(1)：11-13
[250]王颖,励晓红,吕军,等.从改变支付方式入手,求得医改的突破(2)——析“总额预算+按服务单元付费”组合支付方式[J].中国卫生资源,2011,14(1)：13-15.
[251]章滨云,罗力,郝模.医疗费用“总量控制、结构调整”政策的国内研究进展[J].中国医院管理,2002,21(9)：5-8
[252]周文燕,顾海DRGs对我国医疗保险付费方式的启示与应用前景[J].上海医药,2007,(3)：20-22
[253]王桂榕,范淑萍.我国推广应用ICD中的问题与对策[J].中国病案,2002,(3)：47-48.
[254]沈玉景,张命良.按人头付费式的医疗保险在中国是否可行?[J].中国药物经济学,2006,(1)：9-12
[255]罗力.医保包干、按服务量付费与医疗费用控制[J].中国卫生资源，2006,(1)：42-44
[256]王晓京,朱士俊.医疗费用支付方式的比较[J].中华医院管理杂志.2006,22(7)：481-483
[257]官旭华,卢祖沟.我国现阶段卫生筹资政策分析[J].中国卫生经济,2004,23(1)：55-56
[258]颜爱华.三明市医疗保险基金赤字原因分析及相应对策[J].三明学院学报.2005,22(4)：478-480
[259]程晓明.医疗保险学[M].上海：复旦大学出版社,2003：25-26
[1]许光清,邹骥.系统动力学方法：原理、特点与最新进展[J].哈尔滨工业大学学报(社会科学版).2006,4：72-77
[2]王其藩.复杂大系统综合动态分析与模型体系[J].管理科学学报,1999,2：15—20
[3]FORRESTER J W. Industrial Dynamics:A Breakthrough for Decision Makers [J].Harvard Business Review,1958,36(4):37-66.
[4]FORRESTER J W. Industrial Dynamics [M].Cambridge MA:Productivity Press,1961.
[5]FORRESTER J W. Principles of Systems [M].Cambridge MA:Productivity Press,1968
[6]FORRESTER J W. Urban Dynamics [M].Cambridge MA:Productivity Press,1969.
[7]MASS N J. Readings in Urban Dynamics Vol Ⅰ [M].Cambridge MA:Productivity Press,1974
[8]SCHROEDER W W,SWEENEY R E, ALFELD L E. Readings in Urban Dynamics Vol Ⅱ [M].Cambridge MA:Productivity Press,1975.
[9]ALFELD L E, GRAHAMAK.Introduction to Urban Dynamics [M].Cambridge MA:Productivity Press,1976
[10]FORRESTER J W. World Dynamics[M].2 ed. Cambridge MA:Productivity Press,1973.
[11]MEADOWS D H,MEADOWS D L, J BEHRENS III.The Limits to Growth:A Report for the Club of Rome's Project on the Predicament of Mankind [M].NewYork:Universe Books,1972.
[12]MEADOWS D L,MEADOWS DH,Toward Global Equilibrium:Collected Papers [M].Cambridge MA:Productivity Press,1974.
[13]STERMAN JOHN D.Business Dynamics,Systems Thinking and Modeling for a Complex World[M].NewYork:Irwin McGraw-Hill,2000:41-79.
[14]NAILL R F.A System Dynamics Model for National Energy Policy Planning[J].System Dynamics Review,1992,8(1):1-19.
[15]NAILL R F. An Analysis of the Cost Effectiveness of U.S. Energy Policies to Mitigate Global Warming[J].System Dynamics Review,1992,8(2):111-128.
[16]ABDELMONEIM ALI IBRAHIM.A system dynamics approach to african urban problems:a case study from the Sudan [D]. Kent State University,1989.
[17]KOPAINSKY, BIRGIT URSULA.A system dynamics analysis of socioeconomic development in lagging Swiss regions [D].ETH,2005.
[18]ANDREW FORD.Modeling the environment:an introduction to system dynamics models of environmental systems [M].Island Press, Washington DC,1999.
[19]BRIAN DYSON, NI-BIN CHANG.Forecasting municipal solid waste generation in a fast-growing urban region with sys-tem dynamics modeling [J].Waste Management,2002,25(7):669-679.
[20]STERMAN J D. Modeling Managerial Behavior:Misperceptions of Feedback in a Dynamic Decision Making Experiment [J].Management Science,1989,35(3):321-339.
[21]DISNEY S M, POTTER A T, GARDNER B M.The Impact of Vendor Managed Inventory on Transport Operation[J].Transportation Research E,2003,39(5):363-380.
[22]Pierreval H, Bruniaux R, Caux C.A continuous simulation approach for supply chains in the automotive industry[J].Simulation Mod-elling Practice and Theory,2007,15(2):185-198.
[23]Kamath N B, Roy R.Supply chain structure design for a short lifecycle product:a loop dominance based analysis[C]//Proceed-ings of the 38th Hawaii International Conference on System Sciences,2005.
[24]Rabeloa L, Eskandari H.Value chain analysis using hybrid simulation and HP[J].International Journal of Production Economics,2007,105 (2):536-547.
[25]Higuchi T,Troutt M D.Dynamic simulation of the supply chain for a short life cycle product—Lessons from the Tamagotchi case[J].Computers&Operations Research,2004,31 (7):1097-1114.
[26]Stave K A. Using system dynamic to improve public participation in environmental decisions [J]. System Dynamic Review,2002,18 (2):139-167.
[27]Stavo K A. A system dynamics model to facilitate public understanding of water management options in Las Vegas, Nevada [J]. Environmental Management,2003,67(4):303-313.
[28]Janssen M A,Walker B H, Langridge J. An adaptive agent model for analyzing co-evolution of management and policies in a complex range land system [J]. Ecological Modelling,2000, 131(2-3):249-268.
[29]Janssen MA.An exploratory integrated model to assess management of lake utrophication[J]. Ecological Modelling,2001,140(1):111-124.
[30]Guneralp B, Barlas Y. Dynamic modelling of a shallow freshwater lake for ecological and economic sustainability[J].Ecological Modelling,2003,167(1-2):115-138.
[31]Saysel A K, Barlas Y, Orhan Y. Environmental sustainability in an agricultural development project; a system dynamics approach[J].Environmental Management,2002,64(3):247-260.
[32]COOPER K G. Naval ship production:Claim Settled and a Framework Built [J].Interfaces,1980,10(6):20-36.
[33]ABDEL-Hamid T K,MADNICK S E. Software Project Dynamics:An Integrated Approach[M].Englewood Cliffs NJ:Prentice Hall,1991.
[34]Robert H.Pantell, Catherine C.Lewis. Measuring the impact of medical care on children[J]. J Chron Dis, 1987,40(1):99-108.
[35]Jac A.M. Vennix. Knowledge elicitation in conceptual model building:A case study in modeling a regional Dutch health care system[J]. European Journal of Operational Research,1992,59(1):85-101.
[36]Barbara Bridgman Perkins. Re-forming medical delivery systems:economic organization and dynamics of regional planning and managed competition[J]. Social Science & Medicine, 1999,48(2):241-251.
[37]Ahmed wali khwaja.Health insurance,habits and health outcomes:a dynamic stochastic model of investment in health,university of minnesota,2001.
[38]Peter C. Smith, Ann van Ackere. A note on the integration of system dynamics and economic models[J]. Economic Dynamics & Control,2002,26(1):1-10.
[39]Marion Sabine Raunera, Michaela-Maria Schaffhauser-Linzatti. Impact of the new Austrian inpatient payment strategy on hospital behavior:a system-dynamics model[J]. Socio-Economic Planning Sciences, 2002,36(3):161-182.
[40]Marna Hoard. Systems modeling in support of evidence-based disaster planning for rural areas [J]. International Journal of Hygiene and Environmental Health.2005,208(1-2):117-125.
[41]H Grundmann, B Hellriegel. Mathematical modelling:a tool for hospital infection control [J]. Lancet Infect Dis,2006,6(1):39-45.
[42]Elly J. Breedveld, Bert R. Meijboom, Aad A. de Roo. Labour supply in the home care industry:A case study in a Dutch region [J]. Health Policy,2006,76(2):144-155.
[43]M Smits. Impact of policy and process design on the performance of intake and treatment processes in mental health care:a system dynamics case study [J]. Journal of the Operational Research Society.2010, 61(10):1437-1445.
[44]王其藩.SD模型在基础设施研究中的应用[J].管理工程学报,1999(2)：31-35
[45]赵秀生,魏宏森.综合集成方法及其在区域规划中的应用[J].系统辩证学学报,1994(1)：63-69.
[46]韩德林,陈正江.运用系统动力学方法研究绿洲经济-生态系统——以玛纳斯绿洲为例[J].地理学报.1994,49(4)：307-316.
[47]符亚明.奥运经济对北京市产业发展直接影响研究[J].中国软科学,2003(7)：44-47.
[48]程叶青,李同升,张平宇.SD模型在区域可持续发展规划中的应用[J].系统工程理论与实践,2004,12：13-18.
[49]孙晓华.产业集聚效应的系统动力学建模与仿真[J].科学学与科学技术管理,2008,(4)：71-75.
[50]高丽,石学云.教育与经济互动关系的系统动力学分析及其启示[J].陕西师范大学学报(哲学社会科学版),2008，,37(2)：98-101.
[51]傅明明,吕靖.基于系统动力学的港口-区域经济关系研究[J].大连海事大学学报,2009,35(4)：43-46.
[52]谭玲玲.电力行业煤炭需求系统动力学模型[J].系统工程理论与实践,2009,29(7)：55-63.
[53]苏屹,李柏洲.大型企业原始创新支持体系的系统动力学研究[J].科学学研究，2010,28(1)：141-147.
[54]吴二娇,刘璟.广州工业竞争力系统动态预测及政策模拟研究[J].华东经济管理,2010,24(1)：44-48.
[55]侯剑.基于系统动力学的港口经济可持续发展[J].系统工程理论与实践,2010,30(1)：56-61.
[56]申碧峰.北京市宏观经济水资源系统动力学模型[J].北京水利,1995(2)：14-16
[57]陈成鲜，严广乐.我国水资源可持续发展系统动力学模型研究[J].上海理工大学学报,2000,22(2)：154-159.
[58]杨春伟,赵秀生,于素花,等,塔里木河流域水资源调配SD模型及应用[J].农业技术经济,2001(3)：13-17
[59]王武科,李同升,等.基于SD模型的渭河流域关中地区水资源调度系统优化[J].资源科学,2008,30(7)：983-989.
[60]李梅,朱丽,王洪波.城市水资源再生利用系统分析及模拟[J].水资源保护,2008,24(1)：31-33.
[61]牛志强,王延辉,刘明珠.河南省水资源承载能力系统动力学模型及其应用[J].水电能源科学,2009,27(1)：48-50.
[62]童玉芬.北京市水资源人口承载力的动态模拟与分析[J].资源与环境.2010,20(9)：42-47.
[63]封金利,杨维,王贵东.基于SD模型的水资源承载力模拟研究[J].辽宁化工,2010,39(12)：1259-1262.
[64]文雅,宋桂琴,李锐,等,系统动力学仿真方法在土地生态设计中的应用——以渭北高原沟壑区长武县为例[J].土壤侵蚀与水土保持学报,1996,2(3)：48-55.
[65]陈传美,郑垂勇,马彩霞.郑州市土地承载力系统动力学研究[J].河海人学学报,1999,27(1)：53-56.
[66]赵涛.城市土地利用优化配置分析应用[J].地球信息科学,2004(2)：53-57.
[67]张晓玲,吴宇哲,关欣.城市化视角下的土地利用变化研究综述[J].农机化研究,2008,(1)：243-245.
[68]刘炳恩,隽志才,贾洪飞.城市土地利用与交通系统关系的动力学模型[J].吉林大学学报(工学版),2008,38(2)：67-70.
[69]迟英庆,詹强南,杜妍虹.动态环境下持续营销渠道实现的系统动力分析[J].经济问题,2007,(12)：117-118.
[70]周建亨,徐琪.服装业供应链的系统动力学模型分析[J].纺织学报,2008,29(12)：122-125.
[71]吴隽,李杰,张莹.供应链环境下联合库存SD模型研究[J].中国物流与采购,2008,(13)：66-67.
[72]李旭.二级供应链系统库存策略的系统动力学研究[J].系统工程,2009,27(5)：1-6.
[73]郭滕达,李向阳.顾客退货与价值链增值的系统动力学模拟[J].系统管理学报,2009,18(2)：153-157.
[74]汤卫克,姜大立,甘明.基于系统动力学的短生命周期产品供应链牛鞭效应研究[J].物流科技，,2009(12)：77-80.
[75]汪洋,郝红雨.基于系统动力学的供应链物流资金供求平衡[J].工业工程,2009,12(1)：46-50.
[76]刘秉镰,杨明.城市物流园区需求预测的系统动力学模型构建[J].城市交通,2009,7(5)：21-27.
[77]刘秋生,蒋国耀.基于系统动力学的供应链中牛鞭效应的研究[J].中国管理信息化,2009,12(6)：72-75.
[78]于洪洋,周艳山,滕春贤.基于系统动力学的供应链库存仿真研究基于系统动力学的供应链库存仿真研究基于系统动力学的供应链库存仿真研究[J].物流科技,2009,(1)：110-113.
[79]汪洋,黄雯雯.港口群/腹地区域供应链系统物流财务管理的国民经济动态性分析[J].工业工程,2010,13(1)：36-41.
[80]李剑锋,陈燕,等.港口供应链系统动力仿真模型研究[J].计算机工程与应用,2010,46(35)：18-22.
[81]杭文,吉万军,毛海军.基于顾客-销售商互动反馈的库存控制策略仿真[J].系统仿真学报,2010,22(12)：2973-2978.
[82]方艳,邓文博.基于系统动力学的短生命周期产品供应链利润分析[J].物流工程与管理,2010,32(3)：69-72.
[83]廖诺,吴菊华.多级供应链系统动力学建模与仿真研究[J].管理学刊,2010,23(4)：53-55.
[84]何云飞.城市商业区中小零售企业配送联盟研究—基于系统动力学视角[J].物流技术,2010，(10)：18-20.
[85]周三元,胡贵彦.产品回收再生动态行为分析[J].中国流通经济，,2011(1)：31-34.
[86]王继峰,陆化普,彭唬.城市交通系统的SD模型及其应用[J].交通运输系统工程与信息,2008,8(3)：84-89.
[87]张毅媚,张谊.城市交通拥挤的系统动力学模型仿真研究[J].交通与计算机,2008,26(2)：94-101.
[88]孙广林,王健,胡晓伟.城市公交价格组合策略的系统动力学建模与仿真[J].交通运输系统工程与信 息,2010,10(6)：121-127.
[89]FULAI HUANGA,FENG WANG.A system for early-warning and forecasting of real estate development [J].Automation in Construction,2005,14:333-342.
[90]王晓鸣,汪洋,等.城市发展政策决策的系统动力学研究综述[J].科技进步与对策，,2009,26(22)：197-200.
[91]刘汝良,贾仁安,董秋仙.江西省农村人口的仿真模拟预测[J].安徽农业科学,2007,35(28)：8783-878.
[92]贺晟晨,王远,等.城市经济环境协调发展系统动力学模拟[J].长江流域资源与环境,2009,18(8)：698-703.
[93]王红涛,童玉芬.北京市未来劳动力供需状况的政策模拟与分析[J].西北人口,2009,30(5)：56-64.
[94]谢英亮,刘贻玲,张友锋.东江源区寻乌县经济环境协调发展系统动态仿真模型研究[J].安徽农业科学,2009,37(8)：3831-3833.
[95]刘兴华.广西北部湾经济区经济社会可持续发展研究——基于系统动力学的视角[J].广西民族大学学报(哲学社会科学版),2009,31(5)：92-96.
[96]金丽.国际旅游城市形成发展的动力机制与发展模式研究[J].天津商业大学学报.2010,30(3)：55-59.
[97]陈书忠,周敬宣,李湘梅,等.城市环境影响模拟的系统动力学研究[J].生态环境学报2010,19(8)：1822-1827.
[98]赵妍,田强,尚金城.城市生态工业系统模拟、优化调控方法研究[J].生态环境学报2010,19(6)：1416-1421.
[99]沈玉志.中国能源发展的决策模型研究[D].辽宁工程技术大学,2004.Shen Y Z. The research on the strategy model of Chinese energy development(D]. Liaoning Technical University,2004.
[100]谭志豪.基于SD模型的中国能源需求预测[J].消费导刊,2008,(6)：42.
[101]于谨凯,林逢珠.海洋不可再生资源可持续开发的系统动力学机制研究——以海洋石油资源为例[J].中国科技论坛,2010,(7)：106-117.
[102]艾德春,程伟,韩可琦.基于系统动力学的我国煤炭生产总量预测研究[J].煤炭技术,2010,29(5)：7-9.
[103]刘志斌,王君.基于系统动力学的油价预测[J].工业技术经济,2009,28(5)：98-101.
[104]唐旭,张宝生,邓红梅,冯连勇.基于系统动力学的中国石油产量预测分析[J].系统工程理论与实践,2010,30(2)：207-212.
[105]陈海涛.基于系统动力学的中国石油需求系统模型及预测[J].统计与决策,，2010,(20)：98-101.
[106]施国洪,朱敏.系统动力学方法在环境经济学中的应用[J].系统工程理论与实践,2001(12)：104-110.
[107]何世有,章文芳,李光久.环境经济系统SD模型的建立[J].江苏理工大学学报：社会科学版,2001(4)：63-66
[108]杨春伟,赵秀生,于素花,等.塔里木河流域水资源调配SD模型及应用[J].农业技术经济,2001(3)：13-17.
[109]童玉芬.人口变动对干旱区生态环境影响的定量评估模型的应用—以新疆塔里木河流域为例[J].中国人口·资源与环境,2003,13(5)：59-65.
[110]陈兴鹏,戴芹.系统动力学在甘肃省河西地区水上资源承载力中的应用[J].干旱区地理,2002,25(4)：377-382.
[111]刘桂梅,孙松,王辉.海洋生态系统动力学模型及其研究进展[J].地球科学进展,2003,18(3)：427-431.
[112]刘振乾,段舜山,李爱芬,等,湿地蓄水量动态SD仿真研究——以三江平原沼泽湿地为例[J].地理与地理信息科学,2004,20(1)：54-56.
[113]张汉雄,张兴昌,邵明安.长城沿线农牧交错带生态环境恢复重建SD模型研究[J].中国生态农业学报.2005,13(1)：173-178.
[114]贾海峰,岩松,苗.北京水系多藻类生态动力学模型[J].清华大学学报(自然科学版).200949(12)：1993-1996.
[115]蔡玲如,曾伟,王红卫.环境污染博弈问题的系统动力学模型[J].计算机应用研究,2009,26(7)：2465-2468.
[116]李阳,张兆同.基于系统动力学的水污染问题研究[J].安徽农业科学,2010,38(34)：19491-1949.
[117]贺德方,谢科范.国家科技基础条件平台的系统动力学分析[J].中国软科学,2006,(12)：52-57.
[118]李焕荣.基于SD的战略人力资源管理与企业绩效作用机理[J].工业工程,2009,12(6)：2-27.
[119]陈勇.影响供应链合作伙伴关系的因素研究[J].工业技术经济,2009,28(11)：113-116.
[120]刘威,李玉峰,吕巍.组织内部人际信任的系统动力学分析[J].现代管理科学,2009，,(10)：39-41.
[121]关军,马靖忠.产业集群核心创新网络运行的系统动力学模型构建[J].商业时代,2010,(15)：67.
[122]李凌,张鹭鹭,杨祖兴,等.潜在医疗服务需求转化逻辑模型构建[J].第二军医大学学报，2005,26(11)：1213-1216
[123]卢杨,张鹭鹭,欧崇阳,等.城市医院与社区卫生服务中心互动模式及问题分析[J].中国全科医学,2006,9(17)：1400-1402.
[124]欧崇阳，张鹭鹭,杨祖兴.我国卫生资源投入与利用的系统动力学模型初建及模拟[J].第二军医大学学报,2005,26(11)：1220-1223.
[125]张鹭鹭.转型期医院可持续发展机制研究[J].中华医院管理杂志,2003,19：87-89
[126]卢杨,张鹭鹭,马玉琴.医院与社区互动逻辑建模分析[J].中国初级卫生保健,2008,22(1)：15-17.
[127]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统政策干预研究[J].中国全科医学,2010,13(4)：1093-1095.
[128]谢长勇,张鹭鹭,李玲.我国宏观卫生筹资系统模拟与干预结果分析[J].中国卫生经济,2010,29(2)：16-18.
[129]谢长勇,张鹭鹭,等.基于系统动力学方法的我国宏观卫生筹资系统要素分析[J].中国卫生经济,2009,28(3)：8-11.
[130]张鹭鹭,李凌,欧崇阳.基于人群健康的国家医疗卫生服务系统建模设计[J].第二军医大学学报,2005,26(11)：1209-1212.
[131]马玉琴,张鹭鹭,卢杨.农村医疗卫生服务系统系统动力学模型干预研究[J].中国农村卫生事业管理,2007,27(8)：569-571.
[132]田伟,栗美娜,张鹭鹭.我国公共卫生服务系统政策干预研究[J].中国全科医学,2010,13(4)：1093-1095.
[133]田伟,美娜,张鹭鹭.我国公共卫生服务系统的系统动力学模型研究[J].中国初级卫生保健,2009,23(11)：6-8.
[134]张宇,张鹭鹭,马玉琴,等.基于系统动力学的农村人群就医选择行为模型干预研究[J].中国全科医学，,2010,13(8)：2474-2476.
[135]张宇,张鹭鹭,马玉琴.“农村人群就医行为选择”建模设计[J].中国农村卫生事业管理,2009,29(11)：812-814.
[136]张宇,张鹭鹭,马玉琴.农村人群就医选择行为逻辑模型构建[J].中国全科医学,2010,13(8)：2467-2470.
[137]朱燕刚,张鹭鹭,贾建国.“药品价格虚高”问题模型构建与模拟[J].管理评论,2007,19(5)：26-33.
[138]马蔚姝,张再生.基于利益制衡的三医联动系统良性循环模型构建[J].西安电子科技大学学报(社会科学版),2010,20(1)：98-103.
[139]鲁翔,许年珍,袁永根,等.大型医院医疗流程和资源配置的仿真决策系统研究[J].中国医院管理,2005,25(1)：10-13.
[140]李丽清,周重刚,肖俊华.流程再造对医院运营效率的反馈关系图分析[J].华中师范大学学报(自然科学版),2008,42(2)：224-228.
[141]余江,臧雷,王卫东,等.大型综合性医院风险防范系统动力学模型的构建[J].中国医院管理,2009,29(6)：15-16.
[142]罗力,刘芳,舒蝶.中国公立医院经济补偿规律和成本管制的必然性[J].中国医院管理,2010,30(8)：3-5.
[143]李湘君.基于系统动力学的医院系统集成平台建设分析[J].卫生软科学,2010,24(4)：349-351.
[144]王晓燕.社会医疗保险费用控制方案的系统动力学模拟[J].财贸研究,2007,(4)：64-71.
[145]廖晓明,贾清萍.基于系统动力学的新型农村合作医疗系统分析[J].中国行政管理,2007,(9)：66-69.
[146]肖增敏,申俊龙.不同医疗保险补偿机制的系统动力学比较分析[J].南京中医药大学学报(社会科学版),2009,10(4)：230-233.
[147]贾清萍,贾仁安,甘筱青.江西新型农村合作医疗制度实施效应反馈仿真分析[J].系统工程理论与实践,2010,30(5)：888-898.
[148]梁鑫,伯生,寿伟.海城镇职工养老保险可持续发展对策研究[J].统计与决策,2010,(13)：150-152.
[149]蒋军成.试论我国医疗保障体制改革中的政府作用——基于系统动力学的分析[J].宏观经济,2008,7：57-59.
[150]张志丹,汤少梁.城市贫困人口医疗救助系统模型构建研究[J].南京中医药大学学报(社会科学版),2010,11(3)：166-169.
[151]温晓雪,王林.系统动力学思维在药物发现过程中的应用[J].国际药学研究杂志,2009,36(3)：219-223.
[152]许晶晶,少梁.系统动力学方法应用于国家基本药物体系研究的探讨[J].中国药业,2009，18(18)：1-2.
[153]蔡雨阳,施莉莉,H imanshu Ardawatia,等HIV/AIDS国家模型促进艾滋病健康教育探索[J].上海交通大学学报(医学版),2010,30(8)：914-918.
[154]陈书忠,周敬宣,等.城市环境影响模拟的系统动力学研究[J].生态环境学报2010,19(8)：1822-1827.
[155]王继峰,陆化普,彭唬.城市交通系统的SD模型及其应用[J].交通运输系统工程与信息,2008,8(3)：84-89.
[156]张毅媚,张谊.城市交通拥挤的系统动力学模型仿真研究[J].交通与计算机,2008,26(2)：94-101.
[157]刘炳恩,隽志才,贾洪飞.城市土地利用与交通系统关系的动力学模型[J].吉林大学学报(工学版),2008,38(2)：67-70.
[158]贺晟晨,王远,等.城市经济环境协调发展系统动力学模拟[J].长江流域资源与环境,2009,18(8)：698-703.
[159]于谨凯,林逢珠.海洋不可再生资源可持续开发的系统动力学机制研究——以海洋石油资源为例[J].中国科技论坛,2010,(7)：106-117.
[160]MEADOWS D L,MEADOWS DH,Toward Global Equilibrium:Collected Papers [M].Cambridge MA:Productivity Press,1974.