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National Medicines Use.pdf

The Australian Government is required to report every five years on the impact of current fiscal policies on future generations. The first Intergenerational Report (IGR) in 2002 projected future Federal income and expenditure for the next forty years based on expected demographic changes due to the baby boomers effect of increased fertility rates from 1946-1973. The projected growth in GDP was 2.5 times while the federal Government outlays on prescription medicines through the universal Pharmaceutical Benefits Scheme (PBS) was expected to grow fifteen-fold by 2042.

We developed with The National Healthcare Alliance a system dynamics model of a broader view of future medicines use. This joint model replicated the IGR case as context, with additional detail on drivers of new drug use, feedback of benefits of medicines use on macroeconomics, and structural changes in over, under and mis-use of medicines over the next four decades. Main findings are:

IGR projections are sensitive to assumptions, especially workforce participation and productivity growth; effective medicines use contributes to National Health and Wealth, and this contribution depends on the level of under-use, overuse and misuse of medicines.

 The results from this System Dynamics modelling formed the basis for a 2004 Federal Budget Submission to Treasury from the Alliance.



Health System Performance.pdf

The World Health Organization has developed and refined a considerable body of work on Health Systems Performance Assessment, reflected in the World Health Report 2000 on comparing countries' health systems and ongoing worldwide debate. This paper contributes to this debate by presenting an overall System Dynamics (SD) simulation of the key features of the WHO framework, including some feedback interactions among financing, resource generation, service delivery and stewardship, all of which affect healthcare systems performance.

The model is calibrated using Australian healthcare statistics trends over the past 40 years and explores possible futures over the next 40 years.  It discusses the current status of work in progress to clarify the wider issue of the contribution of the health system to the overall well-being of individuals, groups and the nation. The gaps in theory and practice and contentious areas for ongoing research and refinement are explored and potential future enhancements of the simulation are discussed.

These enhancements include:

  • More compelling and engaging animations with the potential to influence public debate about health
    policy;
  • Including datasets and comparisons among other developed countries;
  • Health systems evolution in developing countries; and
  • Global health policy options and debates.


Med error.pdf

Medication errors in hospitals are a large and increasing problem, which has traditionally been considered a result of human error. Recent attempts to reduce errors have emphasised systems approaches and improvements in information and communications technologies (ICT). As part of a multi-method evaluation project for hospital point of care clinical systems, we assembled a team of professionals from a variety of clinical, information management, health management, sociology, linguistics and engineering backgrounds. We built a systems simulation for explicitly representing the interactions among the key determinants of medication errors. These included the complex interactions of patients and staff, information, medications, work practices and the infrastructure and policies within a hospital environment.

Our team simulated hospital inpatient and staff flow, generation and interception of medication errors, and the potential impacts of ICT-enabled work practice changes. This paper describes the System Dynamics Model of long-term context that produces errors in the medication management process. Future extensions include the use of a combined agent based and SD simulation to produce a multi-method, multi-level systems simulation testbed as an integrating framework for evaluating combinations of improvement interventions.