Abstract
Background: Globally, the elimination of health disparity is a significant policy target. Primary health care has been implemented as a strategy to achieve this target in China for almost 10 years. This study examined whether family doctor (FD) policy in Shanghai contributed to eliminating health disparity as expected. Methods: System dynamics modeling was performed to construct and simulate a system of health disparity formation (business-as-usual (BAU) scenario, without any interventions), a system with FD intervention (FD scenario), and three other systems with supporting policies (Policy 1/Policy 2/Policy hybrid scenario) from 2013 to 2050. Health disparities were simulated in different scenarios, making it possible to compare the BAU results with those of FD intervention and with other policy interventions. Findings: System dynamics models showed that the FD policy would play a positive role in reducing health disparities in the initial stage, and medical price control—rather than health management—was the dominant mechanism. However, in this model, the health gap was projected to expand again around 2039. The model examined the introduction of two intervention policies, with findings showing that the policy focused on socioeconomic status improvement would be more effective in reducing health disparities, suggesting that socioeconomic status is the fundamental cause of these disparities. Conclusions: The results indicate that health disparities could be optimized, but not eliminated, as long as differences in socioeconomic status persists.
Highlights
Comparing the health status of civil servants at different levels, Marmot et al found that men in the lowest grade had three times the mortality rate from coronary heart disease compared with the highest grade, from a range of other cause, and from all causes combined, and drew the conclusion that health status follows a certain social gradient [1]
A consensus has developed among scholars that economic development cannot alleviate health disparity but, on the contrary, widens the health gap among social classes defined by socioeconomic status (SES) [6]
Our results indicated that the family doctor (FD) policy will not be able to eliminate health disparity in the long run, it was projected to have positive effects in its early stages
Summary
Comparing the health status of civil servants at different levels, Marmot et al found that men in the lowest grade had three times the mortality rate from coronary heart disease compared with the highest grade (administrators), from a range of other cause, and from all causes combined, and drew the conclusion that health status follows a certain social gradient [1]. A consensus has developed among scholars that economic development cannot alleviate health disparity but, on the contrary, widens the health gap among social classes defined by socioeconomic status (SES) [6]. Findings: System dynamics models showed that the FD policy would play a positive role in reducing health disparities in the initial stage, and medical price control—rather than health management—was the dominant mechanism. In this model, the health gap was projected to expand again around 2039. Conclusions: The results indicate that health disparities could be optimized, but not eliminated, as long as differences in socioeconomic status persists
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