Special issue on health care simulation

Abstract

Health-related issues continue to be global challenges. Both developed and developing nations are struggling with ways to provide affordable access to health services. The threat of global epidemics including HIV, SARS and the spread of other diseases worldwide threaten to undo decades of gains in life expectancy. Poverty and political unrest breeds new diseases that are rapidly spread around the globe. At the same time the organization and delivery of health services are increasingly complex and costly. Papers in this issue demonstrate the power of simulation in addressing these challenges. Computer simulation has become state of the art in many areas and its use is still growing. Two trends can be observed. First, the conceptual scope of both simulation software and models is becoming broader and more flexible. This allows investigators to combine several modelling approaches in the same application. For example, agentbased models allow researchers to combine technical as well as behavioural aspects of systems. Second, partly as a result of the first trend, we see the use of computer simulation increasingly being applied in areas where there used to be reluctance to use this approach, e.g., in policy modelling. The first three papers address health care policy issues. Pasdirtz examines the issue of control of health care expenditures in the US. State-space models of the US health care system and the US economy were developed, estimated with time series data for the late twentieth century and analyzed using modern control theory. The results suggest that control strategies designed to contain health care costs need to be targeted at health care capital investment, prices for physicians’ services and prescription drugs. Policies directed purely at cutting costs in general or increasing efficiency are likely to have little effect. The paper by Anderson and others reports the construction of an agent-based model that has been used to study humanitarian assistance policies executed by governments and non-government organizations (NGOs) for the health and safety of refugees. An experimental design was used to study the relationships among five factors: basic needs, food and water, sanitation, medical resources and security. The simulation demonstrates the critical role of security in providing for the health and well-being of refugees. The importance of security was highlighted in the recommendations that Amnesty International made regarding the African Union Mission in Sudan (AMIS). A major strength of the model is that it allows policy makers to incorporate specific characteristics of refugees and the governmental and nongovernmental organizations that are providing humanitarian aid to the camp. Policy simulations are valuable because of their ability to facilitate training and feedback concerning potential impact of decisions. In the real world policy decisions may have serious consequences. Policy simulation models are useful because they accelerate creation of scenarios, allow rapid changes in parameters, and provide a test bed for concepts and strategies. In the present application, policies can be examined to see how refugee communities might respond to alternative courses of action and how these actions are likely to affect the health and well-being of the community. The third paper in this issue demonstrates the value of simulation as a tool to analyze policies designed to contain Health Care Manage Sci (2007) 10:309–310 DOI 10.1007/s10729-007-9031-x