Aile hekiminin rolünün sistem dinamiği modellemesi kullanılarak incelenmesi

In this study, a two-tier health service system is modeled using system dynamics methodology with the objective of understanding the impact of operational factors on people?s choice of first contact to get medical care. This two-tier health service system is motivated by the transformation of the primary care system to family practice in Turkey. Interviews are conducted with health officers in Düzce to develop a model for patient and doctor flows. The general practitioner is the primary health care provider, whereas state and private hospitals are secondary health care providers in the two-tier health service system. The main principle behind family practice in primary care is to provide a family doctor for every individual in order to improve preventative and curative care and to alleviate hospital workloads. However, current system allows patients to choose hospitals as a first contact for even the simplest conditions. As a barrier for this, a regulation which imposed general practitioners as gate-keepers in the system was implemented, but it remained effective for only seven months. In this study, we explore the dynamics of patient flows in the system using system dynamics modeling. One objective is to understand the reasons for failure of this gatekeeping policy. Operational factors are determined as service quality, trust and waiting time; which are studied in different scenarios to understand dominant factors in the system. Further, we explore implications of changing certain policy parameters on the system performance measures such as daily demand and waiting times for general practitioners and hospitals.