Patients, primary care, and policy: Agent-based simulation modeling for health care decision support

Primary care systems are a cornerstone of universally accessible health care. The planning, analysis, and adaptation of primary care systems is a highly non-trivial problem due to the systems' inherent complexity, unforeseen future events, and scarcity of data. To support the search for solutions, this paper introduces the hybrid agent-based simulation model SiM-Care. SiM-Care models and tracks the micro-interactions of patients and primary care physicians on an individual level. At the same time, it models the progression of time via the discrete-event paradigm. Thereby, it enables modelers to analyze multiple key indicators such as patient waiting times and physician utilization to assess and compare primary care systems. Moreover, SiM-Care can evaluate changes in the infrastructure, patient behavior, and service design. To showcase SiM-Care and its validation through expert input and empirical data, we present a case study for a primary care system in Germany. Specifically, we study the immanent implications of demographic change on rural primary care and investigate the effects of an aging population and a decrease in the number of physicians, as well as their combined effects.