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发表于 2010-1-22 13:57
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Summary
" g. e) |8 A0 N8 V- @) f0 SSocial attention has been increasingly paid to health care systems varied in effectiveness and$ M* K. j$ F+ b- s
efficiency. This ** addresses the assessment and prediction of health care system. First and
5 Z3 _) A* W$ f2 x! l7 J; L0 ^foremost, a metrics list is established and refined for further assessment. Secondly, model tests are
5 Q) S& v9 p* A5 I; n% pconducted between countries. Thirdly, a predictive model based on the relationship between
, H6 M' n6 ^' [% {% W- F$ Q) fchanges and performance is proposed for restructure of the United States health system.
9 w7 P7 r# i' ]2 B! Q( L' E5 |$ ]+ RUnder the guidance of WHO Health System Performance Framework, we gain an insight of the
( F/ O2 i1 r- V5 M8 q; \$ K% aproblem. Focusing on the outcomes, health, responsiveness and financial protection, we devise
' [$ H- Z9 T7 w, J5 qmetrics to build an index system for evaluat ion. Lists which describe each metric are presented
( M" z9 C' T6 vafterwards. Using Comprehensive Evaluation Method (CEM), combinations of metrics are carried5 [$ x2 L* z0 M5 |4 m" @
out, yielding metric o for effectiveness and for efficiency , which are the ultimate goals of A o P
0 q& J7 x2 j M0 chealth care system. With these metrics, we can compare the relative quality of systems. After a; Q0 l7 s& |. Q6 H8 x
thorough search of data sources, we refine the metrics list based on data availability, and also
& H; B* ?8 \: Z( P- {+ Q) Cpresent the estimating and obtaining approaches.
+ v- ?. a1 n7 f1 ]. Q+ l; MFor the purpose of international comparison, Principal Components Analysis is applied to choose5 V7 w5 R* e$ h+ j
the most important and viable metrics. Life expectancy at birth, prevalence of tuberculosis,9 s3 v" V- G- j
immunization coverage among 1-years-olds and fairness of financial contribution are finally
9 x" B* a7 ~* v" N4 D+ {selected. Then modified Analytical Hierarchy Process is processed to weigh each metric. The test
4 u( U5 c1 }, h' |: G7 u5 h% M& `results between the United States and two other countries are showed below:
: _' z0 b0 @# ?6 n% KInvestigating the discrepancy between results, we attribute the cause to the differences in devise of
9 _9 n7 S5 o: V9 ]' p" K Cmetrics and weights in CEM.7 V, J, ~1 P1 w
Then we propose a novel framework for prediction of restructure. Stepwise Regression Analysis is, Y9 E W: p! @( P- d" e+ {
introduced to find the relationship between the major contributing input factors and outcomes., h, G! S- S8 O7 f, M
Further more, after analyzing the variations of functions, possible policy changes to improve are) _# i. X( }9 [; M& m
recommended, including strengthening primary care system and conducting a single payer system.
& s, @6 a# T/ O+ m# fFinally, the strength and weakness of our models are summarized, as well as two urgent aspects for
% f7 g& J- n0 J' Xfuture work. The main achievements and contributions of this ** are concluded in the end. |
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