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发表于 2010-1-22 13:57
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Summary$ M: z9 V' V' y
Social attention has been increasingly paid to health care systems varied in effectiveness and/ _+ o; e; I& Z' ?; Y* B* V5 B: w2 a
efficiency. This ** addresses the assessment and prediction of health care system. First and
- a' b% ^+ ~2 d" p& d$ qforemost, a metrics list is established and refined for further assessment. Secondly, model tests are
4 o6 ~" |, |9 @ N# h; p; ^* F w; qconducted between countries. Thirdly, a predictive model based on the relationship between2 g3 W# W& ]+ V/ v i9 C. z
changes and performance is proposed for restructure of the United States health system.$ `7 [5 d; c! ]6 g7 Y+ c; D
Under the guidance of WHO Health System Performance Framework, we gain an insight of the7 l3 K* V% f. @) W/ f. Q9 m$ g. g
problem. Focusing on the outcomes, health, responsiveness and financial protection, we devise
; a9 B! ^* k% [/ }7 ?8 pmetrics to build an index system for evaluat ion. Lists which describe each metric are presented, N5 f& A% J8 \ m% [
afterwards. Using Comprehensive Evaluation Method (CEM), combinations of metrics are carried
3 N( s' n/ W/ Y* oout, yielding metric o for effectiveness and for efficiency , which are the ultimate goals of A o P! v. {: F5 a: ^. d* _/ u; j* E
health care system. With these metrics, we can compare the relative quality of systems. After a% u- L- I+ j0 Y
thorough search of data sources, we refine the metrics list based on data availability, and also' S! Z$ x: r7 ~$ c1 s7 l
present the estimating and obtaining approaches." T3 D$ k: D8 c* c" D
For the purpose of international comparison, Principal Components Analysis is applied to choose
& b$ G! T' I1 k& ]. t' jthe most important and viable metrics. Life expectancy at birth, prevalence of tuberculosis,
0 J4 L2 D# V+ r! p4 Q$ L: F* ^8 Cimmunization coverage among 1-years-olds and fairness of financial contribution are finally
. ]' T- t* c# O3 [2 cselected. Then modified Analytical Hierarchy Process is processed to weigh each metric. The test+ n( J7 } o4 L* Q9 W/ d& o
results between the United States and two other countries are showed below:
$ i$ @7 q, J3 [7 {5 t$ XInvestigating the discrepancy between results, we attribute the cause to the differences in devise of
' g+ V. I- k: [8 A0 g3 [metrics and weights in CEM.
8 v. L/ L' P/ I) h/ c' bThen we propose a novel framework for prediction of restructure. Stepwise Regression Analysis is
+ d) ]7 z! l: ]% x% |introduced to find the relationship between the major contributing input factors and outcomes.
' P/ W" Y4 o ~. g. `Further more, after analyzing the variations of functions, possible policy changes to improve are* F' Y9 ^( a8 a, K& X
recommended, including strengthening primary care system and conducting a single payer system.
9 O5 a7 b$ A9 pFinally, the strength and weakness of our models are summarized, as well as two urgent aspects for
7 L6 h) E4 K; V# h2 `: `2 M! g' ^future work. The main achievements and contributions of this ** are concluded in the end. |
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