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发表于 2010-1-22 13:57
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Summary% {4 U& q _2 c* h8 \8 q
Social attention has been increasingly paid to health care systems varied in effectiveness and7 F, r2 g. k& ~1 M1 o& k$ q
efficiency. This ** addresses the assessment and prediction of health care system. First and) p! r! U" X: _7 R' O: K
foremost, a metrics list is established and refined for further assessment. Secondly, model tests are
" J- A1 U( o% g2 q/ fconducted between countries. Thirdly, a predictive model based on the relationship between! O3 H2 R: A# O- w, |! r! t
changes and performance is proposed for restructure of the United States health system.
- q% l) h7 e6 k; F8 tUnder the guidance of WHO Health System Performance Framework, we gain an insight of the
6 g# r& R2 c/ V! L+ N' ]' ^problem. Focusing on the outcomes, health, responsiveness and financial protection, we devise% }/ O) G1 U* G5 y
metrics to build an index system for evaluat ion. Lists which describe each metric are presented2 {$ e J8 P' b. ~0 U$ u9 {" m* f# l8 X
afterwards. Using Comprehensive Evaluation Method (CEM), combinations of metrics are carried: S5 B5 ^' ^/ @
out, yielding metric o for effectiveness and for efficiency , which are the ultimate goals of A o P
, f9 f& c* Q$ S, l2 a8 Yhealth care system. With these metrics, we can compare the relative quality of systems. After a
" t2 i2 l+ d1 P1 ~6 o5 D9 tthorough search of data sources, we refine the metrics list based on data availability, and also$ j2 Z- ]3 T1 G8 V
present the estimating and obtaining approaches. z# n1 Z& a/ d
For the purpose of international comparison, Principal Components Analysis is applied to choose
% @" h$ [4 p' ~+ |' n- Ythe most important and viable metrics. Life expectancy at birth, prevalence of tuberculosis,; p: G; H, M% K7 b* I
immunization coverage among 1-years-olds and fairness of financial contribution are finally7 y/ z" ^* q2 S+ I
selected. Then modified Analytical Hierarchy Process is processed to weigh each metric. The test
: V C$ c/ g4 B' i/ K/ Y4 Rresults between the United States and two other countries are showed below:/ p, f3 Q( w) J( Q8 W/ @: b
Investigating the discrepancy between results, we attribute the cause to the differences in devise of& o8 W' o' S. k2 | {# \6 W! D
metrics and weights in CEM.
" ]! L* N5 h2 k f9 G7 A9 uThen we propose a novel framework for prediction of restructure. Stepwise Regression Analysis is
7 q; m2 o: ~2 f1 Wintroduced to find the relationship between the major contributing input factors and outcomes.& o! U' z, a) R3 c4 W: b
Further more, after analyzing the variations of functions, possible policy changes to improve are
0 z( D! T8 }+ qrecommended, including strengthening primary care system and conducting a single payer system.
, J4 N1 I- o( F6 ?: k8 wFinally, the strength and weakness of our models are summarized, as well as two urgent aspects for( G. K: e5 R& ^. u1 ?
future work. The main achievements and contributions of this ** are concluded in the end. |
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