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发表于 2010-1-22 13:57
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Summary
3 G1 R: {9 ~1 ]" {5 iSocial attention has been increasingly paid to health care systems varied in effectiveness and! X! q0 c3 d# b A
efficiency. This ** addresses the assessment and prediction of health care system. First and
# g2 i6 m7 B; \9 Yforemost, a metrics list is established and refined for further assessment. Secondly, model tests are* b1 v8 k' R. \5 r" Q* O
conducted between countries. Thirdly, a predictive model based on the relationship between% h y; p( W& a
changes and performance is proposed for restructure of the United States health system.
- p1 J; i+ P) l1 G% O' @% GUnder the guidance of WHO Health System Performance Framework, we gain an insight of the& @- z& k! w( z! N2 R' k7 e
problem. Focusing on the outcomes, health, responsiveness and financial protection, we devise$ g+ k0 q4 v3 f- t+ w; I* o7 |
metrics to build an index system for evaluat ion. Lists which describe each metric are presented
/ O4 {4 p! |+ q8 p ]/ y- ^afterwards. Using Comprehensive Evaluation Method (CEM), combinations of metrics are carried4 y" \8 r2 g4 A8 z7 c
out, yielding metric o for effectiveness and for efficiency , which are the ultimate goals of A o P
) m7 e- l: |5 Mhealth care system. With these metrics, we can compare the relative quality of systems. After a& Y* j" K" `! E- S% R; q
thorough search of data sources, we refine the metrics list based on data availability, and also
% a' o9 W+ @4 e+ opresent the estimating and obtaining approaches.
+ ~' i8 q4 P* g2 H. pFor the purpose of international comparison, Principal Components Analysis is applied to choose/ w5 n N8 o7 G9 I3 b) I
the most important and viable metrics. Life expectancy at birth, prevalence of tuberculosis,! [, H8 X( u) Y
immunization coverage among 1-years-olds and fairness of financial contribution are finally( U, a9 T8 M# @& K! ]
selected. Then modified Analytical Hierarchy Process is processed to weigh each metric. The test0 |6 I" E4 x* e" _; l/ ~! r
results between the United States and two other countries are showed below:$ h$ `/ g! s8 y. r! i% R9 h6 U
Investigating the discrepancy between results, we attribute the cause to the differences in devise of
8 {$ G/ p$ b9 R, w3 J7 bmetrics and weights in CEM.
$ y+ y% G; x. t* h+ s; KThen we propose a novel framework for prediction of restructure. Stepwise Regression Analysis is
5 G8 R4 Z' U4 l& S9 b4 ?introduced to find the relationship between the major contributing input factors and outcomes.: s9 b4 m! `; T. l' `. y
Further more, after analyzing the variations of functions, possible policy changes to improve are
( A1 y. B; A0 ?- e) b$ t) @5 zrecommended, including strengthening primary care system and conducting a single payer system.
& U) N" e* V$ d) ]5 ~Finally, the strength and weakness of our models are summarized, as well as two urgent aspects for" J, ~7 j9 [" `( F/ |
future work. The main achievements and contributions of this ** are concluded in the end. |
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