软件工程毕业论文：卫生保健系统设计.doc

东北大学软件学院毕业设计（论文）外文参考资料（原文与译文）外文题目：Health care system中文题目：卫生保健系统作 者：Ralph Kimball专 业：软件工程班 级：软件 班学 号：姓 名： 2011年6月10日Health care systemNowadays, the health care systems which are provided by nations have improved their residents health remarkably. Take the USA for example, the life expectancy at birth has raised to 80 years old, while the infant mortality has declined to 7. In other countries of the world, the similar situation also exists widely.Since the health care systems are playing more and more important roles in national health, people often pay much attention to which systems are better and whether the current systems can be improved. However, the aspects of these systems that vary widely between nations (such as how they are funded, the mode which services are delivered, percentage of GDP spent on health care, the personal living habits and so on) are so many that it is hard for us to determine which system is better. Actually, it is impossible and not necessary for us to use the data about all the aspects, thus our tasks are to choose and combine some metrics to evaluate a health care system with sufficient reasons. Then the evaluation method is used between the USA and another country to check up whether it is available.Using the evaluation method, we can gain that the effectiveness between different health care systems is different, which means there is still a long way for nations to improve their health care systems. Based on the fact that any measures that a nation takes can affect the effectiveness of the health care systems evidently, if we want to get much better effective health care systems, some useful measures are absolutely necessary.Part I: Choosing and combining metrics1.1 Choosing metricsAs we all know, aspects of health care systems vary widely between nations, all of which can reflect the effectiveness of health care systems to a certain extent. However, according to the World Health Statistics given by the WHO, the number of metrics is more than 70, it is nearly impossible for us to evaluate a health care system using all of the metrics. To simplify the evaluation, we have chosen some important metrics, which can affect the effectiveness of health care systems more remarkably. Generally, a health care system can be evaluated from the following six aspects: 1) Mortality2) Morbidity 3) Coverage4) Health systems resource 5) Health systems expenditure 6) InequityIn allusion to each aspect, there are some representative metrics. 1.1.1 The reason for the choice of mortalityRefer to the world health statistics given by the WHO, mortality should include life expectancy, healthy life expectancy, infant mortality rate, neonatal mortality rate, maternal mortality ratio, cause-specific mortality rate and so on. Out of question, the life expectancy should be the most important metrics, for all the health care systems aim to extend it as long as possible. Besides, generally speaking, infants and pregnant women often have the weakest vitality, thus infant mortality rate; neonatal mortality rate and maternal mortality rate can be chosen to infect the effectiveness of a certain system. However, another important function of a health care system is the cure for some typical epidemic diseases, hence the mortality rate of typical epidemic sufferer should also be in our consideration.In conclusion, the chosen metrics of mortality are:1) Life expectancy2) Infant mortality rate3) Neonatal mortality rate4) Maternal mortality rate5) Mortality rate of typical epidemic sufferer 1.1.2 The reason for the choice of morbidityFor a health care system, its function is not only the cure for diseases but also preventing them. Concretely, the effectiveness of prevention can be represented by morbidity of typical epidemic diseases.1.1.3 The reason for the choice of coverageIt is a truth that each person should has the equal right to enjoy the health care system, which is the aim pursued by a country at the same time. But in fact, its really a long way to go to gain this ends for there are all kinds of impeditive factors. Consequently, we need to determine the coverage of some medical treatments such as: 1) Immunization coverage2) Antenatal care coverage3) Contraceptive prevalence rate4) Proportion of the population without hospitalization insurance.1.1.4 The reason for the choice of health systems resourceIn our opinions, the more resource a health care system has, the better effectiveness it will be, which means the health care systems resource is another important evaluate aspect. However, since populations of each country widely vary between nations, the per capita share of resources may represent the health system resource more reasonably. The corresponding metrics are:1) Human resource of health systems as %of total population 2) Per capita material resources of health systems1.1.5 The reason for the choice of health systems expenditurePeople typically come into direct contact with a health system as patients, attended by providers, only once or twice a year. More often their contact is as consumers of nonprescription medications and as recipients of health-related information and advice. They meet the system as contributors to paying for it, knowingly every time they buy care out of pocket or pay insurance premiums or social security contributions, and knowingly whenever they pay taxes that are used in part of finance health. Based on the fact that the health care systems expenditure is made up of two parts, where one part is expended by individuals and the other is expended by governments. However, both of them can be represented as total expenditure on health of GDP, thus we choose three metrics in this part:1) The total expenditure on health as %of GDP2) Government and private expenditure on health as %of Total expenditure on health 3) Per capita total expenditure on health.1.1.6 The reason for the choice of inequitiesThe resources devoted to health systems are very unequally distributed, and not at all in proportion to the distribution of health problems. For an ideal health care system, every person should receive most the same medical treatment, however things go contrary to our wishes, there are inequitable factors necessarily when the resource of health care systems are distributed, generally speaking, the inequities must exist between persons and regions. So the inequities should not be ignored.1.1.7 Aggregate the chosen metrics in a tableTo make the chosen results more clearly, we concluded them in the following table. (refer to table 1)Metrics IdentifiedAspect Foundational MetricsmortalityLife expectancyInfant mortality rateNeonatal mortality rateMaternal mortality ratiomortality rate of typical epidemic sufferermorbiditytypical epidemic morbiditycoverageImmunization coverageAntenatal care coverageContraceptive prevalence rateProportion of the population without hospitalization insuranceHealth systems resourcehuman resource of Health systems as %of total populationPer capita material resources of Health systemsHealth systems expenditureTotal expenditure on health as %of GDPGovernment and Private expenditure on health as %of Total expenditure on healthPer capita total expenditure on healthInequitiesInequities in health1.2 Metrics used to compare between existing and potential systemsCost-effectiveness analysis, now, is essential for identifying the services that will produce the most health gain from available resources, but it has to be applied to individual interventions, not broadly against disease or causes. However, on the one hand, the costs can vary greatly from one country and intervention mode to another; on the other hand, it will be changed along with the development of economy in a potential system. Whats more, generally speaking, the more the cost is, the better effectiveness is, which means the change of effectiveness dependents on the costs change to a great extent. Thus the first step to make comparisons between existing and potential systems is to divide the metrics into cost and effectiveness, and then use the cost to determine which system is better.1.2.1 Classing the chosen metricsThe costs here mainly refer to the measures which can be change by people, such as how much can be accomplished with currently available resources people, buildings, equipment and knowledge depends greatly on the past investment and train in that created those resources. Corresponding with the metrics we have chosen, the costs are health systems resource, health systems expenditure and inequities. Since them can be change by people and can affect the effectiveness of a systems directly, we use them to compare the current and potential systems.By all appearances, the rest metrics we have chosen should be the effectiveness. 1.2.2 Conclude the metrics used to compareBased on the analysis above, the metrics used to make comparisons between existing and potential systems are shown in the table 2Table 2. Metrics Used to Make ComparisonsHealth systems resourcehuman resource of Health systems as %of total populationPer capita material resources of Health systemsHealth systems expenditureTotal expenditure on health as %of GDPGovernment and Private expenditure on health as %of Total expenditure on healthPer capita total expenditure on healthInequitiesInequities in health1.3 Combining the chosen metrics Refer to the above analysis that the cost-effectiveness analysis is essential for identifying the systems that will produce the most health gain from available resources, hence the sort we have classed can also be used in this problem.For the metrics included in the cost, we can combine them to get a compositive cost index, similarly, another compositive effectiveness index can be obtained by combining the rest metrics, then the ratio of two compositive indexes named cose-effectiveness can represent whether the system is better than others.Part : Identify current sources of dataAs mentioned above, the number of metrics is more than 70 in the World Health Statistics given by the WHO, it is nearly impossible for us to evaluate a health care system using all of them. On the other hand, some of the metrics which we must use can not be obtained from the statistical data published directly, the only way to solve this problem is to identify the useful data and then modify them.2.1 Identifying dataTo insure the availableness of the chosen metrics, we need to relate the chosen metrics with the current sources of data.2.1.1 Identifying data about mortalityFor mortality, the data such as life expectancy, infant mortality rate, neonatal mortality rate and maternal mortality rate can be acquired from the World Health Statistics directly, thus the data mentioned above should be identified.2.1.2 Identifying data about typical epidemic morbidityHowever, there is no existing data about the mortality rate of typical epidemic sufferer, which means we have to calculate it using the available data. In most cases, the typical epidemic diseases can be represented by AIDS and tuberculosis, because the mortality of AIDS represents the treatment of epidemic diseases while the mortality of tuberculosis represents the controlment of them. Thus the HIV/AIDS mortality rate and TB mortality rate should be chosen.As mentioned above, the typical epidemic diseases can be substituted by AIDS and TB. Then the HIV prevalence among adults aged >15 years and TB prevalence can be used to present the typical epidemic morbidity.2.1.3 Identifying data about coverageFor the proportion of the population without hospitalization insurance dependents on the financial input of a country to a great extent, which will be discussed in the health systems expenditure, the only change in this part is to ignore its effect. Thus the identified data in this part are: immunization coverage, antenatal care coverage and contraceptive prevalence rate.2.1.4 Identifying data about health systems resourceThe health systems resources include both human and material resources, based on the available data, the density of physicians, nurses, etc. and hospital beds per 1000 population should be chosen.2.1.5 Identifying data about health systems expenditureFor all of the data about health systems expenditure can be obtained from the World Health Statistics directly, we dont need to change any of them, which means the data identified in this part are: total expenditure on health as % of GDP, government and private expenditure on health as % of total expenditure on health and per capita total expenditure on health.2.1.6 Identifying data about inequalitiesGenerally speaking, the person who lives in the city with the higher wealth and educational level may receive the better health service. This can represent one aspect of inequalities. However, to describe the inequalities in detail, we choose the data shown in table 3.2.1.7 Concluding the identified dataTo take on the result of identified data more distinctly, we concluded them in one table (refer to table 3)2.2 Modifying the metrics Even though all the identified data could be obtained from the World Health Statistics, we still need to modify some of them to make the metrics more useful.Table 3. Data Identified from World Health Statistics 2007CombinedData IdentifiedmortalityLife expectancyInfant mortality rateNeonatal mortality rateMaternal mortality ratioHIV/AIDS mortality rateTB mortality ratemorbidityHIV prevalence among adults aged>15 yearTB prevalencecoverageImmunization coverage among 1-years-oldsAntenatal care coverageContraceptive prevalence rateHealth systems resourceDensity of physicians、nurses，etchospital beds per 1000 populationHealth systems expenditureTotal expenditure on health as %of GDPGovernment and Private expenditure on health as %of Total expenditure on healthPer capita total expenditure on healthInequitiesProbability of dying aged <5 years per 1000 live birthsratio of rural-urbanratio of lowest-highest Wealthratio of lowest-highest Educational levelChildren aged <5 years stunted for ageratio of rural-urbanratio of lowest-highest t Wealthratio of lowest-highest Educational levelBirths attended by skilled health personnelratio of rural-urbanratio of highest-lowest Wealthratio of highest-lowest Educational levelMeasles immunization coverage among 1-year-oldsratio of rural-urbanratio of highest-lowest Wealthratio of highest-lowest Educational levelComparing table1 with table 4, the typical epidemic morbidity is replaced by HIV prevalence among adults aged>15 years and TB prevalence. Whats more, the integrated inequality is also replaced