Evaluation and Improvement of Health Care Systems Luting Kong Yiyi Chen Chao Ye Beijing University.
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Transcript of Evaluation and Improvement of Health Care Systems Luting Kong Yiyi Chen Chao Ye Beijing University.
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Evaluation and Improvement of Health Care Systems
Luting KongYiyi Chen Chao Ye
Beijing University
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Problem Statement: Evaluating the Effectiveness of Healthcare Systems
Objectives:1. Create model to measure a country’s healthcare system2. Compare two different healthcare systems3. Identifying historical changes of a health care system 4. Investigate how the healthcare system is affected by
changes in the parameters of the model
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Modeling Approach
A. Simplifying the problem
General Assumptions-Healthcare system is an input-output system-Good healthcare system is available to everybody in society
Inequities
Input: Resources Output: Performance HEALTHCARE
SYSTEM
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B. Identifying the Metrics
Performance
Health Level Health Service Coverage
HALE* Infant Mortality Measles Diphtheria HepB TB Rate
*HALE = Health Adjusted Life Expectancy
Inequitiesprobability of dying < 5years / 1000 live births according to race
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Resources
Human Financial
Physicians Nurses Total Expenditure government/private Dentists Pharmacists on health % of GDP expenditure on health
Government Expenditure
Material on health vs Total
hospital beds/10,000 population
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C. Choosing the medium of evaluation
Assumptions System effectiveness = Resources/PerformanceSystem effectiveness and Inequity are independent
Evaluation Vector = (Resources/Performance, Inequities)
The smaller the vector the better the system
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D. Determining the Weights of the Metrics
Method: Analytical Hierarchy Process
Process (e.g Resources)1. State the objective (How are different resources distributed?)2. Define the criteria 3. Pick the Alternatives (Human, Material, Financial)
Assumptionsa) Human Resources are 2 times as important as Materialb) Human Resources are 3 times as important as Financialc) Material Resources are 2 times as important as Financial
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Building conjugated-comparative-matrix from assumptions
-Find eigenvalues-Normalize -Result = weight vectors of each alternative
Human Resources
Material Resources
Financial Resources
Human Resources
1 2 3
Material Resources 1/2 1 2
Financial Resources 1/3 1/2 1
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Formulas
Performance = .613*HealthLevel + .387*CoverageHealthLevel = .6*HALE + .4*(1-InfantMortality)Coverage = .25*(Measles+Diphtheria+HepB+TB)
Resources = .539*Financial + .297*Human + .164*Material Financial = .33*TH + .41*GHtoPH +.26GHtoG Human = .25*(physicians + nurses + dentists
+pharmacists) Material = hospital beds/10,000 population
Inequities = probability of dying < 5years / 1000 live births according to race
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Strengths-Analytical Hierarchical Process method is a good qualitative and quantitative analysis-It is convenient for measuring weights
Weakness-Subjectivity
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E. Models to Compare the Health Care Systems
Model 1
Strengths1. Simple and clear2. Ability to compare any two healthcare systems3. The weights of the Metrics can be adjusted flexiblyExpansionMetrics can have different weights
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Model 2
AssumptionLength of the vector = measures the effectiveness of healthcare system
Strengths-Visual/intuitive
Weakness-weights of Metrics is equal
Compare systems by drawing concentric circles. The system with the smaller circle in better.
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F. Finding the four most important metrics
Assumption: Inequity is mandatory
Method: Incomplete-Induction ModelDesign of the Model:
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Results:Four Metrics:1. M1 = Total expenditure on health as % of GDP2. M2 = Public expenditure/private expenditure3. M3 =HALE4. M4 =Inequities
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G. Applying the models
a. Comparing US and Brazil (Using the 4 Metrics)
Model 1: f(EVUS,EVBRAZIL) = -0.05
Model 2: LUS = 0.92, LBRAZIL = 0.91
ConclusionAccording to both models, Brazil healthcare system is better
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b. Measuring The Historical Change for the 4 Metrics
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Results1. The ratio of public/private expenditure changes more than the
total expenditure on health as % of GDP, both of them increase2. Life expectancy increased, it has reached shower rate of
change3. Inequities have decreased
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H. Further Study
Model with the four Metrics:
Considerations-Inputs: M1, M2
-Outputs: M3, M4
Thus, we can describe the system with the functions below:M3 = f(M1,M2) and M4 = g(M1,M2)
Healthcare System
Total Expenditure on health % of GDP HALE
InequitiesPublic/private expenditure on
health
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Further assumptions1. Life Expectancy (M3) is affected more by total expenditure on
health (M1) than inequities (M4) is.
2. Altering ration of public expenditures to private (M2) affects inequities more than life expectancy (M4) than in life expectancy (M3)
Therefore,
M3 = f(M1) and M4 = g(M2)
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Constructing the functions:A. Life Expectancy, M3
Assumption: -Growth rate is low when input is too small or too large but highwhen the input is appropriate.->Logistic Model
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B. Inequities M4
Assumption-M4 will decrease as M2 increases->inversely proportional function:
M4 = k/M2 where k = 0.548 (from 2004 data)
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I. Putting forward measures:
Group A (affects only M1)1. Limiting the rise of total expenditure on health as % of GDP2. Limiting items and extensions of life insurance3. Limiting use of new technology (increases cost)4. Regulating cost of medicine5. Reducing excessive medical treatment 6. Promoting positive competition between hospitals to reduce
costs
Group B (affects only M2):1. Altering the ratio of public to private expenditure on health
Group C (affects both):1. Increasing the coverage of public insurance
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Results
1. Decrease on total expenditure on health as % of GDP can improve the healthcare system.
2. Increasing the ratio of public expenditure to private improves the system
3. Combination of both
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Strengths-Model is easy and convenient for testing measures
Weakness-A single-independent-variable function is not the best to describe a healthcare system