醫(yī)療外文翻譯---衛(wèi)生保健系統(tǒng)

1、<p><b>　　東北大學(xué)軟件學(xué)院</b></p><p>　　畢業(yè)設(shè)計(jì)（論文）外文參考資料</p><p><b>　?。ㄔ呐c譯文）</b></p><p>　　外文題目：Health care system</p><p>　　中文題目：衛(wèi)生保健系統(tǒng)</p><

2、p>　　作 者：Ralph Kimball</p><p>　　專 業(yè)：軟件工程</p><p>　　班 級(jí)：軟件 班</p><p><b>　　學(xué) 號(hào)：</b></p><p><b>　　姓 名： </b></p><p>　　201

3、1年6月10日</p><p>　　Health care system</p><p>　　Nowadays, the health care systems which are provided by nations have improved their residents’ health remarkably. Take the USA for example, the life

4、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.</p><p>　　Since the health care system

5、s 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

6、 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 w

7、hich system is better. Actually,</p><p>　　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

8、 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 system

9、s, some useful measures are absolutely necessary.</p><p>　　Part I: Choosing and combining metrics</p><p>　　1.1 Choosing metrics</p><p>　　As we all know, aspects of health care syste

10、ms 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 tha

11、n 70, it is nearly impossible for us to evaluate a health care system using all of the metrics. </p><p>　　To simplify the evaluation, we have chosen some important metrics, which can affect the effectiveness

12、 of health care systems more remarkably. Generally, a health care system can be evaluated from the following six aspects: </p><p><b>　　Mortality</b></p><p>　　Morbidity </p>&l

13、t;p><b>　　Coverage</b></p><p>　　Health systems resource </p><p>　　Health systems expenditure </p><p><b>　　Inequity</b></p><p>　　In allusion to

14、 each aspect, there are some representative metrics. </p><p>　　1.1.1 The reason for the choice of mortality</p><p>　　Refer to the world health statistics given by the WHO, mortality should inclu

15、de life expectancy, healthy life expectancy, infant mortality rate, neonatal mortality rate, maternal mortality ratio, cause-specific mortality rate and so on. </p><p>　　Out of question, the life expectancy

16、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 r

17、ate; 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 di

18、seases, hence the morta</p><p>　　In conclusion, the chosen metrics of mortality are:</p><p>　　Life expectancy</p><p>　　Infant mortality rate</p><p>　　Neonatal mortality

19、 rate</p><p>　　Maternal mortality rate</p><p>　　Mortality rate of typical epidemic sufferer </p><p>　　1.1.2 The reason for the choice of morbidity</p><p>　　For a health

20、 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.</p><p>　　1.1.3

21、 The reason for the choice of coverage</p><p>　　It 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,

22、 it’s 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: </p><p>　　Immunization cover

23、age</p><p>　　Antenatal care coverage</p><p>　　Contraceptive prevalence rate</p><p>　　Proportion of the population without hospitalization insurance.</p><p>　　1.1.4 The

24、reason for the choice of health systems resource</p><p>　　In our opinions, the more resource a health care system has, the better effectiveness it will be, which means the health care systems’ resource is an

25、other 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 metri

26、cs are:</p><p>　　Human resource of health systems as %of total population </p><p>　　Per capita material resources of health systems</p><p>　　1.1.5 The reason for the choice of healt

27、h systems expenditure</p><p>　　People 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 nonpre

28、scription 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 socia

29、l security contributions, and knowingly whenever they pay taxes that are used in part of finance health.</p><p>　　Based on the fact that the health care systems expenditure is made up of two parts, where one

30、 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:</p><p>　　

31、The total expenditure on health as %of GDP</p><p>　　Government and private expenditure on health as %of Total expenditure on health </p><p>　　Per capita total expenditure on health.</p>&

32、lt;p>　　1.1.6 The reason for the choice of inequities</p><p>　　The resources devoted to health systems are very unequally distributed, and not at all in proportion to the distribution of health problems. F

33、or 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 ar

34、e distributed, generally speaking, the inequities must exist between persons and regions. So the inequities should not be ignored.</p><p>　　1.1.7 Aggregate the chosen metrics in a table</p><p>　

35、　To make the chosen results more clearly, we concluded them in the following table. (refer to table 1)</p><p>　　1.2 Metrics used to compare between existing and potential systems</p><p>　　Cost-e

36、ffectiveness 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

37、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. What’s mo

38、re, generally speaking, the more the cost is, the bett</p><p>　　Thus the first step to make comparisons between existing and potential systems is to divide the metrics into cost and effectiveness, and then u

39、se the cost to determine which system is better.</p><p>　　1.2.1 Classing the chosen metrics</p><p>　　The costs here mainly refer to the measures which can be change by people, such as how much c

40、an be accomplished with currently available resources – people, buildings, equipment and knowledge – depends greatly on the past investment and train in that created those resources. </p><p>　　Corresponding

41、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

42、 compare the current and potential systems.</p><p>　　By all appearances, the rest metrics we have chosen should be the effectiveness.</p><p>　　1.2.2 Conclude the metrics used to compare</p>

43、;<p>　　Based on the analysis above, the metrics used to make comparisons between existing and potential systems are shown in the table 2</p><p>　　1.3 Combining the chosen metrics </p><p>

44、　　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

45、 in this problem.</p><p>　　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

46、metrics, then the ratio of two compositive indexes named cose-effectiveness can represent whether the system is better than others.</p><p>　　Part Ⅱ: Identify current sources of data</p><p>　　As

47、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 me

48、trics 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.</p><p>　　Identifying data<

49、/p><p>　　To insure the availableness of the chosen metrics, we need to relate the chosen metrics with the current sources of data.</p><p>　　2.1.1 Identifying data about mortality</p><p&g

50、t;　　For 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 sho

51、uld be identified.</p><p>　　2.1.2 Identifying data about typical epidemic morbidity</p><p>　　However, there is no existing data about the mortality rate of typical epidemic sufferer, which means

52、 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 whi

53、le the mortality of tuberculosis represents the controlment of them. Thus the HIV/AIDS mortality rate and TB mortality rate should be chosen.</p><p>　　As mentioned above, the typical epidemic diseases can be

54、 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.</p><p>　　2.1.3 Identifying data about coverage<

55、/p><p>　　For 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 o

56、nly 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.</p><p>　　2.1.4 Identifying data a

57、bout health systems resource</p><p>　　The 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 p

58、opulation should be chosen.</p><p>　　2.1.5 Identifying data about health systems expenditure</p><p>　　For all of the data about health systems expenditure can be obtained from the World Health S

59、tatistics directly, we don’t 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 o

60、n health and per capita total expenditure on health.</p><p>　　2.1.6 Identifying data about inequalities</p><p>　　Generally speaking, the person who lives in the city with the higher wealth and e

61、ducational 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.</p><p>　　2.1.7 Con

62、cluding the identified data</p><p>　　To take on the result of identified data more distinctly, we concluded them in one table (refer to table 3)</p><p>　　2.2 Modifying the metrics </p>&l

63、t;p>　　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.</p><p>　　Comparing table1 with table 4,

64、the typical epidemic morbidity is replaced by HIV prevalence among adults aged>15 years and TB prevalence. What’s more, the integrated inequality is also replaced by inequalities representing in different regions and

65、different people, which means the typical epidemic morbidity and inequalities need to be modified.</p><p>　　2.2.1 Symbols used in part Ⅱ</p><p>　　2.2.2 Modifying the typical epidemic morbidity&l

66、t;/p><p>　　As mentioned above, the typical epidemic diseases here are equal to AIDS and TB. The number of people who die of AIDS per 100,000 epidemic patients can be calculated by using the following formula:&l

67、t;/p><p>　　, (1)</p><p>　　where is the number of people who die of AIDS per 100,000 epidemic patients, is the number of people who die of AIDS per 100,000 AIDS patients, is

68、the number of people infected AIDS per 100,000 population and is the number of people infected TB per 100,000 population.</p><p>　　Similarly, the number of people who die of TB per 100,000 epidemic patients

69、 can be calculated:</p><p>　　, (2)</p><p>　　where is the number of people who die of TB per 100,000 epidemic patients and is the number of people who die of TB per 100,000 T

70、B patients.</p><p>　　Based on the analysis about epidemic diseases’ composing, the total number of people who die of epidemic diseases per 100,000 population is:</p><p>　　,

71、 (3)</p><p>　　Combining (1), (2), (3), the typical epidemic morbidity is:</p><p>　　, (4)</p><p>　　Modifying the inequality</p><p>　　In an ideal health c

72、are system, the ratio rural–urban place of residence, ratio lowest-highest wealth quintile and ratio lowest-highest educational level of mother should be 1, thus the smaller the difference between each radio and 1, the s

73、maller the inequality is. To simplify the calculation, the following equation can be used to obtain the integrated inequality index:</p><p>　　, (5)</p><p>　　where is the

74、rate that represent each inequality (for there are 12 kinds of inequalities, ), is the integrated inequality index. </p><p>　　Part Ⅲ: Choosing the most important and viable metrics</p><p>　　

75、If a metric is made up of mort than one aspect, there are many methods to analyze it, such as AHP and weighted averages, however, there are a lot of subjective factors because both of the hierarchy and weight are man-mad

76、e. In order to make the result more objective, we use the PCA.</p><p>　　As we all know, if there is a certain relationship between two variables, it can be interpreted that part of information which are refl

77、ected by them is the same. In this case, Principal Component Analysis may be the best choice, because based on all the original variables, the PCA can establish new variables as few as possible which are irrelated betwee

78、n each other. At the same time, the new variables can maintain the original information.</p><p>　　Refer to this problem, in order to determine which chosen metrics is more important, we should deal with data

79、 first.</p><p>　　3.1 Dealing with data</p><p>　　Since there are so many data and some of them are very difficult to collect, considering their acquirability and integrality, it’s necessary for u

80、s to deal with them which include two steps.</p><p>　?、?Considering the acquirability we ignored the effect of inequalities. It’s observed that the great mass of inequalities are not given in the World Healt

81、h Statistics, we thought it meant the data about inequalities were hard to collect.</p><p>　?、贑onsidering the integrality we ignored some countries whose data except inequalities were half-baked. </p>

82、;<p>　　3.2 Determining the number of chosen metrics</p><p>　　Using the SPSS, we chalked up the scree plot as figure 1:</p><p>　　The abscissa of the scree plot is the number of components,

83、 while the y-axis is the eigenvalue. From the scree plot we can descry that the eigenvalue of the first component is very high, which means it contributes the most to the interpretation of the original variables. At the

84、same time, there are two inflexions when the number of component is 3 or 5. Since the total variance explained of the first three components is 72.4% which is less than 85%, we chose the first five components whose total

85、 </p><p>　　3.3 Choosing some important metrics</p><p>　　Based on the analysis above, we need to analysis the 14 metrics with the correlate data about 67 countries, the number of principal compon

86、ents is 5.</p><p>　　3.3.1 Analyzing with the PCA</p><p>　　3.3.1.1 The introduction of the PCA</p><p>　　Explanation of the PCA</p><p>　　Principal component analysis was

87、presented by Hotelling in 1933, it is a method of multianalysis, and it can change mass indexes into a few integrated ones and tell apart the key or core factors in system. The basic process of principal component analys

88、is is presented as below:</p><p>　　Normalizing the data of sample</p><p>　　Let the data matrix is, i.e. n indexes and m samples, and normal data matrix is, then the formula of normalization is&l

89、t;/p><p><b>　　,</b></p><p><b>　　Where .</b></p><p>　　Writing out correlative matrix of sample</p><p>　　Let correlative matrix, where the correlativ

90、e coefficient is </p><p><b>　　,</b></p><p>　　and, so R is symmetrical matrix.</p><p>　　Calculating eigenvalue and eigenvector</p><p>　　According to eigenfun

91、ction , eigenvalues can figure out, and </p><p>　　According to homogeneous system of linear equations, the eigenvector corresponding to the eigenvalue can figure out, and for , </p><p>　　Acquiri

92、ng principal components according to the accumulative contribution rate</p><p>　　Firstly, the contribution rates of every principal component are figured out as follow:</p><p>　　Then according t

93、o the rules of accumulative contribution rate as follow to acquire principal components .</p><p>　　Where,, .</p><p>　　General evaluation making use of principal components </p><p>

94、　　Finally, we can use the general evaluation value as follow to make decision. </p><p>　　3.3.1.2 Managing the PCA</p><p>　　Using the SPSS and the data which are dealt, the Component Matrix can b

95、e calculated as table 6:</p><p>　　From the Component Matrix we can descry that in allusion to the first principal component, the contribution coming from life expectancy, infant mortality rate and neonatal m

96、ortality are much greater, whose absolute value all exceed 0.9. Consequently, the first principal component can be interpreted as General health status which contains life expectancy, infant mortality rate and neonatal m

97、ortality. </p><p>　　Similarly, in allusion to the second principal component, the contribution coming from mortality rate of typical epidemic sufferer and typical epidemic morbidity are much greater, thus th

98、e second principal component can be interpreted as the overall epidemic condition which includes mortality rate of typical epidemic sufferer and typical epidemic morbidity. </p><p>　　The third principal comp

99、onent can be interpreted as financial policy including total expenditure on health as %of GDP, per capita total expenditure on health, government expenditure on health as %of total expenditure on health and private expen

100、diture on health as %of total expenditure on health.</p><p>　　In allusion to the forth principal component, there are no metrics whose contributions are great, hence we thought the forth principal component

101、can be ignored.</p><p>　　Finally, in allusion to the fifth principal component, the contribution coming from density of physicians, nurses，etc and hospital beds per 1000 population are much greater, thus the