衛(wèi)生保健系統(tǒng)外文翻譯

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1、　　畢業(yè)設(shè)計(jì)（論文）外文參考資料　?。ㄔ呐c譯文）　　外文題目：Health care system　　中文題目：衛(wèi)生保健系統(tǒng)　　作者：Ralph Kimball

2、專業(yè)：軟件工程　　班級：軟件班　　學(xué) 號：　　姓名： 　　2011年6月10日　　Health care system&l

3、t;/p>　　Nowadays, 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, wh

4、ile 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 nat

5、ional 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 fund

6、ed, 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,<p&

7、gt;　　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 th

8、e 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.&

9、lt;/p>　　Part I: Choosing and combining metrics　　1.1 Choosing metrics　　As we all know, aspects of health care systems vary widely between nations, all of which can r

10、eflect 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

11、 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

12、, a health care system can be evaluated from the following six aspects: 　　Mortality　　Morbidity 　　Coverage&l

13、t;p>　　Health systems resource 　　Health systems expenditure 　　Inequity　　In allusion to each aspect, there are some representative metric

14、s. 　　1.1.1 The reason for the choice of mortality　　Refer to the world health statistics given by the WHO, mortality should include life expectancy, healthy life expectancy, infan

15、t 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

16、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 mortalit

17、y 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 morta　　In c

18、onclusion, the chosen metrics of mortality are:　　Life expectancy　　Infant mortality rate　　Neonatal mortality rate　　Maternal mortality rat

19、e　　Mortality rate of typical epidemic sufferer 　　1.1.2 The reason for the choice of morbidity　　For a health care system, its function is not only the cure fo

20、r 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 coverage

21、　　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, it’s really a long way to go to gain this ends fo

22、r there are all kinds of impeditive factors. Consequently, we need to determine the coverage of some medical treatments such as: 　　Immunization coverage　　Antenatal care coverage&

23、lt;/p>　　Contraceptive prevalence rate　　Proportion of the population without hospitalization insurance.　　1.1.4 The reason for the choice of health systems resource&l

24、t;/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 another important evaluate aspect. However, since po

25、pulations 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:　　Human resource of he

26、alth systems as %of total population 　　Per capita material resources of health systems　　1.1.5 The reason for the choice of health systems expenditure　　People

27、 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-

28、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 t

29、hey 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

30、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:　　The total expenditure on health as %of GDP</p&g

31、t;　　Government and private expenditure on health as %of Total expenditure on health 　　Per capita total expenditure on health.　　1.1.6 The reason for the choice of inequ

32、ities　　The 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 shoul

33、d 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

34、must exist between persons and regions. So the inequities should not be ignored.　　1.1.7 Aggregate the chosen metrics in a table　　To make the chosen results more clearly, we concl

35、uded them in the following table. (refer to table 1)　　1.2 Metrics used to compare between existing and potential systems　　Cost-effectiveness analysis, now, is essential for ident

36、ifying 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 va

37、ry 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 more, generally speaking, the more the cost is, the

38、bett　　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.&l

39、t;/p>　　1.2.1 Classing the chosen metrics　　The costs here mainly refer to the measures which can be change by people, such as how much can be accomplished with currently available resour

40、ces – 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 hea

41、lth 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.</p&

42、gt;　　By all appearances, the rest metrics we have chosen should be the effectiveness.　　1.2.2 Conclude the metrics used to compare　　Based on the analysis above, the met

43、rics used to make comparisons between existing and potential systems are shown in the table 2　　1.3 Combining the chosen metrics 　　Refer to the above analysis that the cost-effect

44、iveness 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 me

45、trics 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

46、 named cose-effectiveness can represent whether the system is better than others.　　Part Ⅱ: Identify current sources of data　　As mentioned above, the number of metrics is more tha

47、n 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 t

48、he statistical data published directly, the only way to solve this problem is to identify the useful data and then modify them.　　Identifying data　　To insure the availableness of

49、the chosen metrics, we need to relate the chosen metrics with the current sources of data.　　2.1.1 Identifying data about mortality　　For mortality, the data such as life expectanc

50、y, 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 Ide

51、ntifying data about typical epidemic morbidity　　However, there is no existing data about the mortality rate of typical epidemic sufferer, which means we have to calculate it using the available data.

52、 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 co

53、ntrolment 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 prevalen

54、ce among adults aged >15 years and TB prevalence can be used to present the typical epidemic morbidity.　　2.1.3 Identifying data about coverage　　For the proportion of the popul

55、ation 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. T

56、hus the identified data in this part are: immunization coverage, antenatal care coverage and contraceptive prevalence rate.　　2.1.4 Identifying data about health systems resource

57、　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 population should be chosen.

58、2.1.5 Identifying data about health systems expenditure　　For all of the data about health systems expenditure can be obtained from the World Health Statistics directly, we don’t need to change any of

59、 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 healt

60、h.　　2.1.6 Identifying data about inequalities　　Generally speaking, the person who lives in the city with the higher wealth and educational level may receive the better health ser

61、vice. 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 data

62、To 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

63、 be obtained from the World Health Statistics, we still need to modify some of them to make the metrics more useful.　　Comparing table1 with table 4, the typical epidemic morbidity is replaced by HIV

64、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 different people, which means the typical epidemic

65、 morbidity and inequalities need to be modified.　　2.2.1 Symbols used in part Ⅱ　　2.2.2 Modifying the typical epidemic morbidity　　As mentioned above, the typic

66、al 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:　　, (1)<

67、;/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 the number of people infected AIDS per 100,000 pop

68、ulation and is the number of people infected TB per 100,000 population.　　Similarly, the number of people who die of TB per 100,000 epidemic patients can be calculated:　　,

69、 (2)　　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 TB patients.　　Based on the ana

70、lysis about epidemic diseases’ composing, the total number of people who die of epidemic diseases per 100,000 population is:　　, (3)　　Combining (1), (2), (3

71、), the typical epidemic morbidity is:　　, (4)　　Modifying the inequality　　In an ideal health care system, the ratio rural–urban place of residen

72、ce, 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 smaller the inequality is. To simplify the calculat

73、ion, the following equation can be used to obtain the integrated inequality index:　　, (5)　　where is the rate that represent each inequality (for there are

74、 12 kinds of inequalities, ), is the integrated inequality index. 　　Part Ⅲ: Choosing the most important and viable metrics　　If a metric is made up of mort than one aspect, th

75、ere 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-made. In order to make the result more objective, we

76、use the PCA.　　As we all know, if there is a certain relationship between two variables, it can be interpreted that part of information which are reflected by them is the same. In this case, Principal

77、 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 between each other. At the same time, the new variables

78、can maintain the original information.　　Refer to this problem, in order to determine which chosen metrics is more important, we should deal with data first.　　3.1 Dealing with dat

79、a　　Since there are so many data and some of them are very difficult to collect, considering their acquirability and integrality, it’s necessary for us to deal with them which include two steps.</p

80、>　?、?Considering the acquirability we ignored the effect of inequalities. It’s observed that the great mass of inequalities are not given in the World Health Statistics, we thought it meant the data about i

81、nequalities were hard to collect.　　②Considering the integrality we ignored some countries whose data except inequalities were half-baked. 　　3.2 Determining the number of chosen

82、 metrics　　Using the SPSS, we chalked up the scree plot as figure 1:　　The abscissa of the scree plot is the number of components, while the y-axis is the eigenvalue. From the scre

83、e 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 same time, there are two inflexions when the numbe

84、r 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 　　3.3 Choosing some importan

85、t metrics　　Based on the analysis above, we need to analysis the 14 metrics with the correlate data about 67 countries, the number of principal components is 5.　　3.3.1 Analyzing w

86、ith the PCA　　3.3.1.1 The introduction of the PCA　　Explanation of the PCA　　Principal component analysis was presented by Hotelling in 1933, it is a method of

87、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 analysis is presented as below:　　No

88、rmalizing the data of sample　　Let the data matrix is, i.e. n indexes and m samples, and normal data matrix is, then the formula of normalization is　　,

89、;　　Where .　　Writing out correlative matrix of sample　　Let correlative matrix, where the correlative coefficient is 　　,

90、　　and, so R is symmetrical matrix.　　Calculating eigenvalue and eigenvector　　According to eigenfunction , eigenvalues can figure out, and

91、　　According to homogeneous system of linear equations, the eigenvector corresponding to the eigenvalue can figure out, and for , 　　Acquiring principal components according to the accumulat

92、ive contribution rate　　Firstly, the contribution rates of every principal component are figured out as follow:　　Then according to the rules of accumulative contribution rate as f

93、ollow to acquire principal components .　　Where,, .　　General evaluation making use of principal components 　　Finally, we can use the general evaluation value

94、 as follow to make decision. 　　3.3.1.2 Managing the PCA　　Using the SPSS and the data which are dealt, the Component Matrix can be calculated as table 6:　　Fro

95、m 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 mortality are much greater, whose absolute value al

96、l exceed 0.9. Consequently, the first principal component can be interpreted as General health status which contains life expectancy, infant mortality rate and neonatal mortality. 　　Similarly, in all

97、usion to the second principal component, the contribution coming from mortality rate of typical epidemic sufferer and typical epidemic morbidity are much greater, thus the second principal component can be interpreted as

98、 the overall epidemic condition which includes mortality rate of typical epidemic sufferer and typical epidemic morbidity. 　　The third principal component can be interpreted as financial policy inclu

99、ding 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 expenditure on health as %of total expenditure on healt

100、h.　　In allusion to the forth principal component, there are no metrics whose contributions are great, hence we thought the forth principal component can be ignored.　　Finally, in

101、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 fifth principal component can be interpreted as t

102、he Resources of health systems, which includes density of physicians, nurses，etc and hospital beds per 1000 population.　　However, there are still more than one metrics in a certain principal componen

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