Evaluation and Improvement of Health Care Systems

Luting KongYiyi Chen Chao Ye

Beijing University

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

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

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

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

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

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

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

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

Strengths-Analytical Hierarchical Process method is a good qualitative and quantitative analysis-It is convenient for measuring weights

Weakness-Subjectivity

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

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.

F. Finding the four most important metrics

Assumption: Inequity is mandatory

Method: Incomplete-Induction ModelDesign of the Model:

Results:Four Metrics:1. M1 = Total expenditure on health as % of GDP2. M2 = Public expenditure/private expenditure3. M3 =HALE4. M4 =Inequities

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

b. Measuring The Historical Change for the 4 Metrics

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

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

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)

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

B. Inequities M4

Assumption-M4 will decrease as M2 increases->inversely proportional function:

M4 = k/M2 where k = 0.548 (from 2004 data)

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

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

Strengths-Model is easy and convenient for testing measures

Weakness-A single-independent-variable function is not the best to describe a healthcare system