Nations have systems for providing health care for their residents. Issues that are often of concern to people and are often in the news include which systems are better and whether current systems can be improved. Aspects of these systems vary widely between nations: how they are funded; whether services are delivered through public, private, or non-profit organizations; whether public insurance is universal for all residents; who is eligible for assistance; what care is covered; whether the latest medical procedures are available; and how much is required as user fees. Other factors that are often debated in determining the quality of care include: coverage for complementary care (glasses, dental, prostheses, prescription drugs, etc); which diseases are the most critical in affecting overall health; percentage of GDP spent on health care; percentage of health care costs that goes toward labor/administrative/malpractice insurance; ratio of public to private spending on health care; per capita spending on health care; growth of per capita spending on health care; number of participating physicians; per capita sick days; fairness of care in terms of age, race, gender, socio-economic class; and many more. Adding to the complications are healthrelated factors such as personal exercise, food availability, climate, occupations of citizens, and smoking habits. 

 

The World Health Organization(WHO), an agency of the United Nations, is a source of data on health factors. The annual World Health Report (http://www.who.int/whr/en/index.html) assesses global health factors and World Health Statistics (http://en.wikipedia.org/wiki/World_Health_Organisation) provides health statistics for the countries in the UN. The production and dissemination of health statistics is a major function of WHO. To many people, these data and the associated analyses are considered unbiased and very valuable to the world community. There are many other sources of reliable health data available. 

 

Part I: Describe several different outcomes (metrics) that could be used to evaluate the effectiveness of a country's health care system, such as average life expectancy of its residents. What metric would you use to make comparisons between existing and potential systems? Can you combine your metrics to make them even more useful in measuring quality? 

 

Part II: Identify current sources of data that provide the raw data needed to compute the metrics you have identified above. You may need to modify your list of metrics based on the availability of data. Explain why you have selected those data and demonstrate how they can be used to assess and compare the relative effectiveness of health care systems as they exist in different countries. 

 

Part III: Choose at least three of the most important and viable metrics for comparing health care systems. Justify why these are the most useful for this purpose. Can any of these help measure the historical change in an existing health care system? Are they measurable and can the data be easily collected? 

 

Part IV: Use your three (or more) metrics to compare the United States health care system with one other country that is considered to have good health care using the most recent year for which you have data. Which country has the better health care system? Is your answer definitive? 

 

Part V: Using your metrics, compare the United States and one other country which is considered to have poor health care using the most recent year for which you have data. Which country has the better health care system? 

 

Part VI: Pick a country’s (US or other) health care system and restructure it to improve the system based on your metrics. Build predictive models to test various changes to determine if the changes will improve the overall quality of the system. Suggest major change(s) that can improve the system. 

 

发现好的医疗保健服务(医保)系统(美国竞赛2008年C题) 

 

各国都有为其居民提供医疗保健服务的系统。人们经常关心而且频繁出现在新闻报道中的问题包括哪个系统更好一点以及是否可以改进当前的服务系统。这些系统的某些方面在不同的国家差别很大：它们是怎么得到资助的；服务是否是通过政府的、私人的或非赢利的机构来提供的；是否政府的保险适用于所有的居民；什么人有资格得到帮助；包括那些医疗服务；是否有最新的医疗方法；要求的用户付费是多少。在确定医保质量时经常争论的其他因素包括：覆盖哪些补充医保服务项目(眼镜、牙齿的治疗、假肢、处方药等)；在影响总体健康中那些疾病是最重要的；医保费用占GDP(国内生产总值)的百分比；劳动/行政/治疗失当保险各占医保费用的百分比；政府和私人用于医保的费用之比；人均医保消费；人均医保消费的增长；参与医保的医生的数目；人均生病天数；就年龄、种族、性别、社会经济阶层而言的医保公平性；以及其他更多的 方面。诸如个人锻炼、可获得的食物、气候、公民的职业以及抽烟习惯等有关健康的因素增加了复杂性。 

 

联合国的一个职能部门World Health Organization(WHO，世界卫生组织，简称世卫组织)是一个健康因素数据的资源库。每年的World Health Report(世界卫生报告) 

 

评估全世界的健康因素，而World Health Statistics(世界卫生统计) 则提供了联合国各国的健康统计数据。产生并广泛传播健康统计数据是WHO的主要职能。对许多人来说，这些数据和相关的分析被认为是无偏见的，而且对国际社会非常有价值。还有许多可靠的健康数据资源可以利用。 

 

第I部分：描述几个可以用来评估一个国家的医保系统有效性的几种不同的结果(评价标准)，例如其居民的平均期望寿命。你们会用什么样的评价标准对现有的和可能的系统进行比较？你们能组合你们的评价标准以使在评价系统的质量方面更加有用吗？ 

 

第II部分：确定能够提供为计算你们先前确定的评价标准所需要的粗略的数据的当前的数据资源。根据可利用的数据，你们可能需要修改你们的评价标准表列。解释你们为什么选用这些数据，并说明怎样用它们来评估和比较存在于不同国家的医保系统的相对有效性。 

 

第III部分：为了比较不同的医保系统，选择至少三个最重要而且切实可行的评价标准。说明为什么这些评价标准是最有用的。这些评价标准中的任何一个能评价一个现有的医保系统的历史变化吗？它们是可以评价的吗?数据是容易收集的吗？ 

 

第IV部分：利用你们具有的数据中最近一年的数据，并用你们的三(或者更多)个评价标准来比较美国的医保系统和另一个被认为有良好医保的国家的医保系统。哪个国家具有较好的医保系统？你们的回答是肯定的吗？ 

 

第V部分：利用你们具有的数据中最近一年的数据，利用你们的评价标准来比较美国的医保系统和另一个被认为有较差医保的国家的医保系统。哪个国家具有较好的医保系统？ 

 

第VI部分：挑选一个国家(美国或其他国家)的医保系统，并基于你们的评价标准来重建该系统以改善该系统。建立评估各种改变的预测模型以确定这些改变会改善该医保系统的总体质量。对能够改善该系统的主要改变提出建议。