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Chronic Illness in a Complex Health Economy: The Perils and Promises of Downstream and Upstream Reforms

机译:复杂卫生经济中的慢性病:下游和上游改革的风险和承诺

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Chronic illness is the largest cause of death and source of health care costs in developed countries and has become a significant problem in developing countries as well. This paper begins with a review of past work in System Dynamics concerning populations with chronic illness. It then presents a generic model of illness in a population and its treatment and prevention, applied to the U.S. population.. The model explains the rising prevalence of illness as well as responses to it, responses which include the treatment of complications as well as disease management activities designed to reduce the occurrence of future complications. The model shows how progress in complications treatment and disease management has slowed since 1980 in the U.S., largely due to a behavioral tug-of-war between health care payers and providers that has resulted in price inflation and an unstable climate for health care investments. The model is also used to demonstrate the impact of moving "upstream" by managing known risk factors to prevent illness onset, and moving even further upstream by addressing adverse behaviors and living conditions linked to the development of these risk factors in the first place.
机译:慢性病是发达国家的最大死亡原因和医疗保健费用来源,并且在发展中国家也已成为一个重大问题。本文首先回顾了《系统动力学》中有关慢性病人群的以往工作。然后,介绍了适用于美国人群的疾病的通用模型及其治疗和预防方法。该模型说明了疾病的流行率及其对疾病的反应,包括对并发症以及疾病的治疗管理活动旨在减少未来并发症的发生。该模型显示,自1980年以来,美国在并发症治疗和疾病管理方面的进展如何放缓,这在很大程度上是由于医疗保健付款人和提供者之间的行为拉锯战导致价格上涨和医疗保健投资的不稳定环境。该模型还用于通过管理已知的风险因素来预防疾病发作,并通过解决与这些风险因素的发展相关的不良行为和生活条件,进一步向上游移动,以证明向上游移动的影响。

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