Accounting for Health and Health Care Approaches to Measuring the Sources and Costs of Their Improvement (2010) / Chapter Skim
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5 Defining and Measuring Population Health
5 Defining and Measuring Population Health
Pages 119-142
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From page 119... ...
The output side of the account is quantified in terms represented by the population's health. Monitoring changing population health on a disease-by-disease basis is also relevant to medical care accounting in the National Income and Product Accounts (NIPAs)
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From page 120... ...
. In addition to current health status, we also consider risk factors that impact future health.
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From page 121... ...
However, life-expectancy methods provide an approach to standardizing death rates that avoids picking a particular reference population; because of this, it is the most widely used method of summarizing population mortality. Typically, life expectancy is computed using a period life table, which sum marizes the age-specific mortality experience of a population over a short time, usually 1 or 3 years.
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From page 122... ...
Life expectancy at birth is often taken as an overall measure of population health, because it aggregates mortality rates for all ages. Life expectancy may also be reported as conditional on achieving a specific age or for subsets of the population.
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From page 123... ...
However, the condition-specific options have major problems as measures of general population health. The first problem is logistical.
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From page 124... ...
population data, and how much detail the measure provides for models associating medical inputs to health.2 Generic HRQoL indexes measure health using standardized weighting sys tems representing community preferences for health states on a scale anchored by 0 (dead) and 1 (full health)
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From page 125... ...
general population that was derived from time trade-off assessments of EQ-5D health states made by a population sample of 4,000 U.S. adults in face-to-face household interviews administered in English (Shaw, Johnson, and Coons, 2005)
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From page 126... ...
While the SF-36v2 yields a health profile summary using 8 domains, the SF-6D has reduced this to 6 domains (physical function, role limitation, social function, pain, mental health, and vitality) , each comprised of 5 to 6 levels and jointly defining about 18,000 health states (Brazier, Roberts, and Deverill, 2002)
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From page 127... ...
Table 5-1 summarizes the pros and cons of the various indexes for use in a health accounts data system. No one measure is uniformly best, and each has strengths and weaknesses.
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From page 128... ...
A second acronym -- QALE (for quality-adjusted life expectancy) -- is used in the population health literature as a summary measure of current health status.
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From page 129... ...
Age-specific death rates from NCHS would be needed as the first input. Data from population surveys using any of the HRQoL indexes described above would suffice for the second.
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From page 130... ...
0 TABLE 5-2 Life-Table Calculation Framework 1 2 3 4 5 6 7 8 9 Populaton Population QALYs Population Population Life Probability Average Life-Years Lived Life-Years QALYs Expectancy of Dying Hypothetical Age- Lived During Lived from Lived from at Beginning QALE at Age During Age Cohort at Start Specific During the the Age This Age to This Age to of Age Beginning of Interval Interval of Interval HRQoL Age Interval Interval Death Death Interval Age Interval 0-1 Years .01 1000 .99 997 997 × .99 1-2 years 990 2-3 … 100 Years and Over
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From page 131... ...
One might use life-table methods to standardize other age-dependent measures, such as restricted activity days, calculating the expected lifetime-restricted activity days for a period cohort with death rates and restricted activity days by age as in the current year, but it seems more natural just to report the actual number of restricted activity days, perhaps stratified into large age groups such as children and adults over and under age 65. Several cross-sectional surveys of HRQoL currently exist; Box 5-1 is a list of data sources.
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From page 132... ...
• The Medical Expenditure Panel Survey (MEPS) , household component, is a large-scale survey of families and individuals across the United States.
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From page 133... ...
are required to adequately measure health across the population broadly, there should be some effort by the statistical agencies to pick a common quality of life instrument to use in the different surveys. Recommendation 5.1: A committee of members from agencies responsible for collecting population health data (Agency for Healthcare Research and Quality, National Center for Health Statistics, Census Bureau, etc.)
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From page 134... ...
Recommendation 5.2: Recognizing the difficulties in estimating the incidence and prevalence of disease, the National Center for Health Statistics should commission research on selecting and specifying a set of important acute and chronic diseases and feasible methods for estimating acute incidence and chronic prevalence that might be part of a national health data system. These 3Assuming that "one life-year is worth $200,000 and accounting for changes in modifiable cardio vascular risk," the authors found that "the net value of changes in health care for patients with type 2 diabetes was $10,911 per patient (95% CI, is $8,480 to $33,402)
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From page 135... ...
5.2.3. QALYs and Disability-Adjusted Life Years A possible alternative to the QALY approach for measuring population health stock would be to base it instead on the disability-adjusted life year (DALY)
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From page 136... ...
At this point, a national health account should focus more on current health than on pre dicted future health, mainly because data will be easier to collect, assemble, and understand. Much can be said about particular risk factors in terms of their future impact in a national report, but overall life expectancy of the current population is a stretch.
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From page 137... ...
Cost-effectiveness studies of medical technology do need to forecast future health and usually do so through use of mathematical modeling of treatment results and personal risk factors associated with patients. Risk factors are characteristics of individuals or individual behaviors that are associated with future health gains in the population.
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Most (not all) of these risk factors are collected as self-reports.
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From page 139... ...
The spread of electronic medical records may facilitate data collection on the factors that are usually in such records. Clearly, better markers are needed of current population health and risk factors to be able to project future health better.
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From page 140... ...
. This chap ter is mainly about estimating the quantity portion of the broad health account's output.
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From page 141... ...
139) : Recognizing that there is a range of uncertainty, a satellite health account should be based on a dollar figure for the value of a year in perfect health derived from estimates in the literature.
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