Using quality of life information to set priorities in health policy

Health care has as primary objectives extending life expectancy and improving quality of life in years prior to death. This paper offers a General Health Policy Model as a method for quantifying these outcomes. The model adjusts life expectancy for diminished quality of life, which is measured using a standardized instrument known as the Quality of Well-being (QWB) scale. The Well-year or Quality Adjusted Life Year (QALY) results from these analyses and serves as a single quantitative expression of health benefit. QALY units integrate side effects and benefits of treatment by combining into a single number, mortality, morbidity, and duration of each health state. Examples show the application of the model relevant to a variety of medical and public health problems, including diabetes, arthritis, AIDS, neonatal circumcision, and tobacco tax. It is suggested that the General Health Policy Model has advantages for guiding both individual and public health decisions.     

Structured Home Study Evaluations: Perceived Benefits of SAFE Versus Conventional Home Studies

Structured decision-making methods are gaining ascendance in child welfare services, in which professionals combine standardized methods of data collection and analysis with clinical judgments. This study measures professionals’ perception of a new approach to home study assessments, the Structured Analysis Family Evaluation (SAFE). Findings indicate that workers favor the use of SAFE overall. Less experienced workers are especially positive about SAFE, while more experienced workers and supervisors tend to be less positive. State-by-state differences also emerged. Open-ended responses offer areas for clarification, training, and potential improvement.     

Gambling among lottery winners: Before and after the big score

The proliferation of state lotteries raises the possibility of increasing pathological gambling because large segments of the population are purchasing tickets. This study, based on a 50% response rate of million dollar winners in Ohio in 1986, indicates lottery winners spend relatively small amounts of money on tickets, did not appreciably increase the amount of money they spent on tickets after winning, and rarely engaged in other forms of gambling before or after they won. These data do not support the assumption that lotteries significantly increase the amount of compulsive gambling in our society, but the subject deserves further exploration.     

Doctor assisted suicide: an analysis of public opinion of Michigan adults

Michigan public opinion on Doctor Assisted Suicide (DAS) was assessed in January 1997 (N=603). Asked if they would consider DAS for themselves, two-thirds would if being kept alive by machine or were experiencing chronic pain; one-half would if they experienced a loss in mobility or independence, became a burden to others, or were diagnosed with a terminal disease; and one-third would if they were incontinent or going to a nursing home. A series of demographic and attitudinal comparisons were made for support for the concept of DAS and as a hypothetical consideration for oneself. The highest support for the concept of DAS was found among the following: men eighteen to twenty-four years old, some college education, $35-60,000/year income, Caucasian, Democrat, liberal, Protestant, and frequent church attendee. The highest self-consideration of DAS was found among the following: men, fifty to fifty-five years old, post-graduate education, $35-60,000/year income, Caucasian, Democrat, liberal, Protestant, and infrequent church attendee.     

Effectiveness, accountability, and efficiency

Management of health care is compromised by its singular reliance on billing information--i.e., a claims trail tells little of what providers think. It relates to neither prevention of disease nor reduction of unnecessary health care costs. Billing information is not the substrate to be used in the pursuit of appropriateness, effectiveness, and value. To improve medical management of health care, a protected, but accessible clinical database is needed.