Healthcare Economics Quiz 1 Flashcards
World Health Organization (WHO) definition of health
[Health is] the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [WHO, 1948] and the “extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources as well as physical capabilities
ways in which info is collected to reach a true health status
from individuals (self-reported: households or individuals surveys), health workers, and administrative records
When looking at health status reported by individuals, what is asymmetric information, reporting biases, and justification biases?
➢ Asymmetric information: I don’t know that I am suffering from
a disease.
➢ Reporting biases: Self-assessments, which are included in
most health national surveys, are affected by social
characteristics and individual health status [Bound et al., 1991]
➢ Justification biases: people would tend to justify their non-
participation to the Labour Force by over reporting a disability
health status identified by health workers or administrative records,
refer to diagnostic (so to Health care demand/consumption)
What about unmeet needs? What about self-medication?)
➢ At a given diagnosis or administrative records, the level of
well-being may differ
➢ A few information about social capital (family background,
social interactions…) and socioeconomic features
(employment status, insurance coverage,…) contributing to
health status
most common health indicators
▪ related to birth and death!
▪ Life expectancy - but doesn’t say anything about quality of life..
▪ Age-specific death rates (e.g., infants, teens)
▪ Cause specific deaths (e.g., breast, lung, cervical cancers)
▪ Births to teens
▪ Very/Low birth weight
Where can we find reporting on health?
Robust, high completeness of reporting, widely available through the National Vital Statistics System, and standardized so as to be are comparable across countries but, also limited due to the lack of information related to Quality of Life (QoL) or morbidity.
What is life expectancy and how can it increase?
▪ Life expectancy at birth is defined as how long, on average, a newborn can expect to live, if current death rates do not change.
▪ Gains in life expectancy at birth can be attributed to a number of factors, including rising living standards, improved lifestyle and better education, as well as greater access to quality health services. This indicator is presented as a total and per gender and is measured in years.
Typology of health status via three models by Mildred Blaxter
Model A: a subjective model; measures of the subjective health status constitute a first set of
health indicators
Model B: Diseases and symptoms, which assess health status according to
a medical or biological model (model B), constitute a second set of
indicators. In this case, poor health status is defined as a
divergence from a physiological or psychic norm.
Model C: Indicators of disability correspond to a social and functional model
(model C) in which the poor health status is defined as an inability
to fulfil normal tasks.
key risk factors indicators
alcohol and tobacco consumptions, and anthropometrical measures (such as
Body Mass Index = kg/m2) which bring information on current and
future health status, as well.
Model A - the subjective model
Consisting of this model is self-assessment health (SAH) or global perceived health which is a subjective measure of how people define their own health. This subjective indicator reflects the social norms and beliefs of individuals on health but also is a good predictor of mortality and access to care. It’s taken through a standardized question recommended by the World Health organization.
▪ “How is your health in general? Is it…” with answer categories Very good /Good / Fair / Bad / Very bad
Model B - the medical (or biological model)
morbidity: the condition of suffering from a disease or medical condition
Morbidity is relative to diseases and measured by the difference to a medical standard
We can measure :
▪ The prevalence of disease: the proportion of a population found to have a condition at a given time
▪ The incidence of a disease: the number of new cases within a specified time period divided by the size of the population initially at risk.
Different types of morbidities:
▪ Measured morbidity
▪ Diagnosed morbidity (declared by the doctor), treated
▪ Self–reported Morbidity (from an individual)
▪ Felt” morbidity
Model C - the social and functional model
This model addresses health as consequences of disease, accidents or aging on the functioning of the individual.
▪ Activity of Daily Living (ADL) [Katz, 1963]
➢ “the things we normally do… such as feeding ourselves,
bathing, dressing, grooming, work, homemaking, and leisure. »
▪ Instrumental Activities of Daily Living (IADL) [Lawton, 1969]
➢ Housework, Preparing meals, Taking medications as
prescribed, Managing money, Use of telephone or other form
of communication, Transportation within the community
▪ Using a person’s functioning level as it relates to ADL and IADL
can help to determine the level of care assistance that person
needs.
The wording of the questionnaires should be done in terms of
ability “Can you alone…go up and down stairs? “
▪ Activities restrictions could be caused by many diseases or
accidents (ex. many diseases or health problems can generate
difficulties in order to cut nails : musculoskeletal disorders,
arthrosis, obesity, pregnancy, sight difficulties, Parkinson
disease…)
▪ These difficulties can be temporary or permanent.
▪ The goal of health professionals is to improve the level of
autonomy of patients through technical assistance, to the patient’s
home planning or learning new skills. If the activities can not be
performed correctly despite these technical device’s patients, they
have recourse to a third party (professional or nonformal care).
Other Measures combining mortality and morbidity
Healthy Life Years (HLY):
➢ HLY measures the number of remaining years that a
person of a given age is expected to live without
disability. It is also called disability-free life expectancy.
➢ It is used to distinguish between years of life free of any
activity limitation and years experienced with at least
one activity limitation. The emphasis is not exclusively
on the length of life, as is the case for life expectancy,
but also on the QoL.
From Health Status to Health Capital
Health status appears as a Health Capital [Grossman, 1972]
submitted to a depreciation process (negative age-health
correlation)
▪ How to protect Health capital?
▪ The Role Of Medicine - Dream, Mirage Or Nemesiis?
[McKeown, 1976]
▪ Multiple determinants of health (behavioral, genetic,
environmental, socio-economic factors, health care system,
etc.)
Factors Influencing Health Status by %
Human Biology 20%
Environment 19%
Lifestyle 51% - smoking, obesity, nutrition, stress, blood pressure, alcohol, drug use
Healthcare 10% - weak role
