Skip to main content
Log in

Using quality of life information to set priorities in health policy

  • Improving The Quality Of Life Of People With And Without Disabilities
  • Published:
Social Indicators Research Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Academy of Pediatrics, Committee on Fetus and Newborn: 1991, Hospital Care of Newborn Infants 5th ed. (American Academy of Pediatrics, Winston, IL).

    Google Scholar 

  • Anderson J. P., J. W. Bush and C. C. Berry: 1986, ‘Classifying function for health outcome and quality-of-life evaluation. Self versus individual models’, Medical Care 24, pp. 454–469.

    Google Scholar 

  • Anderson, J. P., J. W. Bush, M. Chen and D. Dolenc: 1986, ‘Policy space areas and properties of BCU analysis’, Journal of the American Medical Associated 255, pp. 794–795.

    Google Scholar 

  • Anderson, J. P., R. M. Kaplan and M. BeBon: 1989, ‘Comparison of responses to similar questions in health surveys’, in F. Fowler (ed.), Health Survey Research Methods (National Center for Health Statistics, Washington, DC), pp. 13–21.

    Google Scholar 

  • Anderson, J. P., R. M. Kaplan, C. C. Berry, J. W. Bush and R. G. Rumbaut: 1989, ‘Interday reliability of function assessment for a health status measure: The quality of well-being scale’, Medical Care 27, pp. 1076–1084.

    Google Scholar 

  • Ballugooie, E.et al.: 1983, ‘Rapid deterioration of diabetic retinopathy during treatment with continuous subcutaneous insulin infusion’, Diabetes Care 7, pp. 236–242.

    Google Scholar 

  • Bombardier, C., J. Ware and I. J. Russellet al.: 1986, ‘Auranofin therapy and quality of life for patients with rheumatoid arthritis: Results of a multicenter trial’, American Journal of Medicine 81, pp. 565–578.

    Google Scholar 

  • Brook, R. H. and K. Lohr: 1986, ‘Will we need to ration effective health care?’, issues in Science and Technology 3, pp. 68–77.

    Google Scholar 

  • Centers for Disease Control: 1991, ‘Mortality attributable to HIV infection/AIDS United States 1981–1990’, Morbidity and Mortality Weekly Report 40(3), p. 41.

    Google Scholar 

  • Diabetes Control and Complications Group: 1993, ‘The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group’, New England Journal of Medicine 329, pp. 977–986.

    Google Scholar 

  • Fischl, M. A., D. D. Richman and M. H. Griecoet al.: 1987, ‘The efficiency of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: A double-blind, placebo-controlled trial’, New England Journal of Medicine 317, pp. 185–191.

    Google Scholar 

  • Ganiats, T. G., J. D. C. Humphrey, H. L. Tares and R. M. Kaplan: 1991, ‘Routine neonatal circumcision: A cost-utility analysis’, Medical Decision Making 11, pp. 282–293.

    Google Scholar 

  • Hu, T., J. Bai, T. E. Keeler and P. G. Barnett: 1991, ‘The impact of a large tax increase on cigarette consumption: The case of California’, Unpublished Manuscript, School of Public Health, University of California, Berkeley.

    Google Scholar 

  • Kaplan R. M.: 1984, ‘The connection between clinical health promotion and health status: A critical review’, American Psychologist 39, pp. 755–765.

    Google Scholar 

  • Kaplan R. M.: 1985, ‘Behavioral epidemiology, health promotion, and health services’, Medical Care 23, pp. 465–583.

    Google Scholar 

  • Kaplan R. M.: 1990, ‘Behavior as a central outcome in health care’, American Psychologist 45, pp. 1211–1220.

    Google Scholar 

  • Kaplan, R. M.: 1991, ‘Value for money in management of HIV: Health-related quality of life’, in A. Maynard (ed.), Economic Aspects of HIV Management (Colwood Press, London).

    Google Scholar 

  • Kaplan, R. M.: 1993, The Hippocratic Predicament: Affordability, Access, and Accountability in American Medicine (Academic Press, San Diego).

    Google Scholar 

  • Kaplan, R. M. and J. P. Anderson: 1990, ‘The general health policy model: An integrated approach’, in B. Spilker (ed.), Quality of Life Assessments in Clinical Trials (Raven, New York), pp. 131–149.

    Google Scholar 

  • Kaplan, R. M., J. P. Anderson and T. G. Ganiats: 1993, ‘The quality of well-being scale: Rationale for a single quality of life index’, in S. R. Walker and R. M. Rosser (eds.), Quality of Life Assessment: Key Issues in the 1990s (Kluwer Academic Publishers), pp. 65–94.

  • Kaplan, R. M., J. P. Anderson, A. W. Wu, W. C. Matthews, F. Kozin and D. Orenstein: 1989, ‘The quality of well-being scale: Applications in AIDS, cystic fibrosis, and arthritis’, Medical Care 27(3), pp. S27-S43.

    Google Scholar 

  • Kaplan, R. M. and J. W. Bush: 1982, ‘Health-related quality of life measurement for evaluation research and policy analysis’, Health Psychology 1, pp. 61–80.

    Google Scholar 

  • Kaplan, R. M., J. W. Bush and C. C. Berry: 1976, ‘Health status: Types of validity for an index of well-being’, Health Services Research 11, pp. 478–507.

    Google Scholar 

  • Kaplan, R. M., J. W. Bush and C. C. Berry: 1978, ‘The reliability, stability, and generalizability of a health status index’, American Statistical Association, Proceedings of the Social Statistics Section, pp. 704–709.

  • Kaplan, R. M., J. W. Bush and C. C. Berry: 1979, ‘Health status index: Category rating versus magnitude estimation for measuring levels of well-being’, Medical Care 5, pp. 501–523.

    Google Scholar 

  • Klein, R. and B. Klein: 1985, ‘Vision Disorders in diabetes’, in National Diabetes Data Group — Diabetes in America, NIH Publication, pp. 85–1468.

  • Lasker R. D.: 1993, ‘The diabetes control and complications trial. Implications for policy and practice’, New England Journal of Medicine 329, pp. 1035–1036.

    Google Scholar 

  • Lewit, E. M. and D. Coate: 1982, ‘The potential of using excise taxes on reducing smoking’, Journal of health Economics 1, pp. 121–145.

    Google Scholar 

  • Lipid Research Clinics Coronary Prevention Trial Results: 1984, ‘I. Reduction in incidence in coronary heart disease’, Journal of the American Medical Association 251, pp. 351–364.

    Google Scholar 

  • Maynard, A.: 1991, ‘Economic issues in HIV management’, in A. Maynard (ed.), Economic Aspects of HIV Management (Colwood House Medical Publications, London), pp. 6–12.

    Google Scholar 

  • McGinnis, J. M. and W. H. Foege: 1993, ‘Actual causes of death in the United States’, Journal of the American Medical Association 270, pp. 2207–2212.

    Google Scholar 

  • Muldoon, M. R., S. B. Manuck and K. A. Matthews: 1990, ‘Lowering cholesterol concentrations and mortality: A quantitative review of primary prevention trials’, British Medical Journal 301, pp. 309–314.

    Google Scholar 

  • National Center of Health Statistics: 1986, ‘Current estimates from the national Health Interview Survey’ (National Center for Health Statistics, Hyattsville, MD).

    Google Scholar 

  • Peto, R., A. D. Lopez, J. Boreham, M. Thun and C. Heath, Jr.: 1992, ‘Mortality from tobacco in developed countries: Indirect estimation from national vital statistics’, Lancet 339, pp. 1268–1278.

    Google Scholar 

  • Pierce, J. P., A. Farcas, N. Evans, C. Berry, W. Choi, B. Rosbrook, M. Johnson and D. Bal: 1992, Tobacco Use in California (California Department of Public Health, Sacramento, CA).

    Google Scholar 

  • Richman, D. D., M. A. Fischl and M. H. Griecoet al.: 1987, ‘The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: A double-blind, placebo-controlled trial’, New England Journal of Medicine 317, pp. 192–197.

    Google Scholar 

  • Rimm, A. A.: 1985, ‘Trends in cardiac surgery in the United States’, New England Journal of Medicine 312, pp. 119–120.

    Google Scholar 

  • Rokeach, M.: 1973, The Nature of Human Values (Free Press, New York).

    Google Scholar 

  • Rosser, R.: 1993, ‘The history of health related quality of life in 1-1/2 paragraphs’, Journal of the Royal Society of Medicine 86, pp. 315–318.

    Google Scholar 

  • Shade, D., J. Santiago, J. Skyler and R. Rizza: 1983, ‘Effects of intensive treatment on long-term complications in intensive insulin therapy’, Princeton Excerpta Medica, Chapter 5.

  • Schroeder S. A.: 1987, ‘Strategies for reducing medical consts by changing physician's behavior’, International Journal of Technology in Health Care 3, pp. 39–50.

    Google Scholar 

  • Sick Health Services: 1988, The Economist, July 16, pp. 19–22 (anonymous).

  • Steering Committee of the Physicians' Health Study Research Group: 1988, ‘Preliminary report: Findings from the aspirin component of the ongoing Physicians’ Health Study’, New england Journal of Medicine 318, pp. 262–264.

    Google Scholar 

  • Tchobroutsky, G.: 1978, ‘Relation of diabetic control to development of microvascular complications’, Diabetologia 15, pp. 143–152.

    Google Scholar 

  • Thompson, M. S., J. L. Read, H. C. Hutchings, M. Patterson and E. D. Harris, Jr.: 1988, ‘The cost-effectiveness of auranofin: Results of a randomized clinical trial’, Journal of Rheumatology 15, pp. 35–42.

    Google Scholar 

  • U.S. Office on Smoking and Health: 1990, Smoking and Health, a National Status Report: A Report to congress (2nd ed.). US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Rockville, MD.

    Google Scholar 

  • U.S. Surgeon General: 1989, Reducing the Health Consequences of Smoking: Twenty-five Years of Progress (US Department of Health and Human Services, Centers for Disease Control, Rockville, MD).

    Google Scholar 

  • Voulgaropolous, D., L. J. Schneiderman and R. M. Kaplan: 1989, ‘Recommendations against the use of medical procedures: Evidence, judgment and ethical implications’, Unpublished manuscript, University of California, San Diego.

    Google Scholar 

  • Wallerstein, E.: 1985, ‘Circumcision — The unique American medical enigma’, Urological Clinics of North America 12, pp. 123–132.

    Google Scholar 

  • Warner, K. E.: 1986, ‘Smoking and health implications of a change in federal cigarette excise tax’, Journal of the American Medical Association 255, pp. 1028–1032.

    Google Scholar 

  • Wiswell, T. E. and J. D. Roscelli: 1986, ‘Corroborative evidence for the decreased evidence of urinary tract infections in circumcised male infants’, Pediatrics 78, pp. 96–99.

    Google Scholar 

  • World Health Organization: 1987, Tobacco Price and the smoking Epidemic: Smoke-Free Europe (World Health Organization, Copenhagen).

    Google Scholar 

  • World Health Organization: 1993, The HIV/AIDS Pandemic: 1993 Overview global Program on AIDS (WHO, Geneva).

    Google Scholar 

  • Wu, A. W.et al.: 1990, ‘Quality of life in a placebo-controlled trial of zidovudine in patients with AIDS and AIDS-related complex’, Journal of Acquired Immune Deficiency Syndromes 3, pp. 683–690.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Portions of this chapter were adapted from Kaplan, R M (1993)The Hippocratic Predicament: Affordability, Access and Accountability in American Medicine. San Diego: Academic Press and from Kaplan, R. M., Anderson, J. P., & Ganiats, T. G. (1993) The quality of well-being scale: rationale for a single quality of life index. In S. R. Walker & R. M. Rosser (eds)Qualit of life assessment: Key issues in the 1990s. London: Kluwer Academic Publishers, pp. 65–94.

Supported in part by grants from the California Policy Seminar and The National Institutes of Health and Gant P60 AR 40770 from the National Institute of Arthritis, Musculoskeletal, and Skin Diseases of the National Institutes of Health.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kaplan, R.M. Using quality of life information to set priorities in health policy. Soc Indic Res 33, 121–163 (1994). https://doi.org/10.1007/BF01078960

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01078960

Keywords

Navigation