Health-related priorities emanating from Healthy People 2010 indicated two overarching goals: to increase quality and years of healthy life and to eliminate disparities in health status. At noon (ET) on 3/23/2010 President Obama signed into law a contentious bill. That bill, now the Healthcare Reform law, represents America’s effort to provide healthcare insurance for all Americans, hopefully increasing quality and years of healthy life while also eliminating dispairities in health. The question that remains is: how are the insurance companies going to regulate premiums vs. benefits in the most efficient & cost-conscious way? The QALY and DALY health care indicators, sub-concepts of Summary Measures of Population Health (SMPH), may be a way to accomplish this. The two concepts however, are at opposite polar ends—much like a manic/depressive condition. One administrates from a positive quality-of-life viewpoint; the other, from a disability/quality-of-life lack viewpoint—hence, the QALY vs. DALY quandary.
This article presents a detailed review of the global indicators included in Summary Measures of Population Health (SMPH) as a conceptual model, the related sub-concepts, health care indicators (especially QALY and DALY), assumptions on which they are comprised, and how they relate to U.S. national health goals and the global health initiative. Computation of a single digit scalar measure that reflects the properties of SMPH would permit a merger between the health care and the financial sectors of society. One of these primary SMPH sub-conceptual “indicator” models (QALY or DALY) may ultimately be adopted by the U.S. government as the national healthcare framework in providing healthcare access for the population. In the event that the government’s bills directed toward healthcare coverage for all fails, primary SMPH sub-conceptual indicator models (QALY or DALY) may be adopted by private insurers as a means of establishing equality of coverage among their much broader-based policy-holders.
Efforts to increase both quality and numerical years of healthy life, have resulted in the formation of macro-econometric equations intended to provide common denominators to historically complex global life expectancy options. The health-care indicators evolved from SMPH that are explored in this article are: Quality-Adjusted Life Years (QALY), Disability-Adjusted Life Years (DALY), Years of Healthy Life (YHL), Health-Adjusted Life Years (HALY), Disability-Free Life Expectancy (DFLE), Life Expectancy with Disability (DALE), HeaLY (an index comparing healthy life lost to morbidity with life lost due to premature mortality from various other causes), and Health-Adjusted Life Expectancy (HALE). Although the explanations of each of these health-care indicators may appear lengthy, they are all attempts to reduce life expectancy morbidity/mortality, and specific disease probabilities down to a single number from 1-10. Global attempts consolidating this information down to a single digit have come about due to increased pressures from 3rd party payers within the private insurance sector and federally funded healthcare insurance programs like Medicare in the United States and Socialized medicine in Great Britain. The uniform widespread acceptance of one of these healthcare indicators could prove to be cost saving to the funding agencies.
|Keywords:||Summary Measures of Population Health (SMPH), Health-Adjusted Life Years (HALY), Quality-Adjusted Life Years (QALY), Disability-Adjusted Life Years (DALY), Years of Healthy Life (YHL), Disability-Free Life Expectancy (DFLE), Life Expectancy with Disability (DALE), Health-Adjusted Life Expectancy (HALE), HeaLY, Measurement Instrument, Quality of Life (QOL), Health-Related Quality of Life (HRQOL), Macro-Econometrics, Evidence-Based Practice (EBP)|
Associate Teaching Professor of Nursing, College of Nursing, University of Missouri, St. Louis, St. Louis, MO, USA