Holmes A M
School of Public and Environmental Affairs, Indiana University-Purdue University at Indianapolis 46202, USA.
Soc Sci Med. 1995 Nov;41(10):1417-27. doi: 10.1016/0277-9536(95)00118-q.
This paper assesses the appropriateness of QALYs (quality adjusted life years) as a foundation for an index of societal health, and the feasibility of using such an index to guide health care policy. Results of this paper suggest that the standard aggregate QALY index imposes an ethical position on policy makers which may promote inequality in well-being associated with health. It is possible to rectify this problem in theory, but current data are insufficient to estimate such corrected indices. A QALY-based index, constructed using the best available data, indicates morbidity has a significant effect on Canadian health status (e.g. life expectancy figures alone overstate community health by about 10%), that the impact of morbidity is unequal across regions and gender, and that role (the ability to fulfil social functions) and mobility dysfunction are important determinants of ill-health in this population.
本文评估了质量调整生命年（QALYs）作为社会健康指数基础的适宜性，以及使用该指数指导医疗保健政策的可行性。本文结果表明，标准的综合QALY指数将一种伦理立场强加于政策制定者身上，这可能会加剧与健康相关的福祉不平等。理论上有可能纠正这一问题，但目前的数据不足以估计这种校正后的指数。使用现有最佳数据构建的基于QALY的指数表明，发病率对加拿大的健康状况有重大影响（例如，仅预期寿命数字就高估了社区健康约10%），发病率的影响在不同地区和性别之间是不平等的，并且角色（履行社会功能的能力）和行动功能障碍是该人群健康不佳的重要决定因素。
