The present article describes a unit of health status, the "Well-Year," which expresses the output of health programs in terms of the number of years and the health-related "quality of life" produced by a treatment or program. Dividing the cost of the program by the number of Well-Years that it produces gives the cost-utility of the program. This cost-utility ratio can be used in a general health policy model to compare the efficiency of different programs or to assess the relative contribution of different programs and providers in the health care system. A comprehensive standardized measure of health status has many advantages for health planning, decision analysis, and program evaluation. An example demonstrates how the relative production of Well-Years by psychologists might be compared to the contribution of other health care services.
In order to develop an operational definition of health, we found it necessary first to develop the concept of function/dysfunction as a continuum, based on one's ability to carry on the usual daily activities appropriate to social roles. Then, to those operating the health system, each member of the population can be seen as belonging to one and only one state from a class of functional states that can be defined on an ordinal scale. Next, we found it necessary to assign to each state a weight defined on a cardinal scale, the set of weights for these states being called the Health Status Index (HSI). The HSI rests on value judgments, of a societal nature, expressed by the administrators responsible for policy decisions. Prognosis is then defined as the transitional probability of a change in functional state with time. Thus, the concepts “state of health” and “severity of illness” are decomposed into the parameters function/dysfunction and prognosis. Finally, together with an operational definition of time and target population, it becomes possible to give a quantitative definition of the output of a health program (or health system) as the changes in the functional history of the target population resulting from the intervention of the health program (or system). Other concepts that are given quantitative definitions are program effectiveness and population health status. This study next explores the relation between health program output and modern decision theory for program planning, and shows how these analytical tools are useful for fitting the results of the study into larger conceptual frameworks. Finally, the method developed is illustrated, first with a simplified simulated program for computer use, and then with an analysis of a small section of a tuberculosis-control program.
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