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Live Long, Live Well: Quantifying the Health of Heterogenous Populations


  • John Mullahy


Various health-, quality-, and disability-adjusted life year or life expectancy (HALY, QALY, DALY; HALE, QALE, DALE) measures have become gold standards for defining outcomes in technology evaluation, population health monitoring, and other evaluative efforts. As such, it is critical that the analytical framework within which these measures are used for descriptive and evaluative purposes be theoretically consistent and statistically rigorous. For instance, widely-accepted definitions of cost-effectiveness ratios and other technology evaluation criteria that are based on expectations of the respective cost and outcome measures must as such be defined in terms of expected HALYs or QALYs. Similarly, measures like HALEs or QALEs used for population health monitoring are typically concerned with population expectations of such measures (or their corresponding totals). This paper demonstrates that estimation of such expectations necessarily requires consideration of the population variation in and covariation between quality and longevity. From the perspective of several different environments characterizing such heterogeneity, quantification or estimation of measures like QUALs are recondidered. An empirical example of the central issues is provided by means of an analysis of the Years of Healthy Life (YHL) measure drawn from the U.S. National Health Interview Survey.

Suggested Citation

  • John Mullahy, 2000. "Live Long, Live Well: Quantifying the Health of Heterogenous Populations," NBER Working Papers 7895, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:7895
    Note: HC HE

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    References listed on IDEAS

    1. Donald S. Shepard & Richard J. Zeckhauser, 1982. "The Choice of Health Policies with Heterogeneous Populations," NBER Chapters,in: Economic Aspects of Health, pages 253-298 National Bureau of Economic Research, Inc.
    2. Gerdtham, Ulf-G. & Johannesson, Magnus, 2000. "Income-related inequality in life-years and quality-adjusted life-years," Journal of Health Economics, Elsevier, vol. 19(6), pages 1007-1026, November.
    3. A. B. Atkinson & F. Bourguignon, 1982. "The Comparison of Multi-Dimensioned Distributions of Economic Status," Review of Economic Studies, Oxford University Press, vol. 49(2), pages 183-201.
    4. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits: A New Framework for the Analysis of Uncertainty in Cost-Effectiveness Analysis," NBER Technical Working Papers 0227, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Kajal Lahiri & Zulkarnain Pulungan, 2006. "Health Inequality and Its Determinants in New York," Discussion Papers 06-03, University at Albany, SUNY, Department of Economics.
    2. Lahiri, Kajal & Pulungan, Zulkarnain, 2007. "Income-related health disparity and its determinants in New York state: racial/ethnic and geographical comparisons," MPRA Paper 21694, University Library of Munich, Germany.

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    JEL classification:

    • I1 - Health, Education, and Welfare - - Health


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