A GUIDE FOR PLANNING COMMUNITY-ORIENTED HEALTH-CARE - THE HEALTH SECTOR RESOURCE-ALLOCATION MODEL

The objective of this study was to demonstrate the value of a planning model for the design and evaluation of community health services. The health status of Washtenaw County, Michigan was modeled. Data were ob tained from the Michigan Department of Public Health, Medstat Systems, and the medical literature for 32 diseases or conditions, representin g approximately 85% of causes of death and 56% of medical payments (ex cluding medication costs). An expanded life-table approach was used fo r 16 age- and sex-matched cohorts exposed to a disease attack rate, ac cess-to-care rate, case fatality rate, morbidity, and costs. Rates cou ld be modified to reflect changes due to treatment secular trends, or prevention programs. Two alternative delivery methods were considered to show the potential impact of reducing cardiovascular deaths (worksi te initiative), or increasing utilization of services (lay health prom otion) on county health status and costs over time. Deaths, bed days, and annual medical payments were the main outcome measurements. Cardio vascular and cancer conditions are and will be the primary causes of d eath in this population. The most important causes of bed days are mus culoskeletal conditions, chronic obstructive pulmonary disease, accide nts, strokes, and depression. The major health-care payments are for a ngina pectoris and/or other cardiac conditions, musculoskeletal condit ions, accidents, prenatal care and/or childbirth, and depression. The two alternative scenarios illustrate how reductions in mortality are n ot necessarily equated with similar improvements in morbidity or costs . This model presents an overview of the current and projected health status of a community. With such a planning tool, a community can bett er understand the impact of potential prevention or intervention progr ams, and help design its health-care system within the constraints of available resources.