The Inevitability of Mortality? Evaluating Alternatives to the SMR

Study Objectives - (i) To develop a non-mortality based proxy for relative needs for health care among regional populations. (ii) To compare this proxy with a mortality-based proxy for population relative needs. (iii) To evaluate the additional value of a proxy based on a combination of non-mortality and mortality based proxies. Design - Estimation of the relative odds of levels of self-assessed health by selected socioeconomic variables using population survey data. Application of the estimates to regional populations to calculate socioeconomic-based population ‘scores’. Comparison of the correlations of socioeconomic indicator (SEI) scores, standardized mortality rates (SMR) and combined indicator scores with regional populations’ self-assessed health levels. Setting - The province of Quebec, Canada. Coverage - The populations of the 15 health regions in Quebec. Main outcome measure: Performance of proxy indicators in explaining variations in self-assessed health levels among regions’ populations. Results - Variations in SEI scores among regions explain 37% of the observed variation in self-assessed health, 4% more than the level of variation explained by SMR scores. A weighted combination of both mortality and socio-economic based proxies explains 56 per cent of variation in self-assessed health. Conclusions - Justification of ‘deprivation weights’ in population-based resource allocation formulae should be based on empirical support concerning the performance of such weights as proxies for relative levels of need among populations. The SEI developed in this study provides a closer proxy to the self-assessed health of the populations under study than the SMR. The superior performance of the combined indicator suggests that the development of social deprivation indicators should be viewed as a complement to, as opposed to substitute for mortality-based measures in needs-based resource allocation exercises.