Final Report on RREF 2001 - Department of Health

Part B: Development of Options for a Revised RREF
2. The relationships between premature mortality, poorer health status and higher
levels of activity restriction, and the need for HACC services have been
demonstrated in the AIHW reports on health differentials among older
Australians (Mathers, 1990). While there is close relationship between median
household income and life expectancy, inclusion of a separate health indicator
is considered preferable to simply doubling the socio-economic status variable
as it captures a somewhat different perspective on need and draws on a different
source of data than the Census.
3. The Burden of Disease Study (DHS, 2001) provides four measures of Disability
Adjusted Life Years (DALY), Disability Adjusted Life Expectancy (DALE),
Years of life Lost (YLL) and Healthy Years of Life Lost to Disability (YLD).
Discussion with staff involved in the Burden of Disease study identified YLD
as the most appropriate measure for inclusion in the RREF as it measures the
years of healthy life that are lost to disability associated with chronic disease
separately to mortality. The impact of chronic disease is measured as the years
of life spent living with a chronic condition rather than in terms of reduced life
expectancy. The major diseases contributing to YLD are depression, dementia,
osteoarthritis, asthma, diabetes mellitus, breast cancer, stroke, chronic
obstructive pulmonary disease, and ischaemic heart disease, as well as sight and
hearing loss. These conditions are readily recognised as characterising the
HACC target population and correspond closely with the conditions causing
activity restrictions as defined by the ABS.
4. At the LGA level, the high inverse correlation between YLD and life
expectancy (-.71) shows that YLD is associated with premature mortality and
the inverse correlation with median household income (-0.67) shows that higher
YLD is also associated with lower socio-economic status. The lower
correlation of YLD and DALYs for all age groups (0.48) compared to older age
groups (0.53) reflects the difference in the focus of YLD on the prevalence of
non-fatal chronic disease whereas the DALY also reflects fatal conditions.
5. Inclusion of YLD as developed in the Burden of Disease study in the RREF
will be the first use of the study results in a resource allocation tool in Victoria.
Continuing development of the Burden of Disease measures will provide for
review of YLD in the future.
2.6 RESOLUTION OF NEED VARIABLES FOR INCLUSION IN RREF
Of the six need variables initially presented as options for inclusion in the RREF, the residential
care shortfall has been set aside and the five variables remaining to be included in the RREF as
need variables are:
1. median household income
2. years lived with disability
3. access and remoteness as measured by the ARIA
4. language other than English spoken at home
5. Koori population as a proportion of each LGA population.
Profiles of these variables are presented at the end of Part B of the <strong>Report</strong>.
Models of resource allocations under the RREF using these five need variables and base
populations 2 and 3 are presented in Step 7.
<strong>Final</strong> <strong>Report</strong> July 2001 40