BOOKS OF RtfiDIfGS - PAHO/WHO

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TABLE 2-Example of the Determination of Program Value for Incarceration
EVALUATION TECHNIQUES IN HEALTH SERVICE
(1) (2) (3) (4) (5) ((?5 (6
(6) (9)
Index ol
Poss. Change Pgm. Value
Previous 12 Group Ave. Avg. ol Admission Discharge Index od (Discharge Pgm. Value Pos»sab
Month's Earn. Annual Earn. (1) & (2) Level Level Change Level od None) (3) x (6> (3) x (7)
Individual 1. 7.400 11 000 9.200 Mod. Severe - 30% a 70% -2.760 6.440
Individual 2 4,680' 4,680 4,680 Sev. Mod. +40% + 100% 1,872 4,680
Individual 3 5,100 6,500 5,800 Slight None +400% + 40% 2,320 2,320
Total (T) 1,432 13,440
Avg. = T/3 477 4,480
*Based on a minimum wage dl $2.00 per hour.
ioxili;calioln. ;lilhough lnot exremenly cllictivc iii tcl's oí' ils
potential. is ani exlrmnicly elliciien prograin. Wc mighl thercfore
mniove o cxpand t'realment hoeilos al Ihe expense of' incarceralion
aínd try to improve the etlectiveness o ni mehadoane
deloxilicaiion.
1' ablc 3 c.an also givc overall ellicicnlcyaiid cll'clivenccss
indices for the agency's four programs. These are lound by
multiplying each program index by the number of patients in
that program (column 1) und then dividing by the tolal group
sizc:
Overall
Agency
Elliciency
.82x3 + 1.16x57 + I.28X81 + .76x 163
3 + 57 + 81 + 163
= .97
Overall .11 x3 + .6X x57 + .34x81 + .26x 163
Agency 3 + 57 + 81 + 163
Effectiveness
= .36
The poor performance of incarceration is minimized in the
overall indices due to the small number of patients in that
program. In terrns of efficiency. the agency is saving almost
as much. in terms of patient productivity. as the program
cost. The cellectiveness ol' .36 indicales Ihail they are achieving
about onc-third of the maximum possible achievablenot
necessarily a poor showing.
'I'his cxaimple has comparetd Jill'cent progrants hbu Ihe
same model can also be applied to the same program al dillerent
time periods or lo grouLps of patients categorized by
means other Ihan treatment programs: e.g.. by sex. age. or
diagnosis.
Ha;lper'n and Binner 4 point out une of' the inevitable argu-
AJPH November, 1976, Vol. 66, No. 11
mcnis agauinst the index evailiaition model when they) stite
1hil; "... .. ileao ;tlllilI liillof ¡ . a f it iieieil1 Ihe;illih proglra;il mi;ly
not he able to mnax;inmize his 'relurn oni investment. In fiac. he
maiy have lo follow s;ctleics thhail lower hi. reliurn. if he is lo
serve those who need his hclp most." IThis. of course. raises
a tlinidamclal;l quelilon: WVlo hlhold 'cl ccive tihe hem:fit of
¡he program's limited res'ui'ccs For exaimple. bhould ¡he
patient who can utilize them the niost receive the resources
or the patient who needs them the most? There are no meth-
Mlological or technical answers to such moral and ethical
quest ions.
Tlie M'ra'kov Ciin MoIdel
TABLE 3-Drug Treatment Program Evaluation índices (Hypothetical)
'
Eyman's' 1 siatistical evaluation model. the lMarkov
Chain. differs significantly fiom that of H:alpcrn and Binner
in that it focuses exclusively on the functional level of ¡he
patient. using it as the measure of chainge and ihe basis lor
cvallation. T'he Markov model delineates. via contingeicy
tables. the movement of the patient (or groups of patients)
along a scale in terms of the patient's initial position on the
scale.
Eyman used the Marlkov model io evaluaate the efl:ctiveness
of a school progranm antd ain inteinsive treatment program"
in a hospital for the mentally retarded. I-owever. the
Markov modcl is much more powerl'ul than these limited applicalions
suggest. FoI example. as ,¡ill be shown. program
costs can be included in the model so that it has the potential
of being combined with the index model advanced by Halpern
and Binner. In addition. under very general condilions
the model has been used' s
to predict the probable time-
(1) (2) (3) (4) (5) (6)
No. ol Pgm. Program Pgm. Eliciency Ellectiveness
Program Palienis Value Value Poss. Cost Index = {2)/(4) Index = (2)/(3)
Incarceration 3 477 4.480 583 .82 .11
Treatment Home 57 1.510 2,205 1,300 1.16 .68
Methadone
Detroaification 81 975 2,870 760 1.28 .34
Methadone
Maintenance 163' 450 1,753 590 .76 .26