Hypothesis: healthy active life expectancy (HALE) as an index of effectiveness of health and social services for elderly people.

A central problem in the design and evaluation of health and social services for older people lies in the definition of suitable outcome measures. The choice of measure will be dependent on the uses to which it is to be put. There is an inevitable discordance, for example, between a health service purveyor's and a health service customer's view of what constitutes a good health outcome. The purveyor is more interested in independence, the customer in autonomy [1]. For the customer, it is generally accepted that mortality is an insufficient measure at any age but especially so at a time of life when health gains are likely to be proportionately greater from improvements in quality rather than length of survival. For health outcomes in later life it is essential to identify common ground between purveyors and customers and with this aim in view the prevention of disability seems the outcome of choice. Age-specific prevalence rates of disability provide a complex index which is difficult to interpret even when reduced to a single number of an age-standardized rate. We have therefore suggested [2] that the basic outcome measure for health and social services for older people be Healthy Active Life Expectancy (HALE) calculated for ages 65, 75 and 85. HALE is derivable by actuarial calculation from data on age-specific prevalence or incidence rates of disability and will express the average number of years a fit person of the specified age can expect to enjoy before suffering disability. It therefore offers a meaningful means of presentation to the public as well as a summary statistic of complex data for health service managers.

HALE is a specific version of the concept of active life expectancy which has been widely explored as a means of illuminating health policy in a number of contexts [3-7]. We suggest the term Healthy Active Life Expectancy in preference to various alternatives since it emphasizes that the concern is wider than a purveyor-oriented preoccupation with independence and the consumption of services. (The acronym is also encouraging in its correspondence to the modern transcription of the Northern dialect Old English |hal' meaning |uninjured' and |healthy' and which survives in the phrase |hale and hearty' and less obviously in |wassail', originally |waes hal' a drinking toast |be healthy'.)

In the practical management of a health system deeper levels of …