LIBRARY
OF THE
MASSACHUSETTS INSTITUTE
OF TECHNOLOGY
mj
.M414
no, 39069
AUG 11
191
DEWEY LIBRAF
A COST-BEMEFIT ANALISIS OP THE
li.1.7. FACULTY BEAITB SUBVBl PROGBAH
Daniel S. Diaaond
Epbraia B. Bclean, 3xd
Tocaa Boscabecg
399-69
June,
1969
HDD"^
1
1
n
/f
/lo.:
^,J
RECEIVED
AUG 12
M.
i.
T.
1959
LIbKAKltS
I
Table of Contents
The Development of Periodic Health
Examinations
Page
1
Section II:
Overview of the Cost-Benefit Analysis
Page
7
Section III:
The Present System
Page 10
Section IV:
Cost Analysis
Page 13
Section
Benefit Analysis
Page 16
Section VI:
Discussion and Recommendations
Page 26
Section VII:
Summary and Conclusions
Page 36
Section
I:
V:
Bibliography
Page 38
Ihe Oevalcpaent of Periodic Health ExaiiDations
I.
health examinations
Periodic
«ide-spread
have gained
acceptance in t^e Onited Sates in recent years. Beginning as
early
15), articles
1915
as
began appearing in
officially recognised and
approved the
and papers
exaainations
health
reveals that
written
ovch of the
the
better still,
such
wisat
prograos?
"cooplete**
last
in the
MS
First,
the goals and
what
should
a
undiscovered conditions have been
articles exaained
what
are
or
objectives of
"typical"
or
And third, what
i.e., what hitherto
findings in these exaas;
of administering
(1U)
eaperical.
theses.
should be
are tiiese coAditions?
years
exaainations is
phys:^cal exaoination consist of?
have Leen the
periodic
articles axe concexaed with one
following
Second,
review of
a
subject of
on the
— not
vast oajocity of the
more of
or
Hovevex,
support for such
ideological and philosophic^
h
checkups
the Aaerican
physical checkups.
150 articles
over
of such
aedical journals. In 1922«
nedical Association
value of periodic
in suppost
uncovered and how serious
Few of the papers
such exats and only
discussed the cost
three out of
atteapted to quantify the
all the
benefits which
accrued to tb« effoct.
In exaaining these three points,
nedical
question
performed?)
(e.g.,
should
pcpctosiigaoidoscopy
and is not appropriate for discussion here.
first and third points, however,
u£
the second is purely a
deteminiag the
be
The
are essential to the issue
benefits of such health
Hill te discussed in the following pages.
frograas.
They
PAGE
In
at
locJtinf
streamlined iadnstrial
spending
no acre
individual)
up
$300
to
at
arouad the
medical clioiics
individuals to
their ohh.
seek out
Ihfi
for
extensive
the
vaciovs
each
three-day
prestigious
to
point to the uavillingness of
examinations on
foe such
and pay
growth of
physician
a
is interesting
coantcy. It
note that aany of the authors
for
$10
ninvtes uitb
fifteen
ten to
physicals
''executire-type*
fcoa
health screenings (with
than
t^
ranged
costs, cfaacges
2
regular health
checkup prograns
has been alBfist entirely in institutional settings.
oany
To
individuals
problem, it seeas to
doctors*
to
be
naaely, that
a
general
told something
they
that
are unwilling to
pay foe
Dcctoxs
spend
as
healthy
fLeguently
acre
least
patients
because
as
"done sooething**
seeing
sick
the articles
for theo.
tiae
with
sick
for)
does
ones
exaaiaed
(1,
11,
physicians should restrict their practice
they were
trained, that is, the
article (13) even went sc far as
(and
know
what
patients are
the doctor had
generally prefer
Indeed, in
the point was
15)
ones
because it
challenging aedicioe.
these
with
sot
wiiile tli«
Also, doctjors
healthy
private
in
such examinations.
pay for this tiae than if
people to
interesting and
typically, **you
ouch
the dcctor
ailaeot, if any, he is looking
more reluctant to
know;
exaas because they sense
that patients
at
already
physicians
aaong
of supj^oct
supposedly
time and the
nnderstaadably, this has led to
practice tot adaioistering regular
BU£.t
nedical
ap|>arent
right (or, acre
reduce."),
lack
oo
be a vaste of botii theix
they are all
are overwieigiit
have
Mho
is
more
soae of
made that
to that
for which
treatment of the
ill. One
to
suggest that doctors who
PAGE
go
into this
tbeic
thaa
sicilled**
to be
vock teod
type of
colleagues
lese '*Ieataed
their
devote
who
3
and
tiae
eatiiely to sick patients.
Id exaBiQing the
questioa of the benefits
are
these
are anticipated, and
objectives
five
studied,
secoed,
articles
the
benefits
antici>pated
oi
what eitent
to
Suaaaclsing
realized.
jieoefits
periodic
aust be aasveced: first,
health ezaBiaatioos, tvo <]oestioas
Mbat iieoefits
of
These were
encountered.
(1)
The early discovery of disease or infection.
(2)
Health education and
habits.
(3)
The reassurance of the patient.
(U)
The establishiest of
relationship.
<5)
the development
research.
Iteas
were
and
(3)
<U)
counseling fox better health
of
continuing doctor- patient
a
only
can
data
a
base
be appraised
The literature indicates
subjective fashion.
for
nedical
in a
very
that doctors
by and large do feel these objectives axe beiog aet although
sone expressed concern about the possible adverse effects of
creating
Item
a
false sense of security in sioae patients.
(5|
data for nedical research, is h separate iteo
,
tron the other
four.
The benefits which
flcv from medical
research are seldoa of any value to the individuals
directly
invol»ed (except
possibly
recognition fcr the doctor). They are
long-tero nature.
(e.g.,
professional
pf a mere diffuse and
Some research leads to
policy decisions
the contaaination of the air in vines last be below a
certain level)
hazards
for soac
vho are
;
(e.g.,
other research
cigarette
leads to iodeatifying health
smokinq
cpntritvtes
to
lung
PAGE
cancec)
and still other ceseacch helps to indicate types of
;
tieatsent vhich
are aoce
effective thao
i£ passible
that any
or
It
result
ioforaation
froa
connection
wi.th
previous aethods.
gathered
dat4
froa
health eiaas.
However, in
oo explicit discussion was
anticipated benefits
could
these benefits
all of
derived
periodic
the articJ.es reviened,
to the
U
that are
in
all of
given as
expected froa
to be
medical rcsearcb; the value of such effprts is accepted as
a
given, and farther lastif ication is not offeredo
direct benefits
If
physical checkups^
(2)
are
be claimed
to
bouever, it aust
result io spae tangible,
be that iteas
neasurablc effects.
earlier, there
were only three
guantify these
benefits in acnetary tens.
pointed
t.c
who had
studies which
the huaanitariao benefits
(1)
and
As stated
atteapted to
Several others
to the few individuals
potentially-fatal conditions which were
light early enoagfa to be treated.
periodic
for
brought to
But the guestion in these
cases is whether or not these conditions aight not have been
uncovered even aitbout regular checkups*
authocs
suggested, nature
synptcBS
which it
health hazards to
exceptions being
is very
provides
As a nuaber of the
order to
in
the nuaber
good in
of
potential
bring
the attectico of the
individual (the few
diseases like cancer,
glaocoaa, syphilis,
and tuberculosis).
Iherefcre,
lollow,
studies that
in the
basis for inferxing causality.
In
there is
no
other words, even though
mortality or disability was reduced in the grcups undergoing
the
regular
checkups,
ceductions
aere
prograas.
It
due
is
there
solely
very
is
to
possible
no
the
that
proo|
that
initiaion
such
these
of
factors
such
as
PAGE
selt-selectlon
(all pcagcaas
5
wece also
ate volojitacy)
at
work.
was
a«
(3«
f olicyboldets
exaainations
cost
at no
approxiaately
6,000 aen
such
for
a
w^e
was
aaong
entire
^or the
The expected
cost
The
303.
the
of
appcoxiaately $<i€,000 while the
saving to the
coapany of not hawing
realized
thereby not hawing
(and
physical
Proa
deaths occurred.
group
16,662
of
given
participated
who
adainistering the ezaas was
consisted
theaselves.
duration of the project, 217
mortality
Hetcopolitaa losurance
who
to
ExteasioQ
the life
by
study
Ihe
12).
10«
metropolitan
1914-1921
& contcact fcoa the
Institute uader
Co.
period
t^e
doae in
benefits to costs
to atteipt to aateh
Ihe first study
the expected aortality
to pay the
death claias)
was scaewhat in excess of 1126,000.
The second study was done
Corporation
eaployees were
per
reported
and
covered by
exaainatioB
coaaitaent
was
non-work-coBsected
exaaple given
of
Because
Corporation's
[ayaents
cancer),
le.g.,
cancerous
this figure
,
rectal
In
alone was
was
it
and treated
tbe case
growiths
the estiaated
for
the coapany
detected early
resulted.
1,455
average cost
the
of
disability
in the article)
over 1120,000;
Here
.
the potential savings to
or disability
discovery
<2)
study and the
the
conditions cculd be
before death
1960
in
disability
possible to cal<culate
early
on
provide
t«
if serious
$51.
by the Mestinghouse Electric
of the
(the
only
savings were
acre than
the total
cost of the prograa.
Ihe
benefits
third study
,cf
which discussed
reifular checkups was
both
done by
the costs
and
the Consolidated
PAGE 6
Ediscn CoBpany
9),
,at
Mew Yoi
k
in the
period 19U9-1959
(6,
7, 8,
717 persons »ere involved in the study, «ith an avecaqe
cost per exaa o£ $30 to
to the conpany
the savings
payaents
decreases in
both aortality rates
are considered
which
dollars
or death
cents,
but
in illnesses
as veil as
totally disabling.
A
stateaent
paid fcr the
these reductions aore than
made that
and
studies,
indicated significant
vere given Mhich
several percentages
tiio
in reduced disability
expressed in
not
were
Unlike the first
$35.
was
cost of
the program.
In fairness to many of
should
te
pointed
exaaples
out that alacst all of
doctors.
by and for
of
the
described could
the other articles exaoined, it
It is quite possible that
early detection
be translated into
very straiglit fprward fashion.
so few of the atithors felt
maXe such
a
thea were written
calculation.
Hhat
disease
many of the
which
were
aonetary benefits
in a
of
is interesting is that
it iapcrtant enough to bother to
PAGE
Overview of the Ccst-Becefit Analysis
II.
The purpose
n.I.T. faculty
papet is
of this
Health Survey
to analyae
pcogcaa «ith
costs and benefits in order to
the present
lespect to
its
establish whether or not the
nortbuhile; and, if
program is
7
not,
vhat action
should be
taken.
A
1.
nufflber
cf questions follcw fioa this objective:
from whose standpoint should the costs aad benefits
be investigated?
2.
Hhat
is a neasure
words,
hov
does
of
"
worthwhileness"?
define
one
and
In other
aeasare
the
perforaaece cf the prcgcas?
3.
Hhat is the tine horizon
of tiie costs and benefits
(iiaediate vs. long range)
In
answer to
the
first
qaestico, the
parties
most
directly involved in the prcgrao were identified. These are
1.
faculty
The
members
are
who
entitled
to
the
service.
2.
3.
The Medical Departieat which performs the service.
The
n.I.T.
administration
Hhich
pays
for
the
service.
4.
The n.I.T. cofflBuoity as
a
whole, which is affected
by tfkat jiappens to the faculty members.
Parties
who
are
sore
program were not considered.
families of the
distinction
n.I.T.
remotely
connected
on
the
the
Examples of these would be the
faculty members and society
was made
with
basis
of who
boundaries and who is outside of them.
at large.
The
is within
the
PAGE
second question caises the protolei cf soae coBbiaed
3fae
"index
8
of
ccncecning
decisions
would
ubich
HOitliwiiileness*'
be «sed
nodification
retention^
the
guide
to
or
cancellation of the pcogcai.
the administration decides
Since o«ly
the
necessary
it is
progcaft«
benefits to all
parties into
pn the
costs
coabine all
to
single equation,
a
fate of
and
as seen by
the adaii^istration.
criteria
adainistration's
The
functio«e
C,
be
nay
described as
a(I)X(I)
C =
a(C)XiC)
«
*
a(A)X(&)
where
=
a (I)
the
relative
weight,
adaiiiistratico,
eyes
individual
the
of
the
iji
the
of
faculty
BejBber*s cost-benefit relationship.
For X(I)
a(C)
=
the
>= 0, we have a(I)*, otiiewise a
relative
weight,
adiioistration,
Hedicai
the
of
the
io
eyes
(I)
of
••
the
Departaeat*s
(clinic's) cost-benefit relationship.
For X(C)
=
a (A)
the
>= 0, we have aJC)*, otherwise a
relative
weight,
adainistration,
of
io
the
own
its
eyes
(C) "
of
the
cost-benefit
relationship.
For
where
X (A)
>= 0, we have a (A)
X(I)
= B(I)
- K{I)
X (C)
=
BiC)
- K(C)
X(A)
= B(A)
- K(A)
fi
are benefits and
The coapositioD
K
*
,
otherwise atA)**
are costs.
of costs
and benefits
will le discassed in the following sections.
to each
party
PAGE
foe each party,
,
=lb(i)lf(l) and
a
are the benefits, Z|i)
where Y(i)
V (i)
(i)
K
=^
I.w(i) Z (i)
costs, and
th*»
9
b (i)
,
and
their respective relative Heights.
This short analysis indicates that the pxoblea ahead is
that
c£ Identi^f ying
a (i),
b (i)
Ihe
and
and quantifying
all
the Y<i),
Z(i),
h (i) .
objective is
to
only
C» and
oaxioi^ze
positive
solutions are acceptable.
question is
The third
justified on
whether the
budget-year by budget-year basis
a
this is ao investaent for the
preventative,
proqrao has
and involves
future.
to be
or whether
Since the prograa is
the redaction
of sickness
and
death over the work-life of an individual, the benefits will
accrue ovec this
whole tioe span.
This,
therefore, is the
more appropriate tiae horizon.
In
the
next
exanined, including
will come the
section,
the
its purpose
progcao
itself
and scope.
analysis of costs and benefits
fcllowed by a discussion of the fiJidiags.
will
be
Foldowing this
to each party
PAGE 10
Th€ Present System
III.
Faculty Health Survey examinations are being
scheduled for 1966-1969.
He
hope that you iiill
of
this
cpportunity
the
take advaatage
for
evaluation of your health, as our experience with
this program has sbovn it to be of great value.
For the information of new nenbers of the Faculty
this
program
and AdiBinistration,
includes a
ifitervieu,
a
complete
physical
medical
examinat ico, routine blood tests and usinalysis,
There is a fee of 110 for the
all Mithout charge.
chest x-ray.
If an electrccardicgram is indicated
be an additional $10
charge. Special
there kill
are
done
outside
laboratory studies
toy
an
daboratory* and will be charged to you at the cost
to the Medical Oepartieot.
those over
40
should reitura
for
All
Those under UO
exasinatioa on a yearly basis.
have an examination every two
to
should
pl^n
years, unle&s there is some speciai health problem
which makes more frequent examination advisable.
The above
statement is contained
and administration
the faculty
members of
concise description
reflection
in which
manner
of the
be a
thing fcr
good
further >ustif ication
necessary.
As
individual
a
the
latter
and
is a
fact is
a
into
the program vas that "it
therefore
Institute" and
aot felt
to be
have been kept
on an
or dccuaentation was
basis
each
is the
Survey came
the
result, all records
patient
first, it
aod seccnd, it
program. This
the
The original rationale fci
being.
would
the program,
of
description of
o nly
Survey because,
Facalty Health
the n.I.T.
cf H.I.T.
introduction to a discussion of
It is an appropriate
year.
sent to
in a letter
general
no
statistics
ccncecnicg the pverall program have beeo maintained.
The
preceding remarks
criticism of
current
either the
execution.
They
should not
be
concept cf the
are merely
construed as
program or
mentioned to
a
of its
provide
PAGE
conmon conplaint
support for the
analysts
all
of nearlj
(p^chaps alibi)
Nithout detailed
that
resultant
the
data,
11
analysis is necessarily tentative.
Faculty
The
Department
was
Originally
it
Health
Survey
the
of
Inaugurated appioxiaately
Has
designed
oftex
to
Medical
K.I.I.
ago.
years
ten
physical
periodic
examinations to senior faculty esbers and iafoctant eabers
cf
the Institute adninistratioa on a puxely vcluntary basis.
It has since been expanded to include ail faculty aeabers of
the ranJc
employees of
selected
(CSB)
assistant professor or
,cf
the Division
Research
of Sponsored
.
The perscnael
from the DSB Mho
are selected
the Survey
selection is
.
a
rate
of
discontinued and no
to the
noted
$20
fron the
seilect people
from the Bedical Department
This
exaa.
per
has
cross-charge is made. There
individual except
in the
used to
and age
The cost for these exaainations was, until
recently, cross-charged
at
basis for
itself. The
by the OSR
the procedure
adffinistration)
included in
are to be
conbination of position* seniority,
a
(not unlike
DSB
above as Hell as certain
letter.
Survey fox other employees cf the
now
been
is no cost
special laboratory
for the
There is
to the
an Esployee
also
work
Health
Institute, but it is of a
slightly different nature and «ill not be discussed here.
Each
year,
notification
individuals (an excerpt of the
in
the
aost
persons availed
recent period,
sent
is
to
all
eligible
letter Mas given above); and
fiscal
thaaselves of
about 75X of all those eligible.
year
the offer.
1967-1968,
This nuaber
883
is
The names oi those who are
considered eligible are derived froa
the cursent edition of
PAGE 12
the
Geaecal
H.I.T.
turnished
by the
Catalogue
aad
adainistcatioo
notification is senX out; and
txou
and
lists
the OSB.
of
nanes
Only
one
faculty menber chooses
if the
not to respond, there in nc follcu-up.
Since no physical exasinations
meBbeis as
a
coadition of eiplcyient,
are required of faculty
it is foss^^® ^^^ sB
indj.vidual to cone to H.I.T., spend his entire career on the
tacalty, and ne«er once eater
freedcB of
action is« of
the cliaate of
a
soae sort
course, entirely ia
universitr* tut it nakes
the benefits of the Health
without
the fledical Defartaeot.
of
Such
keeping with
the appraisal of
Survey progcaa rather difficult,
reference or
difficult to judge whether these who
any better off than those Mho do not.
control
group, it
is
dp use the prograa are
PAGE 13
Cost Analysis
IV.
Because
depactnents
DepactneiLt)
special nature
of the
vithin
concepts
the
,
H.I.T.
control ace little used.
(including
way
cost
and
vhy this should be so
7he leascas
Costs
appraisal
the
in
Medical
the
accoootinq
cost
of
are not difficult to understand.
systenatic
administcati ve
ot the
ace not used in any
adiinastcative
of
peEfornance and no staff is pcovided to the department heads
to assist thea in naking
eapfaasis given to costs,
of assigning costs
With so little
such calculations.
not surprising that the task
it is
to the Faculty Health Survey
nust be in
the nature of an educated guess.
earlier discussion it
froD the
for scne peeled of tine, a
Mill be
recalled that
charge of $20 was levied against
the CSR for exaainations perforaed upon their personnel.
On
the surface, it would appear that this figure represented at
least
an
approximation
examination.
of
cost
the
of
Upon investigation, however,
conducting
the
it was disclosed
that iihis was not the case;
it was intended merely to cover
the ccst cf laboratory tests
(an
Medical Department)
"out-of-pocket" cost to the
which were provided
without cost to the
DSB persoAuei..
Fecently, however, the Hedical
DepartmeiBt has found it
necessary tc fuxnish certain figures to Medicare in order to
be
accredited as
figures
Audit
a
full-fledged
were prepared
Division
information.
and
medical facility.
direction
under the
serve
as
a
useful
These
of the
source
H.I.T.
of
cost
<30.
PAGE 15
defined, exceed the ansual coat of
$64,000
justify a ccntiauation of the prcgrao?
a
year, and thus
PAGE 16
Benefit Analysis
V.
In attcaptlng
to estiaate the
Hedical Depactnent
the H.I.3.
several pcograns
p£es«nt distinguish aaong its
does not at
in
Ficst,
assessing
total
its
effectiveness.
the perfornaoce of
present tiae
the M.I.T.
is iaportaot to recognize
Faculty Health Suivey pcoqcaa, it
the following points.
benefits of
second,
the Departaent
at
the
is judged,
on the basis of the
and future budgets set, alsost entirely
degree to which the facilities of the departaent are used.
For exaople, if an i-ray unit operates 75X of the total
is coosiderfed to be better
tioe it could possibly run, this
than if it were
be used 90S
begins to
important
to note
equipnent
is highly
analysis
liberally (i.e.*
judged), which
delay
certainly net
without
a
a
going to
is
piece
of
a
to
brisg about
a
a
decision to
x-ray
load on
additional
be made
tiie
detailed
less
severity is
certain level qf
would reduce the
of
It
pf
Thus,
only when
purchase
the
unlikely
this use.
of
considered.
will be
near-capacity use
that
decision to
the tioe, a
cr acre of
additional equipnent
purchase
Further, if it
used only 501 of the tioe.
eguipaent and
eguipaent,
alaost
is
Hedical Departaent
by the
major change ir policy.
Finally, while several sources of possible benefits are
identified
below,
aost
cf
consideration at present.
the
Faculty
Institute's
considerations
Health
are alaost
are
program
in
its
is
purposes of
protect
tc
faculty,
totally ignpred.
into
taken
not
Although one of the
Survey
investment
these
It is
the
econoaic
clear.
PiGB 17
that what is presented belou
then,
for the Bost pact, a
is,
picposal for the analysis cf benefits, and not
of
how
is dpne
i t
or how it
description
a
with available
might be done
data.
purposes
For
benefit analysis
of
groups
three
are
identified, the first two of which are subsets of the third.
both
For each group
measure these
data necessary to
benefits and the
tlie
benefits are specified. Decisicns
the benefits cf the progcaa outweigh
on whether
its cost and on how to
best allocate existing and additional resources require more
than
a
sinple
particular,
identification of
an
objective
benefits
function oust
and costs.
In
be specifj-ed.
An
here because the conversions
objective function is critical
of many of the relevant benefits tc dollars will appear both
difficult and repugnant to
the adainistratorc involved.
objective function,
the specification of an
fact, however,
In
in which weights are associated with the relative inportaoce
of the several benefits, is tantaoount to the saae thing.
The first, and oost obvious, group who ooght to benefit
froa the Faculty
While the
really
Health Survey are the
debate rages
on as tc
does significantly
faculty theaselves.
whether anj
contribute to
such prograa
the discovery
of
health problens before they becooe serious, this possibility
cannot be overlooked.
identifiable
individuals
if
the
Furtheraore, in cases that
data
the periodic
available,
were
exaaination would
into
the
exaaination is
problea
cf
unavailable
carried out, the
certain
have been
the
However, pne iaaediately
difference between life and death.
runs
for
voald be
data.
physician sakes
the faculty aenber's aedical record.
As
each
notes for
Except for a personal
PAGE 18
sent to
letter
the facultj
after the exaiioatioa,
is
The
made.
nedical ceccrd
tl.I.T.
the results
as
net,
is
readily usable
a
soon
the fhysician
no additional record cf
saintained,
presently
aeaber by
source
it
is
data.
of
First, it is coasidered, as perhaps it should be, to be very
confidential.
Second, entries
noo-uniforo,
neasuring
third,
aad,
pecfornance
the
become serious
often
illegible.
of the
Faculty
will require
tie medical record
par.ts of
the relevant
are
Therefore,
Survey
Health
the encoding
either
of
recording of
or the sei^artatc
approach would
The second
data.
nedical record
discovery cf health problems before
program on the basis of
they
in the
not provide
historical
data,
implement.
The results of the eiam cculd be recorded by the
but
should
it
his secretary in
doctor or
a
relatively
be
uniform, specified
easy
to
manner on
standard forms provided for that purpose.
The second benefit of the program to the faculty member
is considerably less tangible that the ^irst:
of anxiety.
from occasiional concern about a
No one is free
seemingly tec-rapid heartbeat,
in the side,
o£ the history cf
shortness of breath,
a
a
family. The Faculty Health Survey
concern for
eliminati-ng such
groundless.
At least
program
a faculty
to the attenticn cf
administration.
A
shortly
examination.
heart disease
Not only
contribute to
it is
was an important
the aedical Depactment
professor had lost a brother due to heart
before
the
faculty
There had also been
in both his
did the
ca<]i
memfcer when
one case where this
pain
a
illness in the
particular
factor has come
disease
the reduction
scheduled
an established history of
mother's and
professor rely
member's
en the
father's families.
Health Survey
to
PAGE 19
allay his
tests
fears, but was quite
that Mere
such aoce
insistent tbat be
thorouqh
be qiven
than the
exaninining
reduction cf annxety pa
the part of
physician judged to be necessary.
This benefit, the
the
faculty, brings
received
in this
frcbably not
up
neu data
a
way lust
be highly
be derivable
professor hi.self.
pxoblei.
froo any
Fears of
Any
benefit
subjective and
source pther
this type
will
than the
will often
re.ain
unccBiBunicated to the exanining physician; and the
physician
has
way cf
no
recording
guesticnnaire, depti
have
to be
used
however, no way
be applied
has not
he
interview, or
to elicit
such
then,
observed.
siailar aechanisa
inforaaticn.
of avoiditg the bias
to any response
It is clear,
be to
what
will
There
is,
that will necessarily
the faculty Beaber
that as iapottant as
the faculty aeober, it
A
aight
aaJce.
this benefit aight
is doubtful that it
could be
aeasured objectively.
Bhile we
view the reduction
of
one most consider the possibility
as the result
has
first
reaction to
created should
that can
be more than
benefit,
learns that he
likely to
occur.
anj such
offset by the
One's
anxiety
iapoived health
froa the treateaent
been discovered.
If,
However, as
of the
pointed out
one of the
by Dr.
one
is
usually that
be expected to result
prcblea that has
times
this is
a
of creating anxiety.
of his exam, a faculty aeaber
aedical prcblea, anxiety
a
anxiety as
Melvin H. ficiaan,
turns out that the
that
further.
little can
/
adainistrator of tie
prograa, it some-
aedical problea discovered will be
be
As it progresses,
done
the
about until
it
progresses
faculty aeaber would becoae
aware of its syiptoms and present hiaseif tc a physician
for
PAGE 20
exaaination.
needlessly
anxiety has
Xhus«
created
been
Without better data there is no
eailiex that «as necessary.
way of kttcwiBg the Bagnitude of
medical controversy about it such a
felt to be
this difficulty.
Although there is
fatal disease as
potentially
diabetes is/in this class.
that
positive
the
of
nature
free tc
prcblcBS,
call
nan; of
for
ledical
not.
us do
relatioBship.
objective
three-fourths of the
actually do
is
wat-h
the event
in
a
whoa he
of
program
Health Survey
the problem
is
knovn
cobc
of
that
roughly
in
for ezans
nothing about
which requires
aeasuresent of
the
aeasuring
that this leasureaent
can the
lias than
is certainly
doctor upon
this says
it is possible
less
a
faculty invited tc
professor-physiciai) relaticnship,
made
be
faculty Benber to establish
It
appear. However,
an attitude.
relationship
the
here again
But
leasurenent.
is
advice
The
presents an opportunity for the
a
benefit identafied
While it
that everyone sfaoold have
good idea
such
of
the physiciao.
establishes with
feels
faculty
final,
third* and
Ihe
can be
anxiety
reduction since it involves less esotion.
The secand group
the
Survey progran
Faculty Health
Departnent.
various
that can be seen
is
as benefitting fros
the H.I.I.
Medical
As was pointed out earlier in this section,
prograas
independejitly.
of
departnent
the
are
not
the
evaluated
However, in order to recognize benefits froa
the Faculty Health Survey progras, this would obviously have
to be changed.
of the
Also, it
was suggested that the utilization
departB£nts* resources is
future resource availabilities
to accept
that the Medical
the major
(budgets).
determinant of
If one is willing
Department views the
growth of
PAGE 21
its budget as
contcibute to this success.
Survey prcgraa can
greater the
success, then the Faculty Health
measure o£
a
extent to which
the services
First, the
advantage of
the faculty take
offered through the
progxaa,
greater the
the
the resources cf the departaent
usage rate of
the benefits of the program
be.
Second,
can
±e efficiently
if
narketed to
then, the
will tend to
to the faculty
the
demand for
ptogtai can be expected to increase.
A
that oight he derived
second benefit
Faculty
Departnent
fioo
scientific
in aatore.
the
research ^oiag on in
vast ascunt is
While
cf view
faculty
n.I.T.
aedical
Their
as
In
veil
has nc
acadeaic
other
project
Bay he
fair aaount
of
general health
as
aore
overextending
of the
outvardly-directed
benefit,
this potential
that, at H.I. 7., the Hedical
coaaitient
primary research
departaents.
contribute to
activation aigfat be both froa
suggesting
however, it aust be recognized
Depar±Ben±
a
analysis, could
of iipicving the
and
research.
is
The Hedical Oepartaent,
yet to be learned.
this body of knowleqe.
the point
there is
prcgraa
Survey
the field of periodic aedical exans, a
collection and
through data
Health
by the Medical
Therefore,
such
as do
a
the
research
Medical Cepactaent,
the
at
least as it ^s presently ccnstitoted.
dcctcc-patient
The
benefit to
relationship*
the faculty aeaber, is
identified
as
also reco<gnized to
a
be a
benefit by the fhysiciao. In other words, it is iaportant to
the
Redical Departaent
physician that
the faculty
aeaber
feel free to call upon hio wbenvever he feels the aeed to do
so.
It
his
side
is also possible
otf
the
that the physician
relaticnsnip,
knoving
benefits froa
t-bat
be,
the
PAGE 22
ptotessiouAl healer,
Ne€dl€£s
to say,
vill te called
not only
upon in tine
aeasurement but
of need<
quantification
will be difficult.
In attempting
Health
to seasure the
Program,
SorTOv
Departaent phys^ciaas,
the
Cepaitsent
exaainaticns.
a
doctors
Ihe doctors
iDportance, five
benefits cf
perceived
the
Medical
questionnaire was sent to
each of
as
tiho
currently
by
adainister
were asked to rank,
reasons for having periodic
resuLts are shown in Table
the Faculty
in order of
checkups. The
1.
Physicians* Bankings of Seasons for Ccaductinq
the Faculty Health Survey Prograi
Reason
these
PAGE 23
The fical ijeoefit to the Medical Departacnt is sonewhat
related
successful
second
the
to
pact of
k
enhance the
progran will
Health Suivey
Factiilty
pcevicns benefit.
the
ceputaticD and status of the Hedical Eefiactneot.
As pointed
the physician
engaged in
appeac that
it can
out eacliec,
healing the sick, is viewed
health screening, as opposed to
less conpetent
as being
by soie
The exteot to
professional status.
Ccoaunity*s
the il.I.T.
uocertaiD.
Departaient serves
Hedical
professionalism
of
the
since
effect,
is
the
in addition
other functions
conducting Health Survey prograns.
and
Hedical Department
little
well have
nay
It
lower
of
applies to
which this
of the
>iicw
tfaecefoce,
and,
to
Nevertheless, the status
Eepartment
important,
are
Committee that periodically
particularly where the Visiting
evaluates the Medical department is concerned.
now turn
Vie
<Mir
whole to consider the benefits
Health
Survey
totality
program.
its
of
faculty, staff,
which
is
cbvioiisly,
the H.I.T. Community as
attention to
various
it receives from the Faculty
the
By
Coaaunity
constituent
for the
budget.
the community benefits if,
mean
we
the
students,
parts:
the administration,
and most particularly,
responsible
a
First,
and
quite
through the program,
a
coBBunicable disease is discovered and its spxead prevented.
The
discussed under
discovery of
the
measurement here
probslems o£
law
the benefit to
disease.
requires
are
identical to
the faculty lembers
Cne advantage
the discovery
of
in this case
certais
those
of the
is that
communicable
diseases to be officially reported.
A
second pptential benefit of the frogiat to the H.I.T.
PAGE 2U
CcBBunity, particularly to the adiioistcatioxi
a
greater
number of working years frci its faculty.
like n.I.T.
coBpetition
anong
ffl€Bber
universities
quite high.
quality is
highly
is a
fcr
skilled group.
The
of
this
piofeEsor<s
a
faculty
vorse, death, is indeed serious.
the work of
with students* aakes
greater
The faculty of an
a
such
a
on various
faculty aealiec
Institute conoittees as
depacitieiUbal and
a
loss, therefore, of
The
due to illness, or,
In addition,
is to receive
each year, and
cuabez of norkinq days
institution
,
veil as
less even harder
his work
to t^^ke.
For
example, it Bay turn out that upon the death cf Professor X,
Professor
Y*s
of another university is
Y
list
publications
cf
reputation
may be
However,
the
Professor
X
on
a
par
graduate
four
honors
and
with
theses
as well as his work
as
those
well
Beasure
departaent
this
would be
effect,
essential.
department adBinistiation would
as
his
of Professor
X.
supervised
by
beinq
on the coDoittee to End All
CoBBittees are act qoinq to be easily handled by
To
Professor
available.
the
In
a
cooperation
most
of
cases, only
be in a position
data regarding the medical absence or
new man.
each
the
to supply
cause pf death of its
faculty menibers.
Finally,
the
progcaa say
be
creating good will toward H.I.T. on
and potentia^l faculty aeabers.
the faculty
pension plan.
as
a
The
real "fringe
viewed
as a
tool
for
the part of its current
The program aay be viewed by
benefit** like
only way to measure the
vacations or
extent to which
good will has been, or Bight be, created through the prograa
would be
by
seans of attitude
newly hiced faculty as well as
surveys of both
current and
those who declined the offer
PAGE 25
ot a positicn fioa n.I.T.
PAGE 26
Oiscussion and BecoaaeAdatioDS
VI.
Cne
analysis
greatest
the
oi
itself
understanding
is
gieatei
a
pn the
kenefits
part of
of
cost-benefit
the
anareness
increased
and
the decision
aakecs o£
the
dinensions and aagaitude of the decisions inviclved.
discussion exeaplifies
Ihe folicwing
still exist.
the needs
uhich
These can be soised up as
O)
Additional data
|2)
Coiplete knowledge of available alternatives
<3)
Rules Mhich lead from data to alternatives.
Additional Tata
Ihe need for
data can be broken into
nuafcer of data
a
sets.
FrohabilitiPfi
7vo na;ior types of probabilities
needed
in
order to
help
deteraiae
are required.
the benefits
One is
of
the
frogran, and the other is helpful in deciding which diseases
to check for.
calculating the
In
inportant tc ceaenber
percent of people
benefits
of
the psograa,
that the crucial variable
who had an illness acrested
tc eaily detection
through this prograa.
difference between
this fraction
and the probability
due tc
a
check_up
of the illnass being
(periodic or
is
is not the
or cured due
Bather
(taken as
it
a
it is the
probability)
arrested or cured
otherwise)
outside
of
the
prograa.
In order to
determine which diseases tc
check for, we
need to know probabilities cf cccurencee of various diseases
PAGE 27
in
population
the
which
with
of successful
profcabilities
concerned
ace
we
tceatnent
once
and
disease
a
is
detected.
Value PunctioDs
Ibe
jdicectly as
fraction
value
exact
of
of the
pcogcaa
by using the
deaand function, or indirectly
a
menbecs who
faculty
individual
the
to
advantage
take
of
the
service as an "index of satisfaction") Bust be established.
Ihe value aust be fcuBd cf this individaal satisfaction
to
function
lineac
(e.g.,
criteria
For
example,
is
is it
twice as
worthwhile if
adiinistcatioB.
the
rather than 300 faculty aenbers participate)
ccaplicated function? An exaa^le of such
this
600
is it a aore
icc
fuactioa is given
a
in the illustration of the decision algpritha given below.
Market Behavior
to deteraine
is iapprtant
It
Data en new faculty joining
been in existence.
characteristics
of
would
faculty
the
as well as
the progcaa and
out as related to
on pa;rtici pants dropping
faculty
ten years that it has
participatica in the progran over the
to
treads of
the
be
great
of
interest.
Unfortunately, most of the
xs currently unavailable.
inforaation suggested above
will not suffice, since
Gae££ing
the analysis is very sensitive to these probabilities.
Ihe Need for Knowledae of Alternatives
Between
there
exists
Benefits
expansion
a
to the
wide
and cancellation
range
adoinistration
of
possible
of
oay
the
prograa,
aodif ications.
be iocxeased
by
tlie
following stxategies:
(1)
Increase
the
nuaber
ot
faculty
neabers
PAGE 28
participatinq
ctteiinq ioduceients
achieved by
This
proqraa.
the
in
pressure, in the foci of
a
can
be
aad/ec applying
••p«H" ci "push."
Increase the pull.
i»4
loprove the iiage of the proqcam.
i(i)
Change the faculty aeabcrs* perception
(ii)
of it
(perhaps
through an educational
prograa)
Give incentives.
(iii)
(b)
i2)
Increase the push.
(i)
Make it cospulsory.
(ii)
Sanction aenbers who do aot use it.
this
under
eligible for
coapcsiticn of the qrou<F
Change the
variables
The
service.
strategy
this
aanipulated
to be
tiae
age,
say be
at
the
Institute, position in the Institute, past aedical
record, etc.
Ihis lay be achieved by
(a|
Expanding the coverage.
(b|
flaking
it available only
group for
to that
HhOB the benefits are the greatest.
(3)
Change the frequency of the eyaiina tions.
often.
(a)
Exanine ncre
(b)
Examine only upon entrance to the Institute.
(c)
Make
ci
less
the decisicn tc
exaoine
a
function of
age and past nedical record.
(d)
(U)
Exanine on
Change
the
a
random basis.
type
and
conposition
of
the
of
the
exanination.
(a)
Standardize
examination.
the
composition
PAGE 29
leave it to the discretiion of the doctor.
(fc)
Change
(c|
specific
the
ace
that
tes<ts
adaioisteced.
or reduce
Expand
(d4
illnesses
list of
the
tested fee.
illsesses tested
the list of
Vary
(e)
foe fcoa
ezaaination to exaoinatioa.
Costs
strategies (2),
get
and
(3)
this service
can
adoioistiraticD
the
to
(U)
reduced
be
by
or by encouraging the faculty to
outside cf
self-adainistered
n.I.I.« by
tests, etc.
Eenetits to the Medical Cepactient
collecting data uhich aay serve as
by increasing
Any of
the number
cf
j^ar
these alternatives Hould
can te iacceased by
a basis fcr research
ticipaats
proqraa.
ia the
also change the
and
costs and
benefits to the individual.
The Meed to jtnoa the Transf oraaticn Process
It must
interrelated
be deterained hou
and how
they are
alternatives as discussed above.
diagram
of the
all costs and
related
decisioo-sakiiig process
to the
aight be brought
to
be
fcllcued
individual, cliaio
together in order to
by H.I.T.
The
to various
policy
The followiiK) logical flow
ccnceptoalize this problem. The diagraa
and benefits
benefits are
is
an atteapt
to
shows hou the costs
and adainistration
deteraine the policy
diagraa is
followed by
numerical exanple that illustrates how it aay be used.
a
PAGE 30
tl.I.T. Faculty Health Survey Progzaa
Oecision-Hakiog Process
Start
=
X
E(A)
K(A)
•
VK
Expand
CoDtioue
FHS
FHS
**to
O
Input a
Faculty Meiber
N
B(A)
K|A)
B(I)
K(I)
B(C)
K<C)
I(I)
1(C)
I
n
=
N
1
-0
benefits realized directly by the adaisistcaticn
costs incurred directly by the a^ninistration
benefits realized directly by the iadividaal
costs incurred directly by the iodividnal
benefits realized birectly by the clinic
costs incurred directly by the ciioic
index of individual's satisfaction with the progtaa
index of clinic's satisfaction with the prcgraa
total satisfaction index
faculty she use service
faculty eligible for service
PAGE 31
PAGE 32
6(A), have
adainistcatioB,
ooe of
values.
pcEsibie
thjcee
These fcencfits arc those vihich ueie discussed in the earlier
ceplace
having tc
avoided by not
well as the expense that is
ace avoided, as
a
payments that
and disability
consist of death
secticn and
bigblyregarded
seabec ct
the faculty
with an oat£idec.
First, let us assuae that this figsce is $100,000.
X
-
= B(A)
=
K<A)
100,000 - 6a, coo
= 36,000
uith
=
X
thao zero
ouch greater
and very
can
This expansion
Survey.
exaainaticns
take
cqapulsory ^difficult
>>
0)
(X
0)
the Faculty Health
Hake
aaoy foras:
to do
the
university
ia a
of the
.0
ana so
fcequency of the exaaioati/as,
prograa, increase the
>
Therefore, the
.
"larketing" effort on behalf
increase the
,
(X
action is to expand
indicated ccurse of
setting)
this is both greater than zero
36, COO,
forth.
second case,
As a
let us
benefits to
assuae the
be
$65,000.
K
= 65,00C
=
Here,
X
-
64,CCC
1,000
is greater
thas zero, but
not very
auch greater.
Thus the Health Survey is continued, but not expanded.
As a final case,
let us assnae that the direct benefits
tc the adflinistratioa are only
in
X
the benefits whic^ accrue to the
being less than zero,
individual
facalty
Since this results
ia0,000.
oeaber
and
the
to
clinic
aust
be
faculty as
to
exaaioed.
The
first &tep
is
a
canvass
of
the
PAGE 33
whether
tiiey
theiselves of the Health Survey.
wish to avail
Each laculty leaber,
exanination.
1
at
is
H,
imited
to
aeafcec coipaces
3h« faculty
(consisting of the out-of-pocket
physical
liave a
the cost,
K(I)
cost foe latoratocy tests,
to the benefit of.
etc,
plus the iatangifcle cost cf ti>e lest),/ the decision is
ade
to
exaaioation, and n
have the
The canvass is continued until
have been "asked,** i.e.,
who
have expressed
Survey, i.e., they have bad
currently
about
the curve
an exaiination.
75X. Given
derived fcoa tbe
(total).
H
this
scale along
dollars)
are deternined
For this
exaiple, let us
by
toward the
This figure is
an index,
R,
function shown below.
and the
the faculty,
positive disposition
a
by 1.
all eligible faculty Beabers
represents the fraction of
The ratio, B,
n/M,
=
N
is iDCfeaented
1(1),
exact shape cf
The
the abscissa
(expressed in
adainistrAtion folicy
assaae that fox
is
B = .75«
aakecs.
I (I)
=
2C,00C.
Individual Index Function
R
Figure
The
oext
step
is to
2
exaiine
the
relationship,
Y,
B(I).
FiGB 34
between cc£ts«
benefits, B(C),
K(C), and
This ouaber is arrived
Depactient (the clinic).
Medical
fee the
at by the
clinic staff and lay be positive oc negative. Here again* an
value, ¥« froa a function
index, 1(C), is derived trcs this
whose general shape is sbcwB belcw. (As before* t ha shape of
the curve
and the scale of
the abscissa ace
deterained by
la this case, let as assvae that 1(C)
the adainistcatioa.)
=
5,000.
Clinic Index function
Figure
3
the overall index, I, is but
and clinic indices.
I
=
In this exaiple,
1(1)
= 20,000
=
the sua of the individual
1(C)
5, COG
25,000
Fron the earlier assuaption that
egual£
40,000 -
direct
benefit to
cover th€
cost of
64,000
the
or <-24«CC0.
adaiaistration
the progiaa by
comprising the benefits that axe
I
then
ctber aocds,
the
-
e|A)
In
40,000,
is iasufficieat
$24,000.
The
to
index, I«
realised by the individual
faculty
aesfcecs and
adainisttation
patticulix, is
the ansnej
is
I
by the
clinic
bck coapaced
as
to
^this
>= |X|? Substituting
is clearly
yes.
Thus,
appraised by
the
difference.
In
<25,00€
the
>»|-2U,000r?)
decision is
aade to
continue the prograa.
I£
the
iadei bad
additional benefits
been
had not
less
than
X, i.e.,
been sufficieat
to
if
the
underwrite
the deficit, the Faculty Health Survey program would have
to
b€ re-evaluated and possibly dCMngraded,
PAGE 36
SuoaaEy and CodcIusIcds
fIJ.
No clear-cot
costs
ansvec to the
and i:^De£its
prograa
been
has
found.
adainistration* costs
estiaating the
H.I.T. Faculty
the
of
problem of
Fzci
can can
Health
Survey
standpoint
the
be quajAified*
of
the
but not
the
clearly
benefits.
The Hedical
Oepartient
has
act /identified
the
ccsta of tunoinq this prograa, as distinguished froa others,
and DC
policy has
benefits.
individual
The
originating,
make-up.
fpr
Because
treated
as
the
aost part,
adoinistraticr
(the
and
that
individual was
fraction
by the
the progsaa.
infpraaticn on
of
decisica-aakec)
views
benefits
psychological
his
of data, the
who participate in
deficiency is
costs
froa
represented
box
estiaation of
for the
both
has
cf the lack
black
a
faculty oeabers
ifflpoctant
been established
the
of
The aost
hov
the
costs
and
benefits to the individual and to tke Hedical Oepartaent.
In light of
this situation, the best
was felt to be that of outlining
a
bovi
ccvrse of action
cost-benefit analysis
might be conducted, what inforaatioo shpuld be collected and
how
this
infoxaation
analysis.
A
result
this
of
nuaerical
study,
shculd
exaaple
the
incorporated
be
uas
into
also provided.
the
As
a
prcblea
was
foraalized
called to
its
tost
sensitive
for increased
benefits,
structured,
attention
was
aspects and
new lines
of action,
and
have emergedc
Ihis stody nay serve the B.I.T. adainistjratian, as well
as these of
ether institutions »ith siailar
programs, as
a
guide for collecting infcriation and subsequently evaluating
PAGE 37
their programs. Its publication may also serve to
inform the prime
beneficiaries of the program (the faculty) and perhaps result
in some
change in their attitudes toward it.
PAGE 38
BIEIIC66JFHX
(1)
*•'
**"J"^'
FP. 670-67
i.,
12)
_^f"^^'^.fi-
"P!"°dic Hedical O.erhaul," The lancet,
1,
Septeiber 26, 1953.
-Hestinqhouse
—B-' xheic
Hvest.ent
Hanageient
Health
Value, - Journal of
OccAipaAicaal fledicine, 2, pp. 80-91, February,
1960,
Exaninations
13)
Durblia, 4. I., E. L.
fisk, and B. «, iiopf, "Physical
refects as flevealed by Periodic flealtb
Exalinatiois "
"^'^i"^
Scieaces!mr
'*^
p^.
^^
57TsSJ°
576-594, n*"?"!**^
October, ?'
1925.
^"^^
•'P«^i°^i<^
fledical I«a.inaticas,«
A-erican
«fi-^!t^f'
Hedical
Association Bulletin, 16. p. ia. Bay 15,
1922.
(5)
Fisk, I.
"Periodic ExasinaUon of Supposedly Well
Kentucky fledical Journal,'
12/pp. lol-ns
i...
Persons,"
February,
1,
*
1915.
^^
**
'
'^»
^''^
"Periodic Health E.a.inations
Zxecu^U«'; ?•;;
"'''""" "' '"^^^^' '^'
2J1-2UrS;;, \\\T"^^^
of
pp-
^^^
""-^ ""^
Early Detection
Per!nf?; **.Bxa.matron."
Industrial
^!ri
Surgery. 25, pp. 251-257, June, 1956.
by
and
^
of Disease
Hedicine
^^^
Periodic Health
''^'^^' •'^*»«
?°- *•
Exa^i^Iti^' «•
Exajination,"
Inoustrial Medicine and Surqery.
urgery,
2a
^a,
FF. 161-167, April, 1955.
^^^
^•* *• '^^ ^^'^' ^""^ G- "r- Hurphy, "Periodic
h^^^^k'.^'
Health
Exaainations:
A Long Tern
Study, 1949-1959 «
Journal pf Occupational Hedicine,
3,
13-20
^^'^
pp.
^ '
January, 1961.
(10)
Knixjht,
^
A., "The
Valu€of Periodic Ejta.inaUons of
Insurance Policyholders," Proceedings of
the
Association of Life insuiance Hedical
Directors
of
Anerica, 8, p. 25., 1921-22.
Life
'^^^
rKfi!""'..
*':'
*''°'
*^^ LcndcD
lS?8''«ay 29: ^Sfs!"'
ili)
Post, "Periodic Helath
'°"'"'' °' «edicine, 258,
p.
rtetrcpolitan
Life
Insurance
Co.,
"The
Periodic aedical E.a.ination," Statistical Value of
Bulletin
of the MetrcFolitan
Life Insurance Co., 3,
pp.
*^*^
*
Noveaber, 1921.
"n
'^^^
"^*'* Cut-cf-Iown
ExectiTe Checkup,"
^nnrn^?' /l/' *
"'-^i^i
^^^
Association,
^\
157, "^^
p^.
M\
TA January*"r^"°
159-160,
14, 1961.
PAGE 39
(lU)
Exa»lQations5
"Periodic Health
S. ,
6.
Siegel,
Departaent of
SU.
litecatuce,
Abstracts £ec« the
Service
Health
Public
Welfare,
Health, Education, and
1963.
PublicatiQD No. 1010, Bacch,
••
3.B.
Date Due
'_
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199)
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