Therefore, independent of the effects on health status, the process of care is
also important in contributing to welfare.
The output of prevention is more difficult to observe than the output of
treatment. Typically preventive activities are aimed at health improvements or
maintenance in the long term and the ’improvement’ may not be a gain in
health status but the avoidance or minimisation of deterioration in health.
Thus, improvement is defined relative to what would have been the case in the
absence of the preventive program.
Is the output of health promotion more than health status gains? We would
argue probably yes. Information about health and risks to health may be
valued even if it does not change behaviour. Participation in health promotion
programs may be enjoyable apart from any health status changes. The outputs
and outcomes of treatment and prevention are summarised diagrammatically in
figure 6.
Therefore, to categorise the outcomes of health care, including prevention, as
only health gains is a very narrow view. The provision of information and
satisfaction with the process of health care are also relevant to consumer
welfare and hence should be regarded as part of the conceptual framework of
health outcomes.
17
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