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20
Costs,organizationandmanagementofhospitals
ÉtudesEconomiques,theFrenchNationalInstituteofEconomicStudiesandSta-
tistics),itconstitutedacomprehensiveevaluationofsocialdisability.Ourquestion-
naireincludedsixofthesevenareasofsocialdisabilityconsideredasfollows:the
"workingconditions”gurelargelyinthefieldof"health”.
23
Eachofthesixareas
groupedtwotofourspecificindicators,i.e.atotalof14indicators[Table1].Some
oftheseindicatorsarethesumofseveralvariables,givingatotalof30variables.
Theindicatorswerenotredundant.Thequestionnaireonsocialdisabilityincluded
213itemsandtheresponseswereusedtoobtainasocialdisabilityscorebasedon
variables,indicatorsandareas.Villeneuve
24
showedapopulationnaturallyendowed
by4.3disabilitiesonaverage.Underfourdisabilities,wecandefineanon-social
disabilitysituation.FollowingVilleneuve,
25
wepostulatethatthepresenceof1to4
accumulateddisabilitiesdoesnotindicatesocialdisability(class1=nosocialdis-
ability).Villeneuve
26
determinedtheclass1range(1to4indicators).Soweareleft
with10indicatorstodispatchintodisabilityclasses.Inarstapproach,wedecided
tocomputethreeotherhomogeneousclasses:from5to7disabilities,aslightsocial
disability(class2);from8to10disabilities,animportantsocialdisability(class
3);over10disabilities,aseveresocialdisability(class4).Inasecondapproach,
wecouldmergetwoclassestogetherincasewegettoosmallanumberofpatients
inoneclasstomakeasensitivityanalysis.Thefinaldisabilityscoreisnotobtained
bythesumofthescoresineachareabutbythepresenceofanumberofindicators
identifiedastheworse.Sincesocialdisabilityisoftenassociatedwithalanguage
barrier,thequestionnairewastranslatedintoEnglishandMandarin
27,28
tocaterto
awiderrangeofrespondents.
2)Qualityoflife:Thequalityoflifelevelassociatedwithasocialdisabilitylevel
wasestimatedwithageneralqualityoflifequestionnaire(Euroqol).Accordingtothe
resourceallocationmodel,29qualityoflifeispotentiallyagoodindicatorofresources
required;particularlywhenthehypothesisofcorrelationbetweensocialdisability
andqualityoflifeisconfirmed.Thequalityoflifequestionnairewascompletedby
avisualanalogicscaletostudythecorrelationbetweenseveresocialdisabilityand
diminishingqualityoflife.Asthesocialdisabilityquestionnaireincluded213items,
theEuroqolquestionnairewaschosen(EQ5-D,Frenchversion,5)becauseitconsists
ofvequicktoanswerquestions.Theresponsestothequalityoflifequestionnaire
weregivenascorebyPrietoetal.30whoshowedthatthesameweightingcanbegiven
toeachanswerwithoutaffectingsignificantlytheresults.The"measuredlifequal-
23J.L.Borkowski,L.Kasparian(1991),Construiredesindicateursd’inégalitésEnquête
«Étudedesconditionsdevie»1986–1987,DocumentdetravailF9106.INSEE,Paris.
24A.Villeneuve(1991),LamesuredesinégalitéssoussonaspectmultidimensionnelEnquête
«Étudedesconditionsdevie»1986–1987,DocumentdetravailF9105.INSEE,Paris.
25Ibidem.
26Ibidem.
27D.Castiel,P.H.Bréchat,M.C.Mathieu-Grenouilleau,R.Rymer(2009)Socialdisabilityand
publichospitals:towardsamodelofresourceallocation,SantéPublique2,p.195–212.
28Ibidem.
29D.Castiel(1995),Equitéetsanté,ÉditionsENSP,Rennes.
30L.Prieto,J.A.Sacristan(2004),Whatisthevalueofsocialvalues?Theuselessnessofassess-
inghealth-relatedqualityoflifethroughpreferencemeasures,BMC.Med.Res.Methodol.4,10.