Conducted from 1974 to 1982 in 6 sites: Dayton, Ohio; Seattle, Washington; Fitchburg-Leominster and Franklin County, Massachusetts; and Charleston and Georgetown County, South Carolina. These sites represent four census regions (Midwest, West, Northeast, and South), as well as urban and rural areas. Attempted to determine what effects alternative cost-sharing plans and a staff-model Health Maintenance Organization (HMO) had on the use of medical services and individual health outcomes. The main purpose was to assess how the cost of health services affected individuals' use of services, their satisfaction with health care, the quality of their care, and the state of their health. To study the effects of health insurance coverage, a comprehensive method for measuring health and monitoring changes in health over time was developed. Health status was seen as having 4 dimensions: physical, mental, social, and physiological. Physical health focused on 5 categories of activities: self-care, mobility, exertion, role fulfillment, and leisure pursuits. Mental health focused on mood and anxiety disorders along with loss of control over feelings, thoughts, and behavior. Social health was assessed by the frequency of several kinds of participation, interaction, and resources, covering family and home, social life, and community involvement. Physiologic health was determined by looking at a number of physical disorders both in adults (aged 14 to 61) and children (aged 0 to 13) that would be easily traced over time and would be responsive to changes in the level and quality of medical care. For adults, acne, congestive heart failure, and sleeping pill and tranquilizer use were considered. For children, variables included allergic conditions (asthma, eczema, hay fever), anemia, middle ear disease, hearing impairment, and vision impairment. Also included were general health measures based on single questions about health-related pain and worry, and a rating of health (excellent, good, fair, poor). Health habits described aspects of smoking, consumption of alcohol, weight, height, and exercise.
