Double jeopardy and the use of QALYs in health care allocation.

Abstract

The use of the Quality Adjusted Life-Year (QALY) as a measure of the benefit obtainedfrom health care expenditure has been attacked on the ground that it gives a lower value to preserving the lives ofpeople with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled. We can all agree that when we spend money from the public purse on health care, we should try to get value for money. But there the agreement stops. What is value for money in health care? The outcomes of health care expenditure are so diverse that we need a common standard by which to compare them. The most promising common standard, many believe, is the Quality Adjusted LifeYear, or QALY. In essence, this standard says that the value we get from spending money on health care can be measured in terms of the number of years of life gained, as long as we provide an appropriate rate of discount for periods in which, as a result of ill-health or disability, the quality of life is poor. Several techniques have been used to establish the appropriate rate of discount. The most direct of these, the time trade-off, asks people how long a

Altersrationierung

“…Aus den in der gesichteten Literatur beschriebenen Definitionen und Möglich-keiten der Altersrationierung in der Medizin kann ein "double jeopardy" geschlussfolgert und diskutiert werden [22,29]. Dieses bedeutet, dass Methoden zur gesundheitsökonomischen Evaluation die Inanspruchnahme medizinischer Leistungen in dem Maß einschrän-ken, dass Menschen mit bereits bestehenden gesundheitlichen Problemen (in diesem Fall der ältere/alte morbide Patient) die Leistungen nur noch bedingt erhalten sollen [27].…”

The Americans with Disabilities Act and Health Care Allocation

“…The most robust ethical argument for the permissibility of disability discrimination in health care was first proposed by Singer, McKie, Kuhse and Richardson (1995) and then elaborated by McKie, Richardson, Singer, and Kuhse (1998). Hereafter, I will use a general term to refer to these authors, and call them the Melburnians because they all worked at Monash University in Melbourne.…”

“…Several philosophers have offered normative arguments for the permissibility of unequal treatment on the basis of disability in health care. The most powerful of these was proposed by Singer et al (1995) and put forward by McKie et al (1998). Their argument is often criticized on the grounds that unequal treatment on the basis of disability in health care is in fact a form of wrongful discrimination, rather than by establishing that such treatment cannot be justified.…”

“…As far as I can see, there is no effective normative criticism against the normative argument for the permissibility of unequal treatment of disabled and non-disabled patients. In this paper, I will propose a normative argument against unequal treatment in health care on the basis of disability by virtue 109 THE AMERICANS WITH DISABILITIES ACT of criticising the argument first made in Singer et al (1995). I will accept their theoretical framework but derive an argument against the permissibility of unequal treatment on the basis of disability in health care.…”

Purchasing population health: Aligning financial incentives to improve health outcomes

“…5. Ethical concerns, such as protecting disadvantaged populations (Harris 1987;Bell and Mendus 1988;Williams 1992;Singer et al 1995), the distribution of benefit over few versus many (Olsen 1994), and the process of social valuation of HALEs (Williams 1988), need to be explored. 6.…”