Health state after treatment: a reason for discrimination?

Abstract

In this paper the issue of discrimination between patients based on the health improvement that each can achieve is addressed. Previous research in this area by Nord has shown that, in this context, society's preferences may be quite opposite to the principle of health maximization present in cost utility analysis. Using a different experimental design from that used by Nord, some results are achieved which suggest that social preferences may be somewhere in between two opposite extremes, which are that discrimination based on the degree of health improvement is never acceptable and that discrimination based on the degree of health improvement is always acceptable.

Severity as an independent determinant of the social value of a health service

“…The idea that it is unfair to give a lower priority to those with a limited capacity for improvement-e.g. the disabled and chronically ill-is well known in the philosophical literature [33][34][35], and empirical studies of public preferences provide further support for it, both in the context of life-saving and lifeenhancing treatment [36][37][38][39][40][41]. What the present study shows, on this interpretation, is that the importance of potential is subject to diminishing marginal returns, as severity decreases, conversely, the value of observing others achieve their potential increases disproportionately as the health state of the person deteriorates.…”

Social preferences for prioritizing the treatment of severely ill patients: The relevance of severity, expected benefit, past health and lifetime health

“…In each of the budget allocation exercises more was allocated to group A than groups B or C. This confirms that the size of the health improvement achieved by different patient groups is important (Nord, Richardson et al 1995a;Abellan-Perpiñán and Prades 1999;Roberts, Bryan et al 1999). However, if participants had sought to maximise health, group A would have received 100 per cent of the budget in each exercise.…”

“…A similar order effect was detected in a study by Abellan-Perpiñán and Prades (1999). They asked a group of subjects to choose between a life-saving operation that would make Charles 'completely healthy', and one that would give James a life 'with moderate pain and dependency on crutches for walking'.…”

Incremental cost per quality-adjusted life year gained? The need for alternative methods to evaluate medical interventions for ultra-rare disorders

“…These results are not very dissimilar from some statements obtained in the Norwegian survey on orphan drugs mentioned above, such as "all should have equal access to health care regardless of cost" [177] -but Nord's study appears much more robust due to the repeated challenging of respondents and alerting them to the issue of opportunity costs. Corresponding findings were reported by Abellan-Perpinan and Pinto-Prades [127], who asked a Spanish convenience sample of respondents how they would allocate a budget between two treatments with the same outcome but the second of them twice as expensive as the first one. Seventy-four percent of respondents preferred a 2:1 budget allocation, regardless of the opportunity cost [127].…”

“…Corresponding findings were reported by Abellan-Perpinan and Pinto-Prades [127], who asked a Spanish convenience sample of respondents how they would allocate a budget between two treatments with the same outcome but the second of them twice as expensive as the first one. Seventy-four percent of respondents preferred a 2:1 budget allocation, regardless of the opportunity cost [127]. These results are consistent with the findings obtained in studies reported earlier, for example, two studies examining social preferences for the allocation of scarce organs for transplantation in England [168] and the USA [160], and an Australian exercise in healthcare budget sharing [159].…”