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Prioritizing Health Care: Is “Health†Always an Appropriate Maximand?

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  • Adam Oliver

    (LSE Health and Social Care, London School of Economics London, United Kingdom)

Abstract

In recent years, a few health economists have begun to question the ethical underpinnings of the standard practice of quality-adjusted life year (QALY) maximization as a ubiquitous decision rule in the allocation of health care resources. Prominent among these is Erik Nord, who conjectures that QALY maximization discriminates against the chronically ill and disabled when prioritizing between different individuals (or groups of individuals) for life-extending interventions. Nord has recommended that life years gained should always be given a weight equal to 1 in these circumstances. This article reports an experiment designed as an initial attempt at eliciting some of the thought processes employed by people when they prioritize life-saving health care interventions between patients who differ only in respect to the presence or absence of a disability. The results show that in the priority-setting contexts used, a majority of the respondents perceived the relative health status of the different patients as irrelevant, providing some tentative support for Nord’s argument.

Suggested Citation

  • Adam Oliver, 2004. "Prioritizing Health Care: Is “Health†Always an Appropriate Maximand?," Medical Decision Making, , vol. 24(3), pages 272-280, June.
    • Handle: RePEc:sae:medema:v:24:y:2004:i:3:p:272-280
    DOI: 10.1177/0272989X04265479
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    References listed on IDEAS

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    1. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the ‘Fair Innings’ Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132, March.
    2. Magnus Johannesson, 2001. "Should we aggregate relative or absolute changes in QALYs?," Health Economics, John Wiley & Sons, Ltd., vol. 10(7), pages 573-577, October.
    3. Erik Nord, 2001. "The desirability of a condition versus the well being and worth of a person," Health Economics, John Wiley & Sons, Ltd., vol. 10(7), pages 579-581, October.
    4. Alan Williams, 2001. "The ‘fair innings argument’ deserves a fairer hearing! comments by Alan Williams on Nord and Johannesson," Health Economics, John Wiley & Sons, Ltd., vol. 10(7), pages 583-585, October.
    5. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
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    1. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.

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