IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v9y2000i1p57-68.html
   My bibliography  Save this article

QALYs and ageism: philosophical theories and age weighting

Author

Listed:
  • Aki Tsuchiya

Abstract

QALY maximization is sometimes criticized for being ‘ageist’, because, other things being equal, the elderly, with a shorter life expectancy, will be given lower priority. On the other hand, there are philosophical arguments that, for different reasons, advocate rationing health care to the elderly, even when the size of the expected benefits in QALY terms is the same across older and younger patients. This paper examines six proposals, both from the philosophical and the health economics literature, that will lead to such conclusions. These are: two variants of the so‐called fair innings argument, the fair innings weights, the Disability Adjusted Life Year (DALY) age weighting, the biographical life span, and the prudential lifetime account. Two questions are addressed with regard to each of these. First, what is the reason for choosing the younger patient when the QALY gains are equal; second, will the younger patient continue to be chosen even when the QALY gains to the older patient are larger. The paper studies the relationship between the six proposals and explores their possible implications for QALY maximization. Copyright © 2000 John Wiley & Sons, Ltd.

Suggested Citation

  • Aki Tsuchiya, 2000. "QALYs and ageism: philosophical theories and age weighting," Health Economics, John Wiley & Sons, Ltd., vol. 9(1), pages 57-68, January.
    • Handle: RePEc:wly:hlthec:v:9:y:2000:i:1:p:57-68
    DOI: 10.1002/(SICI)1099-1050(200001)9:1<57::AID-HEC484>3.0.CO;2-N
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/(SICI)1099-1050(200001)9:13.0.CO;2-N
    Download Restriction: no
    File URL: https://libkey.io/10.1002/(SICI)1099-1050(200001)9:1<57::AID-HEC484>3.0.CO;2-N?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Busschbach, Jan J. V. & Hessing, Dick J. & De Charro, Frank Th., 1993. "The utility of health at different stages in life: A quantitative approach," Social Science & Medicine, Elsevier, vol. 37(2), pages 153-158, July.
    2. Johannesson, Magnus & Johansson, Per-Olov, 1997. "Is the valuation of a QALY gained independent of age? Some empirical evidence," Journal of Health Economics, Elsevier, vol. 16(5), pages 589-599, October.
    3. 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.
    4. Tsuchiya, Aki, 1999. "Age-related preferences and age weighting health benefits," Social Science & Medicine, Elsevier, vol. 48(2), pages 267-276, January.
    5. Cropper, Maureen L & Aydede, Sema K & Portney, Paul R, 1994. "Preferences for Life Saving Programs: How the Public Discounts Time and Age," Journal of Risk and Uncertainty, Springer, vol. 8(3), pages 243-265, May.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Anand, Paul, 2003. "The integration of claims to health-care: a programming approach," Journal of Health Economics, Elsevier, vol. 22(5), pages 731-745, September.
    2. Daniel Eisenberg & Gary Freed & Matthew Davis & Dianne Singer & Lisa Prosser, 2011. "Valuing health at different ages," Applied Health Economics and Health Policy, Springer, vol. 9(3), pages 149-156, May.
    3. Malcolm Oswald, 2015. "In a democracy, what should a healthcare system do? A dilemma for public policymakers," Politics, Philosophy & Economics, , vol. 14(1), pages 23-52, February.
    4. Arthur E. Attema & Werner B. F. Brouwer & Jose Luis Pinto‐Prades, 2022. "Reference‐dependent age weighting of quality‐adjusted life years," Health Economics, John Wiley & Sons, Ltd., vol. 31(12), pages 2515-2536, December.
    5. Stolk, Elly A. & Brouwer, Werner B. F. & Busschbach, Jan J. V., 2002. "Rationalising rationing: economic and other considerations in the debate about funding of Viagra," Health Policy, Elsevier, vol. 59(1), pages 53-63, January.
    6. Attema, Arthur E. & Brouwer, Werner B.F., 2012. "A test of independence of discounting from quality of life," Journal of Health Economics, Elsevier, vol. 31(1), pages 22-34.
    7. Richard Edlin & Aki Tsuchiya & Paul Dolan, 2012. "Public Preferences For Responsibility Versus Public Preferences For Reducing Inequalities," Health Economics, John Wiley & Sons, Ltd., vol. 21(12), pages 1416-1426, December.
    8. Ottersen, Trygve & Mbilinyi, Deogratius & Maestad, Ottar & Norheim, Ole Frithjof, 2008. "Distribution matters: Equity considerations among health planners in Tanzania," Health Policy, Elsevier, vol. 85(2), pages 218-227, February.
    9. Al-Janabi, Hareth & Wittenberg, Eve & Donaldson, Cam & Brouwer, Werner, 2022. "The relative value of carer and patient quality of life: A person trade-off (PTO) study," Social Science & Medicine, Elsevier, vol. 292(C).
    10. Clémence Thebaut & Paul-Loup Weil-Dubuc & Jérôme Wittwer, 2022. "The Philosophical Justifications of the “Fair Innings Argument” and Related Controversies," Working Papers halshs-03670001, HAL.
    11. Luyten, Jeroen & Kessels, Roselinde & Atkins, Katherine E. & Jit, Mark & van Hoek, Albert Jan, 2019. "Quantifying the public's view on social value judgments in vaccine decision-making: A discrete choice experiment," Social Science & Medicine, Elsevier, vol. 228(C), pages 181-193.
    12. Santos, João Vasco & Cylus, Jonathan, 2024. "The value of healthy ageing: Estimating the economic value of health using time use data," Social Science & Medicine, Elsevier, vol. 340(C).
    13. Robberstad, Bjarne & Norheim, Ole F., 2011. "Incorporating concerns for equal lifetime health in evaluations of public health programs," Social Science & Medicine, Elsevier, vol. 72(10), pages 1711-1716, May.
    14. David L.B. Schwappach, 2003. "Does it matter who you are or what you gain? an experimental study of preferences for resource allocation," Health Economics, John Wiley & Sons, Ltd., vol. 12(4), pages 255-267, April.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208, February.
    2. Mira Johri & Laura J. Damschroder & Brian J. Zikmund‐Fisher & Peter A. Ubel, 2005. "The importance of age in allocating health care resources: does intervention‐type matter?," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 669-678, July.
    3. Eva Rodríguez & José Luis Pinto, 2000. "The social value of health programmes: is age a relevant factor?," Health Economics, John Wiley & Sons, Ltd., vol. 9(7), pages 611-621, October.
    4. Mæstad, Ottar & Norheim, Ole Frithjof, 2009. "Eliciting people's preferences for the distribution of health: A procedure for a more precise estimation of distributional weights," Journal of Health Economics, Elsevier, vol. 28(3), pages 570-577, May.
    5. Adele Diederich & Jeannette Winkelhage & Norman Wirsik, 2011. "Age as a Criterion for Setting Priorities in Health Care? A Survey of the German Public View," PLOS ONE, Public Library of Science, vol. 6(8), pages 1-10, August.
    6. Denburg, Avram E. & Ungar, Wendy J. & Chen, Shiyi & Hurley, Jeremiah & Abelson, Julia, 2020. "Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey," Health Policy, Elsevier, vol. 124(6), pages 647-658.
    7. Mouter, Niek & van Cranenburgh, Sander & van Wee, Bert, 2017. "Do individuals have different preferences as consumer and citizen? The trade-off between travel time and safety," Transportation Research Part A: Policy and Practice, Elsevier, vol. 106(C), pages 333-349.
    8. Rebecca Shaw & Paul Dolan & Aki Tsuchiya & Alan Williams & Peter Smith & Roger Burrows, 2001. "Development of a questionnaire to elicit public preferences regarding health inequalities," Working Papers 040cheop, Centre for Health Economics, University of York.
    9. Mæstad, Ottar & Norheim, Ole Frithjof, 2012. "A universal preference for equality in health? Reasons to reconsider properties of applied social welfare functions," Social Science & Medicine, Elsevier, vol. 75(10), pages 1836-1843.
    10. Olof Johansson‐Stenman & Minhaj Mahmud & Peter Martinsson, 2011. "Saving lives versus life‐years in rural Bangladesh: an ethical preferences approach," Health Economics, John Wiley & Sons, Ltd., vol. 20(6), pages 723-736, June.
    11. Jaldell Henrik, 2013. "Cost-benefit analyses of sprinklers in nursing homes for elderly," Journal of Benefit-Cost Analysis, De Gruyter, vol. 4(2), pages 209-235, August.
    12. repec:cup:judgdm:v:16:y:2021:i:1:p:1-19 is not listed on IDEAS
    13. Odejar, Maria & Baker, Rachel & Ryan, Mandy & Donalson, Cam & Bateman, Ian J. & Jones-Lee, M & Lancsar, Emily & Mason, Helen & Pinto Paredes, JL & Robinson, A & Shackley, P & Smith, R & Sugdem, R & Wi, 2010. "Weighting and valuing quality-adjusted life-years using stated preference methods: preliminary results from the Social Value of a QALY Project," MPRA Paper 108869, University Library of Munich, Germany.
    14. Karen Huang & Regan M. Bernhard & Netta Barak-Corren & Max Bazerman & Joshua D. Greene, 2021. "Veil-of-ignorance reasoning mitigates self-serving bias in resource allocation during the COVID-19 crisis," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 16(1), pages 1-19, January.
    15. Murray, Christopher J. L. & Acharya, Arnab K., 1997. "Understanding DALYs," Journal of Health Economics, Elsevier, vol. 16(6), pages 703-730, December.
    16. Bleichrodt, Han & Crainich, David & Eeckhoudt, Louis, 2003. "Comorbidities and the willingness to pay for health improvements," Journal of Public Economics, Elsevier, vol. 87(11), pages 2399-2406, October.
    17. Hansen, Lise Desireé & Kjær, Trine, 2019. "Disentangling public preferences for health gains at end-of-life: Further evidence of no support of an end-of-life premium," Social Science & Medicine, Elsevier, vol. 236(C), pages 1-1.
    18. Anand, Paul, 2003. "The integration of claims to health-care: a programming approach," Journal of Health Economics, Elsevier, vol. 22(5), pages 731-745, September.
    19. Attema, Arthur E. & Brouwer, Werner B.F. & l’Haridon, Olivier & Pinto, Jose Luis, 2015. "Estimating sign-dependent societal preferences for quality of life," Journal of Health Economics, Elsevier, vol. 43(C), pages 229-243.
    20. Henrik Hammar & Olof Johansson‐Stenman, 2004. "The value of risk‐free cigarettes – do smokers underestimate the risk?," Health Economics, John Wiley & Sons, Ltd., vol. 13(1), pages 59-71, January.
    21. J.C. Herbert Emery & Jesse A. Matheson, 2012. "Should income transfers be targeted or universal? Insights from public pension influences on elderly mortality in Canada, 1921-1966," Canadian Journal of Economics, Canadian Economics Association, vol. 45(1), pages 247-269, February.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:9:y:2000:i:1:p:57-68. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.