Rationalizing- as opposed to rationing- healthcare

09 Jul 2009

I just read a great LA Times column by Michael Hiltzik that offers one of the most lucid definitions of a Quality Adjusted Life Year (QALY) I’ve seen. He is describing the weaknesses of the way it is rated (where a subjectively-assessed rating of quality of life is assigned a quantitative number between 0 and 1), and the way it is translated into justification for certain interventions and not others based on the use of an arbitrary threshold (ie that treatments above 50,000 GBP aren’t “worth it” despite considerations like whether the patient is young or old, or whether the patient’s caregivers might avoid lost income if the treatment is given, etc). It’s worth checking out.

Many of these same issues will be grappled with in other sectors as more people strive to measure impact and make data-driven decisions about where to put resources. Also, methodologies like stakeholder and SROI analysis, which systematically consider the economic (and other) impacts on all major stakeholders, might help overcome some of the common sense flaws in the QALY, by including considerations like the economic impact to patients’ family members of patient treatment (for example, parents might not lose income from missing work if their children are treated and therefore healthier).

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