A qualitative study of the extent to which health gain matters when choosing between groups of patients

Title: A qualitative study of the extent to which health gain matters when choosing between groups of patients
Authors: Dolan, Paul and Cookson, Richard
Publisher: Health Policy, 51 (1). pp. 19-30
ISSN: 0168-8510
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Abstract: There is considerable debate about the appropriateness of allocating health care resources on the basis of the size of the health improvement that they generate. The aim of this study was to elicit the general public’s views about the extent to which health gain matters vis-à-vis other considerations. A total of 60 respondents took part in group discussions designed to enable them to raise, discuss, and reflect upon, different arguments. The qualitative data showed that many responses were being generated by factors that were not directly included in the questions, and so it is difficult to meaningfully interpret the results of other studies which have asked similar questions but which have not looked at the reasons underlying the responses. However, a clear message did come through from the data; namely, that equality of access should prevail over the maximisation of benefits. However, this was subject to the outcome constraint that treatments are sufficiently effective. An important question for future research, then, is ‘how effective do treatments have to be for the principle of equal access to apply?’

A note on QALYs versus HYEs: health states versus health profiles

Title: A note on QALYs versus HYEs: health states versus health profiles
Author: Dolan, Paul
Publisher: International journal of technology assessment in health care, 16 (4). pp. 1220-1224
ISSN: 0266-4623
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Abstract: This paper considers the question of what ought to be valued in the context of measuring the outcomes of healthcare interventions. The answer is discrete health states in the case of the quality-adjusted life-year (QALY) model and an entire health profile in the case of the healthy-years equivalent (HYE) approach. How well the weighted average of values attached to the former approximates the overall value attached to the latter depends on the validity of the assumptions of the QALY model. The paper considers some of the empirical literature relating to them. One of the most important assumptions, which from the limited evidence available appears not to hold, is additive separability. However, it is argued that violation of this assumption does not in itself invalidate the QALY approach, since in some circumstances it might be more appropriate to elicit the value of a health state independently of the states that succeed it. Investigation into this issue is identified as one of the key areas where future research efforts should be directed.

Principles of justice in health care rationing

Title: Principles of justice in health care rationing
Authors: Cookson, Richard and Dolan, Paul
Publisher: Journal of medical ethics, 26 (5). pp. 323-329
ISSN: 0306-6800
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Abstract: This paper compares and contrasts three different substantive (as opposed to procedural) principles of justice for making health care priority-setting or “rationing” decisions: need principles, maximising principles and egalitarian principles. The principles are compared by tracing out their implications for a hypothetical rationing decision involving four identified patients. This decision has been the subject of an empirical study of public opinion based on small-group discussions, which found that the public seem to support a pluralistic combination of all three kinds of rationing principle. In conclusion, it is suggested that there is room for further work by philosophers and others on the development of a coherent and pluralistic theory of health care rationing which accords with public opinions.