Question

Question 4

1. Mention and discuss some of the ethical challenges with the QALY as a measure of health benefit. Give an example of double counting of benefits in cost benefit analysis
2. Explain how measures of compensation (e.g., willingness to pay) can be estimated and discuss whether they offer advantages compared to QALY measures.
3. Explain what is meant by a welfarist, extra welfarist and a social decision-making approach to the economic evaluation of health care technologies.

Answer 1

A. Someone's wrong can be your right, which means your right will definitely, at some point, be someone else's wrong. Most of the time, the “right” choice is subjective. In business, many of these ethical challenges appear in the form of bribes, conflicts of interest, issues of honesty and integrity, and whistle-blowing.

B. To determine QALYs, one multiplies the utility value associated with a given state of health by the years lived in that state. A year of life lived in perfect health is worth 1 QALY (1 year of life × 1 Utility value).

C. Rules and principles for guiding decision-making in the health care sector have been debated for decades. Here, we present a critical appraisal of the two most important paradigms in this respect: welfarism and extra-welfarism. While the former deals with the maximization of the overall sum of individual utilities as its primary outcome, the latter has been focusing on the maximization of the overall health status. We argue that welfarism has three main problems: (1) its central idea of overall sum of individual utilities does not capture societal values decisively relevant in the context of health; (2) the use of the Potential Pareto Improvement brings an unresolvable separation between efficiency and equity; and (3) individual utility may not be a good measure in the health sector, given that individuals might value things that diminish their overall health.