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The Proceedings of the Twentieth World Congress of Philosophy

Volume 1, 1999


Dan W. Brock
Pages 215-229
DOI: 10.5840/wcp20199911

Ethical Issues in the Construction of Cost-Effectiveness Analyses for the Prioritization and Rationing of Healthcare

The dominant methodology in health policy for prioritizing and rationing health care resources is cost-effectiveness analysis, typically using quality adjusted life years (QALYs) or disability adjusted life years (DALYs) to measure health outcomes. The construction of these measures involves a number of moral or value choices, including: How should states of health and disability be evaluated, and whose preferences (e.g., the disabled or non-disabled) should be used? How should these evaluations reflect that prioritization will involve tradeoffs between health benefits for different persons or groups? Do all QALYs count equally, no matter what age at which they are received? Should discount rates be applied to health benefits? I will show the nature of the moral issues at stake in answering these questions, and briefly argue how they should be answered.