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QALYs and the capability approach

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  • Richard Cookson

    (School of Medicine, Health Policy and Practice, University of East Anglia, UK)

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    Abstract

    This explores the applicability of Sen's capability approach to the economic evaluation of health care programmes. An individual's 'capability set' describes his freedom to choose valuable activities and states of being ('functionings'). Direct estimation and valuation of capability sets is not feasible at present. Standard preference-based methods such as willingness to pay are feasible, but problematic due to the adaptive and constructed nature of individual preferences over time and under uncertainty. An alternative is to re-interpret the QALY as a cardinal and interpersonally comparable index of the value of the individual's capability set. This approach has limitations, since the link between QALYs and capabilities is not straightforward. Nevertheless, the QALY approach is recognisable as an application of the capability approach since it pays close attention to functionings, through the use of survey-based multi-attribute health state valuation instruments, and permits conceptions of value other than the traditional utilitarian ones of choice, desire-fulfilment and happiness. Furthermore, suitably re-interpreted, it can account for (i) non-separability between health and non-health components of value; and suitably modified it can also account for (ii) process attributes of care, which may have a direct effect on non-health functionings such as comfort and dignity, and (iii) sub-group diversity in the value of the same health functionings. Copyright © 2005 John Wiley & Sons, Ltd.

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    File URL: http://hdl.handle.net/10.1002/hec.975
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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 14 (2005)
    Issue (Month): 8 ()
    Pages: 817-829

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    Handle: RePEc:wly:hlthec:v:14:y:2005:i:8:p:817-829

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    Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    1. Tania Burchardt & Julian Le Grand, 2002. "Constraint and Opportunity: Identifying Voluntary Non-Employment," CASE Papers case55, Centre for Analysis of Social Exclusion, LSE.
    2. Hurley, Jeremiah, 2000. "An overview of the normative economics of the health sector," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 2, pages 55-118 Elsevier.
    3. 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.
    4. Loomes, Graham & McKenzie, Lynda, 1989. "The use of QALYs in health care decision making," Social Science & Medicine, Elsevier, vol. 28(4), pages 299-308, January.
    5. Richard Cookson, 2003. "Willingness to pay methods in health care: a sceptical view," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 891-894.
    6. Sakiko Fukuda-Parr, 2003. "The Human Development Paradigm: Operationalizing Sen'S Ideas On Capabilities," Feminist Economics, Taylor & Francis Journals, vol. 9(2-3), pages 301-317.
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    9. Joshua A. Salomon & Christopher J.L. Murray, 2004. "A multi-method approach to measuring health-state valuations," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 281-290.
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    Cited by:
    1. Sabina Alkire, 2008. "Concepts and Measures of Agency," OPHI Working Papers ophiwp010, Queen Elizabeth House, University of Oxford.
    2. HERRERO, Carmen & MORENO-TERNERO, Juan D., . "Opportunity analysis of newborn screening programs," CORE Discussion Papers RP -2109, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    3. Joanna Coast & Richard Smith & Paula Lorgelly, 2008. "Should the capability approach be applied in Health Economics?," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 667-670.
    4. Dasgupta, Parasmani & Saha, Rana & Nubé, Maarten, 2008. "Changes in body size, shape and nutritional status of Middle-Class Bengali boys of Kolkata, India, 1982-2002," Economics & Human Biology, Elsevier, vol. 6(1), pages 75-94, March.
    5. Brouwer, Werner B.F. & Culyer, Anthony J. & van Exel, N. Job A. & Rutten, Frans F.H., 2008. "Welfarism vs. extra-welfarism," Journal of Health Economics, Elsevier, vol. 27(2), pages 325-338, March.
    6. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39.
    7. Simon, Judit & Anand, Paul & Gray, Alastair & Rugkåsa, Jorun & Yeeles, Ksenija & Burns, Tom, 2013. "Operationalising the capability approach for outcome measurement in mental health research," Social Science & Medicine, Elsevier, vol. 98(C), pages 187-196.
    8. Lalit Garg & Sally McClean & Brian Meenan & Peter Millard, 2010. "A non-homogeneous discrete time Markov model for admission scheduling and resource planning in a cost or capacity constrained healthcare system," Health Care Management Science, Springer, vol. 13(2), pages 155-169, June.
    9. Bleichrodt, Han & Quiggin, John, 2011. "Capabilities as Menus: A Non-Welfarist Basis for QALY Evaluation," Risk and Sustainable Management Group Working Papers 151199, University of Queensland, School of Economics.
    10. Samuel Shillcutt & Damian Walker & Catherine Goodman & Anne Mills, 2009. "Cost Effectiveness in Low- and Middle-Income Countries," PharmacoEconomics, Springer, vol. 27(11), pages 903-917, November.
    11. P. G. Ardeni & C. Tinonin, 2013. "Capability-Deprivation as Determinant of Underweight in Children: Perspectives from an Indian Case-Study," Working Papers wp904, Dipartimento Scienze Economiche, Universita' di Bologna.
    12. Al-Janabi, Hareth & Keeley, Thomas & Mitchell, Paul & Coast, Joanna, 2013. "Can capabilities be self-reported? A think aloud study," Social Science & Medicine, Elsevier, vol. 87(C), pages 116-122.
    13. Abellán Perpiñán, José Mª & Sánchez Martínez,Fernando I. & Martínez Pérez, Jorge E., 2007. "La medición del bienestar social relacionado con la salud/The Measurement of the Health Related Social Welfare," Estudios de Economía Aplicada, Estudios de Economía Aplicada, vol. 25, pages 823 - 24 PÃ, Diciembre.

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