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Utilities vs. Rights to Publicly Provided Goods: Arguments and Evidence from Health-Care Rationing

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  • Paul Anand

    ()
    (Department of Economics, Faculty of Social Sciences, The Open University)

  • Allan Wailoo

Abstract

This paper challenges the QALY maximizing approach to rationing health care on the grounds of the consequentialist (and sometimes approximately utilitarian) moral framework on which it is based. An alternative methodological approach is suggested and, in addition to consequences, four normative determinants of health care entitlements are identified: rights, public opinion, social contracts and community values. Survey evidence is presented which shows support for these alternative frameworks and a rejection of consequentialism. The paper suggests that a (if not the) major challenge facing the designers of rationing guidelines is that of pluralism, i.e. the need to integrate considerations from a set of frameworks.

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Bibliographic Info

Paper provided by The Open University, Faculty of Social Sciences, Department of Economics in its series Open Discussion Papers in Economics with number 14.

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Date of creation: Jan 2000
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Publication status: Published in Economica, London School of Economics and Political Science, vol. 67(268), pages 543-77, November
Handle: RePEc:opn:wpaper:14

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Cited by:
  1. Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208.
  2. Tania Stafinski & Devidas Menon & Deborah Marshall & Timothy Caulfield, 2011. "Societal Values in the Allocation of Healthcare Resources," The Patient: Patient-Centered Outcomes Research, Springer, vol. 4(4), pages 207-225, December.
  3. Amartya Sen, 2002. "Why health equity?," Health Economics, John Wiley & Sons, Ltd., vol. 11(8), pages 659-666.
  4. Paul Anand, 2002. "The Integration of Claims to Health-Care: a Programming Approach," Open Discussion Papers in Economics 45, The Open University, Faculty of Social Sciences, Department of Economics.
  5. Johansson-Stenman, Olof & Martinsson, Peter, 2008. "Are some lives more valuable? An ethical preferences approach," Journal of Health Economics, Elsevier, vol. 27(3), pages 739-752, May.
  6. Daniel Eisenberg & Gary Freed & Matthew Davis & Dianne Singer & Lisa Prosser, 2011. "Valuing health at different ages," Applied Health Economics and Health Policy, Springer, vol. 9(3), pages 149-156, May.
  7. Johansson-Stenman, Olof & Martinsson, Peter, 2003. "Are Some Lives More Valuable?," Working Papers in Economics 96, University of Gothenburg, Department of Economics.
  8. Anand, Paul & van Hees, Martin, 2006. "Capabilities and achievements: An empirical study," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 35(2), pages 268-284, April.
  9. Richardson, Jeff & McKie, John, 2007. "Economic evaluation of services for a National Health Scheme: The case for a fairness-based framework," Journal of Health Economics, Elsevier, vol. 26(4), pages 785-799, July.

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