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Choosing who shall not be treated in the NHS

Author

Listed:
  • Charny, M.C.
  • Lewis, P.A.
  • Farrow, S.C.

Abstract

In the face of severe resource constraints, health care systems are seeking both to control costs and to ensure maximum benefits for the resources consumed. The use of Quality Adjusted Life Years (QALYs) is becoming more widely advocated as a decision aid in the solution of resource allocation problems. The QALY combines two dimensions of health outcome--the quantity of life and its quality--in such a way that choices between different services with different purposes can be made using comparisons based on common units of measurement. The combination of these two dimensions allows comparisons between services with different objectives, such as curing and caring services. The QALY, however, lacks a third dimension which is vital to the decision-making process to which it is intended to contribute: the worth of a specific life relative to others. This paper presents results based on interviews of 719 residents of Cardiff drawn at random from the electoral register. The results suggest that further development of the novel methodology used to establish the relative value placed on various human lives is worthwhile. Evidence is given which indicates that the public consider lives to be of unequal worth. The results also show that these values are consistent for different types of choices phrased in different ways on a large number of control variables, implying the existence of a cultural stable value system which is a necessary prerequisite if consensus values of human life are to be used to assist decision-making in non-private health care systems. The paper suggests that it is right that the value system of those who pay for a group-funded health care system (such as the NHS) should guide choices between services. It is suggested that these choices are not the prerogative of professionals, whose view should carry no more weight than that of any other citizen. It is recognised that the suggestion that lives are not intrinsically of equal worth poses serious ethical problems for society, but the exploration of the value system of society, as advocated in this paper, may highlight issues which need further consideration.

Suggested Citation

  • Charny, M.C. & Lewis, P.A. & Farrow, S.C., 1989. "Choosing who shall not be treated in the NHS," Social Science & Medicine, Elsevier, vol. 28(12), pages 1331-1338, January.
    • Handle: RePEc:eee:socmed:v:28:y:1989:i:12:p:1331-1338
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    Citations

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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, February.
    2. Julia Fox‐Rushby, 1993. "Appraising the use of contingent valuation: A note in response," Health Economics, John Wiley & Sons, Ltd., vol. 2(4), pages 361-362, December.
    3. James, Marilyn, 1999. "Towards an integrated needs and outcome framework," Health Policy, Elsevier, vol. 46(3), pages 165-177, March.
    4. Mira Johri & Laura J. Damschroder & Brian J. Zikmund‐Fisher & Peter A. Ubel, 2005. "The importance of age in allocating health care resources: does intervention‐type matter?," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 669-678, July.
    5. Dolan, Paul & Shaw, Rebecca, 2004. "A note on a discussion group study of public preferences regarding priorities in the allocation of donor kidneys," Health Policy, Elsevier, vol. 68(1), pages 31-36, April.
    6. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the ‘Fair Innings’ Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132, March.
    7. Anita Lal & Mohammad Siahpush & Marjory Moodie & Anna Peeters & Robert Carter, 2018. "Weighting Health Outcomes by Socioeconomic Position Using Stated Preferences," PharmacoEconomics - Open, Springer, vol. 2(1), pages 43-51, March.
    8. Gu, Yuanyuan & Lancsar, Emily & Ghijben, Peter & Butler, James RG & Donaldson, Cam, 2015. "Attributes and weights in health care priority setting: A systematic review of what counts and to what extent," Social Science & Medicine, Elsevier, vol. 146(C), pages 41-52.
    9. Jana Rogge & Bernhard Kittel, 2016. "Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-15, June.
    10. Julie Ratcliffe, 2000. "Public preferences for the allocation of donor liver grafts for transplantation," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 137-148, March.
    11. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January.
    12. 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.
    13. Cookson, Richard, 2000. "Incorporating psycho-social considerations into health valuation: an experimental study," Journal of Health Economics, Elsevier, vol. 19(3), pages 369-401, May.
    14. Colin Green & Karen Gerard, 2009. "Exploring the social value of health‐care interventions: a stated preference discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 951-976, August.
    15. Rebecca Shaw & Paul Dolan & Aki Tsuchiya & Alan Williams & Peter Smith & Roger Burrows, 2001. "Development of a questionnaire to elicit public preferences regarding health inequalities," Working Papers 040cheop, Centre for Health Economics, University of York.
    16. Aki Tsuchiya & Richard Edlin & Paul Dolan, 2009. "Measuring the societal value of lifetime health," Working Papers 2009010, The University of Sheffield, Department of Economics, revised May 2009.
    17. Gyrd-Hansen, Dorte, 2004. "Investigating the social value of health changes," Journal of Health Economics, Elsevier, vol. 23(6), pages 1101-1116, November.
    18. Royston, Geoff, 1998. "Shifting the balance of health care into the 21st century," European Journal of Operational Research, Elsevier, vol. 105(2), pages 267-276, March.
    19. Colin Green, 2001. "On the societal value of health care: what do we know about the person trade‐off technique?," Health Economics, John Wiley & Sons, Ltd., vol. 10(3), pages 233-243, April.

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