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QALYs and the capability approach

  • Richard Cookson

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

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    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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    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
    Contact details of provider: Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    1. 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.
    2. Dolan, P. & Gudex, C. & Kind, P. & Williams, A., 1996. "Valuing health states: A comparison of methods," Journal of Health Economics, Elsevier, vol. 15(2), pages 209-231, April.
    3. 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.
    4. Culyer, A J, 1989. "The Normative Economics of Health Care Finance and Provision," Oxford Review of Economic Policy, Oxford University Press, vol. 5(1), pages 34-58, Spring.
    5. Tania Burchardt & Julian Le Grand, 2002. "Constraint and Opportunity: Identifying Voluntary Non-Employment," CASE Papers case55, Centre for Analysis of Social Exclusion, LSE.
    6. 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.
    7. 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.
    8. 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.
    9. 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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