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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)

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.

Suggested Citation

  • Richard Cookson, 2005. "QALYs and the capability approach," Health Economics, John Wiley & Sons, Ltd., vol. 14(8), pages 817-829.
  • Handle: RePEc:wly:hlthec:v:14:y:2005:i:8:p:817-829
    DOI: 10.1002/hec.975
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    File URL: http://hdl.handle.net/10.1002/hec.975
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    References listed on IDEAS

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    Cited by:

    1. Coast, Joanna & Flynn, Terry N. & Natarajan, Lucy & Sproston, Kerry & Lewis, Jane & Louviere, Jordan J. & Peters, Tim J., 2008. "Valuing the ICECAP capability index for older people," Social Science & Medicine, Elsevier, vol. 67(5), pages 874-882, September.
    2. 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 927-950, Diciembre.
    3. Wildman, John & McMeekin, Peter & Grieve, Eleanor & Briggs, Andrew, 2016. "Economic evaluation of integrated new technologies for health and social care: Suggestions for policy makers, users and evaluators," Social Science & Medicine, Elsevier, vol. 169(C), pages 141-148.
    4. 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.
    5. Lorgelly, Paula K. & Lorimer, Karen & Fenwick, Elisabeth A.L. & Briggs, Andrew H. & Anand, Paul, 2015. "Operationalising the capability approach as an outcome measure in public health: The development of the OCAP-18," Social Science & Medicine, Elsevier, vol. 142(C), pages 68-81.
    6. Coast, Joanna & Smith, Richard D. & Lorgelly, Paula, 2008. "Welfarism, extra-welfarism and capability: The spread of ideas in health economics," Social Science & Medicine, Elsevier, vol. 67(7), pages 1190-1198, October.
    7. 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.
    8. Richard Smith & Paula Lorgelly & Hareth Al-Janabi & Sridhar Venkatapuram & Joanna Coast, 2012. "The Capability Approach: An Alternative Evaluation Paradigm for Health Economics?," Chapters,in: The Elgar Companion to Health Economics, Second Edition, chapter 39 Edward Elgar Publishing.
    9. Bleichrodt, Han & Quiggin, John, 2013. "Capabilities as menus: A non-welfarist basis for QALY evaluation," Journal of Health Economics, Elsevier, vol. 32(1), pages 128-137.
    10. 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.
    11. Maria Ana Lugo & Esfandiar Maasoumi, 2008. "Multidimensional Poverty Measures from an Information Theory Perspective," Working Papers 85, ECINEQ, Society for the Study of Economic Inequality.
    12. 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.
    13. Carmen Herrero & Juan Moreno-Ternero, 2008. "Opportunity analysis of newborn screening programs," Review of Economic Design, Springer;Society for Economic Design, vol. 12(4), pages 259-277, December.
    14. 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.
    15. Mitchell, Paul Mark & Roberts, Tracy E. & Barton, Pelham M. & Coast, Joanna, 2015. "Assessing sufficient capability: A new approach to economic evaluation," Social Science & Medicine, Elsevier, vol. 139(C), pages 71-79.
    16. Rogowski, Wolf H. & Schleidgen, Sebastian, 2015. "Using needs-based frameworks for evaluating new technologies: An application to genetic tests," Health Policy, Elsevier, vol. 119(2), pages 147-155.
    17. repec:spr:soinre:v:135:y:2018:i:2:d:10.1007_s11205-016-1502-3 is not listed on IDEAS
    18. 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.
    19. 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.
    20. 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.
    21. Richard Cookson & Owen Cotton-Barrett & Matthew Adler & Miqdad Asaria & Toby Ord, 2016. "Years of good life based on income and health: Re-engineering cost-benefit analysis to examine policy impacts on wellbeing and distributive justice," Working Papers 132cherp, Centre for Health Economics, University of York.
    22. 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.
    23. Peter Makai & Willemijn Looman & Eddy Adang & René Melis & Elly Stolk & Isabelle Fabbricotti, 2015. "Cost-effectiveness of integrated care in frail elderly using the ICECAP-O and EQ-5D: does choice of instrument matter?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(4), pages 437-450, May.

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