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QALYs and ageism: philosophical theories and age weighting

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  • Aki Tsuchiya

Abstract

QALY maximization is sometimes criticized for being ‘ageist’, because, other things being equal, the elderly, with a shorter life expectancy, will be given lower priority. On the other hand, there are philosophical arguments that, for different reasons, advocate rationing health care to the elderly, even when the size of the expected benefits in QALY terms is the same across older and younger patients. This paper examines six proposals, both from the philosophical and the health economics literature, that will lead to such conclusions. These are: two variants of the so‐called fair innings argument, the fair innings weights, the Disability Adjusted Life Year (DALY) age weighting, the biographical life span, and the prudential lifetime account. Two questions are addressed with regard to each of these. First, what is the reason for choosing the younger patient when the QALY gains are equal; second, will the younger patient continue to be chosen even when the QALY gains to the older patient are larger. The paper studies the relationship between the six proposals and explores their possible implications for QALY maximization. Copyright © 2000 John Wiley & Sons, Ltd.

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  • Aki Tsuchiya, 2000. "QALYs and ageism: philosophical theories and age weighting," Health Economics, John Wiley & Sons, Ltd., vol. 9(1), pages 57-68, January.
    • Handle: RePEc:wly:hlthec:v:9:y:2000:i:1:p:57-68
    DOI: 10.1002/(SICI)1099-1050(200001)9:1<57::AID-HEC484>3.0.CO;2-N
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    3. Malcolm Oswald, 2015. "In a democracy, what should a healthcare system do? A dilemma for public policymakers," Politics, Philosophy & Economics, , vol. 14(1), pages 23-52, February.
    4. Arthur E. Attema & Werner B. F. Brouwer & Jose Luis Pinto‐Prades, 2022. "Reference‐dependent age weighting of quality‐adjusted life years," Health Economics, John Wiley & Sons, Ltd., vol. 31(12), pages 2515-2536, December.
    5. Stolk, Elly A. & Brouwer, Werner B. F. & Busschbach, Jan J. V., 2002. "Rationalising rationing: economic and other considerations in the debate about funding of Viagra," Health Policy, Elsevier, vol. 59(1), pages 53-63, January.
    6. Attema, Arthur E. & Brouwer, Werner B.F., 2012. "A test of independence of discounting from quality of life," Journal of Health Economics, Elsevier, vol. 31(1), pages 22-34.
    7. Ottersen, Trygve & Mbilinyi, Deogratius & Maestad, Ottar & Norheim, Ole Frithjof, 2008. "Distribution matters: Equity considerations among health planners in Tanzania," Health Policy, Elsevier, vol. 85(2), pages 218-227, February.
    8. Al-Janabi, Hareth & Wittenberg, Eve & Donaldson, Cam & Brouwer, Werner, 2022. "The relative value of carer and patient quality of life: A person trade-off (PTO) study," Social Science & Medicine, Elsevier, vol. 292(C).
    9. Richard Edlin & Aki Tsuchiya & Paul Dolan, 2012. "Public Preferences For Responsibility Versus Public Preferences For Reducing Inequalities," Health Economics, John Wiley & Sons, Ltd., vol. 21(12), pages 1416-1426, December.
    10. Clémence Thebaut & Paul-Loup Weil-Dubuc & Jérôme Wittwer, 2022. "The Philosophical Justifications of the “Fair Innings Argument” and Related Controversies," Working Papers halshs-03670001, HAL.
    11. Luyten, Jeroen & Kessels, Roselinde & Atkins, Katherine E. & Jit, Mark & van Hoek, Albert Jan, 2019. "Quantifying the public's view on social value judgments in vaccine decision-making: A discrete choice experiment," Social Science & Medicine, Elsevier, vol. 228(C), pages 181-193.
    12. Robberstad, Bjarne & Norheim, Ole F., 2011. "Incorporating concerns for equal lifetime health in evaluations of public health programs," Social Science & Medicine, Elsevier, vol. 72(10), pages 1711-1716, May.
    13. David L.B. Schwappach, 2003. "Does it matter who you are or what you gain? an experimental study of preferences for resource allocation," Health Economics, John Wiley & Sons, Ltd., vol. 12(4), pages 255-267, April.

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