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QALYs and ageism: philosophical theories and age weighting

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  • Aki Tsuchiya

    (Centre for Health Economics, University of York, York, UK)

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.

Suggested Citation

  • Aki Tsuchiya, 2000. "QALYs and ageism: philosophical theories and age weighting," Health Economics, John Wiley & Sons, Ltd., vol. 9(1), pages 57-68.
  • 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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    References listed on IDEAS

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    1. Johannesson, Magnus & Johansson, Per-Olov, 1997. "Is the valuation of a QALY gained independent of age? Some empirical evidence," Journal of Health Economics, Elsevier, vol. 16(5), pages 589-599, October.
    2. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the 'Fair Innings' Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132.
    3. Busschbach, Jan J. V. & Hessing, Dick J. & De Charro, Frank Th., 1993. "The utility of health at different stages in life: A quantitative approach," Social Science & Medicine, Elsevier, vol. 37(2), pages 153-158, July.
    4. Tsuchiya, Aki, 1999. "Age-related preferences and age weighting health benefits," Social Science & Medicine, Elsevier, vol. 48(2), pages 267-276, January.
    5. Cropper, Maureen L & Aydede, Sema K & Portney, Paul R, 1994. "Preferences for Life Saving Programs: How the Public Discounts Time and Age," Journal of Risk and Uncertainty, Springer, vol. 8(3), pages 243-265, May.
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    Cited by:

    1. Anand, Paul, 2003. "The integration of claims to health-care: a programming approach," Journal of Health Economics, Elsevier, vol. 22(5), pages 731-745, September.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.

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