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Utilities vs. Rights to Publicly Provided Goods: Arguments and Evidence from Health-Care Rationing


  • Paul Anand

    () (Department of Economics, Faculty of Social Sciences, The Open University)

  • Allan Wailoo


This paper challenges the QALY maximizing approach to rationing health care on the grounds of the consequentialist (and sometimes approximately utilitarian) moral framework on which it is based. An alternative methodological approach is suggested and, in addition to consequences, four normative determinants of health care entitlements are identified: rights, public opinion, social contracts and community values. Survey evidence is presented which shows support for these alternative frameworks and a rejection of consequentialism. The paper suggests that a (if not the) major challenge facing the designers of rationing guidelines is that of pluralism, i.e. the need to integrate considerations from a set of frameworks.

Suggested Citation

  • Paul Anand & Allan Wailoo, 2000. "Utilities vs. Rights to Publicly Provided Goods: Arguments and Evidence from Health-Care Rationing," Open Discussion Papers in Economics 14, The Open University, Faculty of Social Sciences, Department of Economics.
  • Handle: RePEc:opn:wpaper:14

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    Cited by:

    1. Johansson-Stenman, Olof & Martinsson, Peter, 2008. "Are some lives more valuable? An ethical preferences approach," Journal of Health Economics, Elsevier, vol. 27(3), pages 739-752, May.
    2. 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.
    3. Daniel Eisenberg & Gary Freed & Matthew Davis & Dianne Singer & Lisa Prosser, 2011. "Valuing health at different ages," Applied Health Economics and Health Policy, Springer, vol. 9(3), pages 149-156, May.
    4. 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.
    5. van Exel, Job & Baker, Rachel & Mason, Helen & Donaldson, Cam & Brouwer, Werner, 2015. "Public views on principles for health care priority setting: Findings of a European cross-country study using Q methodology," Social Science & Medicine, Elsevier, vol. 126(C), pages 128-137.
    6. Bert van Wee, 2011. "Transport and Ethics," Books, Edward Elgar Publishing, number 14281.
    7. 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.
    8. Johansson-Stenman, Olof & Martinsson, Peter, 2003. "Are Some Lives More Valuable?," Working Papers in Economics 96, University of Gothenburg, Department of Economics.
    9. Tania Stafinski & Devidas Menon & Deborah Marshall & Timothy Caulfield, 2011. "Societal Values in the Allocation of Healthcare Resources," The Patient: Patient-Centered Outcomes Research, Springer;Johns Hopkins Bloomberg School of Public Health, vol. 4(4), pages 207-225, December.
    10. Amartya Sen, 2002. "Why health equity?," Health Economics, John Wiley & Sons, Ltd., vol. 11(8), pages 659-666.
    11. 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.
    12. Coast, Joanna, 2009. "Maximisation in extra-welfarism: A critique of the current position in health economics," Social Science & Medicine, Elsevier, vol. 69(5), pages 786-792, September.
    13. Anand, Paul & van Hees, Martin, 2006. "Capabilities and achievements: An empirical study," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 35(2), pages 268-284, April.
    14. Tsuchiya, Aki & Dolan, Paul, 2007. "Do NHS clinicians and members of the public share the same views about reducing inequalities in health?," Social Science & Medicine, Elsevier, vol. 64(12), pages 2499-2503, June.

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