Health Care Analysis

, Volume 3, Issue 3, pp 226–229 | Cite as

QALYs: Maximisation, distribution and consent. A response to Alan Williams

  • Paul T. Menzel
Main Feature Health Economics and Health Care Priorities


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  1. 1.
    In his Further Reading' list printed in the University of York Discussion Paper Williams puts chapter 5 of myStrong Medicine: The Ethical Rationing of Health Care (1990), Oxford University Press, in the ‘Criticisms of the QALY Approach’ category. That needs qualification. While I strongly criticised particular QALY-building questions there, I argued that within the arena of non-congenital, not-early-onset conditions, true ‘QALY-bargain’ questions can generate genuine consent based power for even a maximise-QALYs model. I concluded by saying that because of their many moral complications, ‘perhaps they will end up as the morally tragic figure on the health policy stage, on the right track but somehow doomed to failure’. I strongly disagree with the unfriendly critics who think that the attempt to maximise QALYs produced with our health care resources is fundamentally on the wrong track.Google Scholar
  2. 2.
    Nord, E. (1993). The trade-off between severity of illness and treatment effect in cost-value analysis of health care.Health Policy 24, 227–238.Google Scholar
  3. 3.
    Nord, E. (1994). The person trade-off approach to valuing health care programmes.Working Paper 38, National Center for Health Program Evaluation, University of Melbourne.Google Scholar
  4. 4.
    Menzel, P. (1990).Strong Medicine: The Ethical Rationing of Health Care, Oxford University Press, New York.Google Scholar
  5. 5.
    I held this doubt inStrong Medicine, 80–81, and in Menzel, P. (1992). Oregon's denial: disabilities and quality of life.Hastings Center Report 22(6), 21–25.Google Scholar
  6. 6.
    This sort of array has been suggested by Erik Nord (correspondence).Google Scholar
  7. 7.
    Such complex and chronic-illness-sensitive expressions of relative value should be elicited by sufficiently refined questions built into the very foundation of the QALY-estimating model. Note that merely pursuing such questions seriously posits a more complex structure in the whole enterprise: that we need more thanone sort of ‘QoL rating’ to be able to prioritise life-savingand quality enhancement services. We can still get the two essential dimensions clearly related (one of the fundamental purposes of QALYs), but the structure of the model required to do that accurately is more complex than most have surmised.Google Scholar

Copyright information

© John Wiley & Sons, Ltd. 1995

Authors and Affiliations

  • Paul T. Menzel
    • 1
  1. 1.Pacific Lutheran University TacomaUSA

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