|
In order to ration health care as
fairly as possible, we will need a way of measuring how much good is
accomplished by any given medical therapy.
One way of making such measurements
is the Quality Adjusted Life Year, or
QALY.
The QALY purports to measure the amount
of good a medical therapy does, in terms of how much time that
therapy adds to a patient's life. (To gain one life-year is to make
one person live one year longer than he otherwise would have
lived.)
But many therapies don't improve
life expectancy. Instead, they "merely" improve symptoms, or
increase the quality of life. These therapies are obviously
worthwhile, and the QALY gives us a way to convert, mathematically
speaking, the amount of quality added to a person's life
into a life-year equivalent. This sleight of hand
theoretically allows all medical therapies to be compared to each
other on an
equal basis, whether or not they actually prolong life, and thus allows the
numerical ranking of medical services in
terms of amount of good they provide.
There are many problems with QALYs,
both in the mechanics of calculating them, and in the ethical
implications of such calculations. Nonetheless, QALYs seem to be the
best measure devised so far for objectifying the benefit of medical
therapies - a prerequisite for an equitable rationing system.
As part of our mission to help you
understand and survive the American health care system, YourDoctorintheFamily.com
offers
an extensive discussion of QALYs. Our premise is that, if
we're going to use QALYs to ration health care, we need to derive the
methodology for calculating QALYs from firm ethical precepts. For if
we don't let our ethical precepts determine how we do
the calculations, then the calculations will, by default, determine
our ethical precepts.
See Six
Guiding Principles for Rationing for a discussion of how the
ethics must come first, then the calculating. Click here for a detailed discussion on
QALYs, especially on how the ethical
precepts we choose will show us how to do the math.
Don't thank us. It's what we do.
We're your
on-line guide to understanding and
surviving the American health care system.
YourDoctorintheFamily.com
Home Page
|