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QALYs and the capability approach

Cookson, R. (2005) QALYs and the capability approach. Health Economics, 14 (8). pp. 817-829. ISSN 1057-9230

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This explores the applicability of Sen's capability approach to the economic evaluation of health care programmes. An individual's capability set describes his freedom to choose valuable activities and states of being (functionings). Direct estimation and valuation of capability sets is not feasible at present. Standard preference-based methods such as willingness to pay are feasible, but problematic due to the adaptive and constructed nature of individual preferences over time and under uncertainty. An alternative is to re-interpret the QALY as a cardinal and interpersonally comparable index of the value of the individual's capability set. This approach has limitations, since the link between QALYs and capabilities is not straightforward. Nevertheless, the QALY approach is recognisable as an application of the capability approach since it pays close attention to functionings, through the use of survey-based multi-attribute health state valuation instruments, and permits conceptions of value other than the traditional utilitarian ones of choice, desire-fulfilment and happiness. Furthermore, suitably re-interpreted, it can account for (i) non-separability between health and non-health components of value; and suitably modified it can also account for (ii) process attributes of care, which may have a direct effect on non-health functionings such as comfort and dignity, and (iii) sub-group diversity in the value of the same health functionings.

Item Type: Article
Keywords: capability approach • economic evaluation • welfarism • QALY • process attributes
Institution: The University of York
Academic Units: The University of York > Centre for Health Economics (York)
Depositing User: York RAE Import
Date Deposited: 06 Aug 2009 13:25
Last Modified: 06 Aug 2009 13:25
Published Version: http://dx.doi.org/10.1002/hec.975
Status: Published
Publisher: John Wiley & Sons
Identification Number: 10.1002/hec.975
URI: http://eprints.whiterose.ac.uk/id/eprint/6213

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