Dolan P
University of Newcastle, Newcastle-upon-Tyne, UK.
J Health Econ. 1998 Jan;17(1):39-52. doi: 10.1016/s0167-6296(97)00022-2.
It has been suggested by a number of economists that decisions about how to allocate scarce health care resources should be informed by the cost per quality-adjusted life-years (QALYs) of the different alternatives. One of the criticisms of the QALY approach is that it is based on the measurement of individual utility; yet the values elicited are used to inform social choice. In this respect, it is argued that the QALY approach fails to take account of distributional issues that are known to be important in the context of health care. This paper addresses this issue and presents an approach grounded in microeconomic theory that is flexible enough to deal with a wide range of efficiency-equity trade-offs, while making the nature of the trade-off transparent. In addition, it is an approach that is relatively simple to investigate empirically, and the results of a preliminary study are presented as illustration of this.
一些经济学家认为，关于如何分配稀缺医疗资源的决策应以不同备选方案的每质量调整生命年（QALY）成本为依据。对QALY方法的批评之一是，它基于个体效用的衡量；然而所引出的价值却被用于为社会选择提供依据。在这方面，有人认为QALY方法没有考虑到在医疗保健背景下已知很重要的分配问题。本文探讨了这个问题，并提出了一种基于微观经济理论的方法，该方法足够灵活，能够处理广泛的效率与公平权衡问题，同时使权衡的本质透明化。此外，这是一种相对容易进行实证研究的方法，并且给出了一项初步研究的结果作为例证。
