Department of Philosophy and Religion, Mississippi State University, PO Box JS, Mississippi State, MS, 39762, USA.
Health Care Anal. 2020 Mar;28(1):45-61. doi: 10.1007/s10728-019-00382-w.
Proposals for health care cost containment emphasize high-value care as a way to control spending without compromising quality. When used in this context, 'value' refers to outcomes in relation to cost. To determine where health spending yields the most value, it is necessary to compare the benefits provided by different treatments. While many studies focus narrowly on health gains in assessing value, the notion of benefit is sometimes broadened to include overall quality of life. This paper explores the implications of using subjective quality of life measures for value assessment. This approach is claimed to be more respectful of patients and better capture the perspectival nature of quality of life. Even if this is correct, though, subjective measurement also raises challenging issues of interpersonal comparability when used to study health outcomes. Because such measures do not readily distinguish benefits due to medical interventions from benefits due to personal or other factors, they are not easily applied to the assessment of treatment value. I argue that when the outcome of interest in value assessment is broadened to include quality of life, the cost side of these measures should also be broadened. I show how one philosophical theory of well-being, Jason Raibley's "agential flourishing" theory, can be adapted for use in quality of life research to better fit the needs and aims of value assessment in health care. Finally, I briefly note some implications of this argument for debates about fairness in health care allocations.
中文译文：
医疗成本控制的建议强调高价值的医疗护理，以此来控制支出，而又不影响医疗质量。当在这个上下文中使用时，“价值”是指成本相关的结果。为了确定医疗支出在哪里产生最大的价值，有必要比较不同治疗方法提供的效益。虽然许多研究在评估价值时狭隘地关注健康收益，但受益的概念有时会扩大到包括整体生活质量。本文探讨了使用主观生活质量措施进行价值评估的含义。这种方法据称更尊重患者，并更好地捕捉生活质量的视角性质。即使这是正确的，主观测量在用于研究健康结果时，也会引起具有挑战性的人际可比性问题。由于这些措施不易区分医疗干预带来的益处和个人或其他因素带来的益处，因此它们不易应用于治疗价值评估。我认为，当价值评估中感兴趣的结果扩大到包括生活质量时，这些措施的成本方面也应该扩大。我展示了一种幸福感的哲学理论，即杰森·雷利的“代理繁荣”理论，如何适应生活质量研究，以更好地满足医疗保健中价值评估的需求和目标。最后，我简要地指出了这一论点对医疗保健分配公平性辩论的一些影响。
