La preocupación por la equidad en la evaluación de programas sanitarios

Abstract

Cost-utility analysis is the main analytical tool in order to guide resource allocation in the health sector based on economic evaluation techniques. It is based on a health output measure called Quality-Adjusted Life Years (QALYs). Economic evaluation has usually suggested that resource should be distributed in order to maximize the number of QALYs gained. This is consistent with the principle of health maximization. This paper shows that this principle may not agree with the way that society would like to see health resources allocated. We show that several disputed social values are implicit inside the health maximization principle. Once we show that some of these value judgements may not agree with social preferences, an alternative way of conducting economic evaluations is shown that has not the objective of maximizing health. It is shown that concern for the most severe patients , for those with less potential to benefit from medical treatments or for handicapped can be introduced in an economic evaluation in a meaningful way without discriminating those patients.