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Valuing the Benefits and Costs of Health Care Programmes: Where's the 'extra' in extra-welfareism?

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  • The application of Sen's concept of extra-welfarism to problems of allocations of resources to health underlies the justification of quality adjusted life years (QALYs) as the method of valuing the benefits of health care. In this paper we critically appraise the application from both conceptual and empirical perspectives. We show that the alleged limitations of the welfarist approach are essentially limitations in its application, not in the capacity of the approach to accomodate the concerns of extra-welfarists. Moreover, the arguments used to justify the application of the extra-welfaist framework are essentially welfarist. We demonstrate that the methods used to measure QALYs share their basic theoretical roots with welfarist valuation methods, such as willingness to pay (WTP). Althought QALYs and WTP share many challenges, we aregue that WTP provides a method which performs better with respect to those challenges. In the context of evaluating alternative allocations of health care resources we are left asking what is 'extra' in extra-welfarism. IHE Working Paper 01-04

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    Attribution-NonCommercial-NoDerivatives 4.0 International