Hostname: page-component-7c8c6479df-995ml Total loading time: 0 Render date: 2024-03-19T05:15:09.282Z Has data issue: false hasContentIssue false

AGE-WEIGHTING*

Published online by Cambridge University Press:  01 July 2008

Greg Bognar*
Affiliation:
Harvard University

Abstract

Some empirical findings seem to show that people value health benefits differently depending on the age of the beneficiary. Health economists and philosophers have offered justifications for these preferences on grounds of both efficiency and equity. In this paper, I examine the most prominent examples of both sorts of justification: the defence of age-weighting in the WHO's global burden of disease studies and the fair innings argument. I argue that neither sort of justification has been worked out in satisfactory form: age should not be taken into account in the framework of the burden of disease measure, and on the most promising formulations of the fair innings argument, it turns out to be merely an indicator of some other factor. I conclude by describing the role of age in theories of justice of healthcare resource allocation.

Type
Essay
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Broome, J. 1988. Good, Fairness and QALYs. In Philosophy and medical welfare, ed. Bell, J. M. and Mendus, S., 5773. Cambridge: Cambridge University Press.Google Scholar
Broome, J. 1999. Fairness. In Ethics out of economics, 111–22. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Broome, J. 2002. Measuring the burden of disease by aggregating well-being. In Summary measures of population health: Concepts, ethics, measurement, and applications, ed. Murray, C. J. L., Salomon, J. A., Mathers, C. D. and Lopez, A. D., 91113. Geneva: World Health Organization.Google Scholar
Busschbach, J. J. V., Hessing, D. J. and de Charro, F. Th.. 1993. The utility of health at different stages in life: A quantitative approach. Social Science and Medicine 37, 153–8.CrossRefGoogle ScholarPubMed
Callahan, D. 1987. Setting limits: Medical goals in an aging society. New York: Simon & Schuster.Google Scholar
Cropper, M. L., Aydede, S. K. and Portney, P. R.. 1994. Preferences for life saving programs: How the public discounts time and age. Journal of Risk and Uncertainty 8, 243–65.CrossRefGoogle Scholar
Daniels, N. 1985. Just health care. Cambridge: Cambridge University Press.CrossRefGoogle ScholarPubMed
Daniels, N. 1988. Am I my parents' keeper? An essay on justice between the young and the old. New York: Oxford University Press.Google Scholar
Daniels, N. 1996. Problems with prudence. In Justice and justification: Reflective equilibrium in theory and practice, 284301. Cambridge: Cambridge University Press.Google Scholar
Daniels, N., Kennedy, B. and Kawachi, I.. 2004. Health and inequality, or, why justice is good for our health. In Public Health, Ethics, and Equity, ed. Anand, S., Peter, F. and Sen, A., 6391. Oxford: Oxford University Press.Google Scholar
Goerdt, A., Koplan, J. P., Robine, J.-M., Thuriaux, M. C. and van Ginneken, J. K.. 1996. Non-fatal health outcomes: Concepts, instruments and indicators. In The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020, ed. Murray, C. J. L. and Lopez, A. D., 99116. Cambridge, MA: Harvard School of Public Health on behalf of the WHO and the World Bank.Google Scholar
Harris, J. 1985. The value of life. London: Routledge & Kegan Paul.Google Scholar
Harris, J. 1988. More and better justice. In philosophy and medical welfare, ed. Bell, J. M. and Mendus, S., 7596. Cambridge: Cambridge University Press.Google Scholar
Hausman, D. M. 2007. What's wrong with health inequalities? Journal of Political Philosophy 15, 4666.CrossRefGoogle Scholar
Johannesson, M. and Johansson, P.-O.. 1997. Is the valuation of a QALY gained independent of age? Some empirical evidence. Journal of Health Economics 16, 589–99.CrossRefGoogle ScholarPubMed
Johri, M., Damschroder, L. J., Zikmund-Fisher, B. J. and Ubel, P. A.. 2005. The importance of age in allocating health care resources: Does intervention-type matter? Health Economics 14, 669–78.CrossRefGoogle ScholarPubMed
Kamm, F. M. 1993. Morality, mortality. Volume I: Death and whom to save from it. New York: Oxford University Press.Google Scholar
Kamm, F. M. 2002. Health and equity. In Summary measures of population health: Concepts, ethics, measurement, and applications, ed. Murray, C. J. L., Salomon, J. A., Mathers, C. D. and Lopez, A. D., 685706. Geneva: World Health Organization.Google Scholar
Kappel, K. and Sandøe, P.. 1992. QALYs, age and fairness. Bioethics 6, 297316.Google Scholar
Lewis, P. A. and Charny, M.. 1989. Which of two individuals do you treat when only their ages are different and you can't treat both? Journal of Medical Ethics 15, 2832.Google Scholar
Lockwood, M. 1988. Quality of life and resource allocation. In Philosophy and Medical Welfare, ed. Bell, J. M. and Mendus, S., 3355. Cambridge: Cambridge University Press.Google Scholar
McKie, J., Richardson, J., Singer, P. and Kuhse, H.. 1998. The allocation of health care resources: An ethical evaluation of the ‘QALY’ approach. Aldershot: Ashgate.Google Scholar
McMahan, J. 2002. The ethics of killing: Problems at the margins of life. Oxford: Oxford University Press.CrossRefGoogle Scholar
Murray, C. J. L. 1996. Rethinking DALYs. In The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and Projected to 2020, ed. Murray, C. J. L., and Lopez, A. D., 198. Cambridge, MA: Harvard School of Public Health on behalf of the WHO and the World Bank.Google Scholar
Murray, C. J. L. and Acharya, A. K.. 1997. Understanding DALYs. Journal of Health Economics 16, 703–30.CrossRefGoogle ScholarPubMed
Murray, C. J. L., Salomon, J. A., Mathers, C. D. and Lopez, A. D.. 2002. Summary measures of population health: Conclusions and recommendations. In Summary measures of population health: concepts, ethics, measurement, and applications, 731–56. Geneva: World Health Organization.Google Scholar
Nord, E. 1999. Cost-value analysis in health care: Making sense out of QALYs. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Nord, E., Street, A., Richardson, J., Kuhse, H. and Singer, P.. 1996. The significance of age and duration of effect in social evaluation of health care. Health Care Analysis 4, 103–11.CrossRefGoogle ScholarPubMed
Parfit, D. 1984. Reasons and persons. Oxford: Clarendon Press.Google Scholar
Rodríguez, E., and Pinto, J. L.. 2000. The social value of health programs: is age a relevant factor? Health Economics 9, 611–21.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
Tsuchiya, A. 1999. Age-related preferences and age weighting health benefits. Social Science and Medicine 48, 267–76.Google Scholar
Tsuchiya, A., Dolan, P. and Shaw, R.. 2003. Measuring people's preferences regarding ageism in health: some methodological issues and some fresh evidence. Social Science and Medicine 57, 687–96.CrossRefGoogle ScholarPubMed
Veatch, R. M. 2000. Transplantation ethics. Washington, DC: Georgetown University Press.Google Scholar
Williams, A. 1997. Intergenerational equity: an exploration of the ‘Fair Innings’ argument. Health Economics 6, 117–32.3.0.CO;2-B>CrossRefGoogle ScholarPubMed