One concern raised by critics of a government-run, single-payer healthcare system like Medicare for All is that the government will start rationing health care to keep costs down.
But some healthcare industry players are already trying to ration health care by using the QALY system.
Quality-adjusted life years, or QALYs, were “originally developed as a measure of health effectiveness for cost-effectiveness analysis, a method intended to aid decision-makers charged with allocating scarce resources across competing health-care programs,” according to the medical journal Value in Health. They are used by firms like the U.K.’s National Institute for Health and Care Excellence (NICE) and the U.S.’s Institute for Clinical and Economic Review (ICER) to guide drug price decision-making.
Sometimes NICE and ICER use QALY analysis to pressure drug companies to lower their prices. However, they also are used to prevent drugs from going to market or discourage health insurance companies from covering costly drugs, which can prevent patients from receiving life-saving or life-improving treatments.
Here’s how QALYs work: if a person suffering from depression or multiple sclerosis has a QALY value of 0.5, that means they have 50 percent of the value of one year of life of a healthy person. The underlying principle is to mathematically quantify the quality of life for people with certain health conditions.
If, say, the price for an antidepressant is too high relative to how much it would improve the quality of life of a depressed individual — who already has a shorter life expectancy than an average healthy person — then a firm like ICER will recommend that antidepressant not go to market.
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