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Developing methods that really do value the ‘Q’ in the QALY

  • PAUL DOLAN (a1)

Most health economists recommend that improvements in health be valued by asking members of the general public to imagine themselves in different states of health and then to think about how many years of life they would give up or what risk of death they would be willing to accept in order to be in full health. In this paper, I argue that preferences are not a very good guide to future experiences and a more suitable way to value health is to ask people in different states of health how they think and feel about their lives. Valuing health in this way may result in greater priority being given to mental health services. Whatever the precise implications, it is my contention that it is much better to ration health care according to real experiences rather than according to hypothetical preferences.

Corresponding author
*Correspondence to: Paul Dolan, Professor of Economics, Tanaka Business School, Imperial College London, South Kensington Campus, London SW7 2AZ, UK. Email:
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Brazier, J., Roberts, J. and Deverill, M. (1999), ‘The estimation of a preference-based measure of health from the SF-36’, Journal of Health Economics, 21(2): 271292.
Broome, J. (1993), ‘Qalys’, Journal of Public Economics, 50: 149167.
Dar, R., Ariely, D. and Frenk, H. (1995), ‘The effect of past injury on pain threshold and tolerance’, Pain, 60: 189193.
Dolan, P. (1997), ‘Modelling valuations for EuroQol health states’, Medical Care, 11: 10951108.
Dolan, P. (2000), ‘The measurement of health-related quality of life for use in resource allocation decisions in health care’, in Culver, A. J. and Newhouse, J. P. (eds), Handbook of Health Economics, Vol. I, Amsterdam: Elsevier Science BV, pp. 1724–1760.
Dolan, P. (2007), ‘Finding a NICEr way to value health: from hypothetical preferences to real experiences’, Social Market Foundation.
Dolan, P. and Kahneman, D. (2008), ‘Interpretations of utility and their implications for the valuation of health’, Economic Journal.
Dolan, P., Peasgood, T. and White, M. (2008), ‘Do we really know what makes us happy: a review of the economic literature on the factors associated with subjective well-being’, Journal of Economic Psychology.
Dolan, P. and White, M. (2006), ‘Dynamic well-being: connecting what we anticipate with what we experience’, Social Indicators Research, 75(2): 303333.
Dolan, P., Shaw, R.Tsuchiya, A. and Williams, A. (2005), ‘QALY maximisation and people's preferences: a methodological review of the literature’, Health Economics, 14(2): 197208.
Gilbert, D. T. and Wilson, T. D. (2000), ‘Miswanting: some problems in the forecasting of future affective states’, in Forgas, J. (ed.), Thinking and Feeling: The Role of Affect in Social Cognition, Cambridge: Cambridge University Press.
Harsanyi, J. C. (1996), ‘Utilities, preferences, and substantive goods’, Social Choice and Welfare, 14: 129145.
Kahneman, D., Wakker, P. and Sarin, R. (1997), ‘Back to Bentham? Explorations of experienced utility’, Quarterly Journal of Economics, 112: 375405.
Kahneman, D., Krueger, A. B.Schkade, D. A.Schwarz, N. and Stone, A. A. (2004), ‘Toward national well-being accounts’, American Economic Review, 94(2): 429434.
Sprangers, M. A. G. and Schwartz, C. E. (1999), ‘Integrating response shift into health-related quality of life research: a theoretical model’, Social Science and Medicine, 48(11): 15071515.
Ubel, P. A., Loewenstein, G.Hershey, J.Baron, J.Mohr, T.Asch, D. A. and Jepson, C. (2001), ‘Do nonpatients underestimate the quality of life associated with chronic health conditions because of a focusing illusion?’, Medical Decision Making, 21: 190199.
de Wit, G. A., Busschbach, J. and De Charro, F. (2000), ‘Sensitivity and perspective in the valuation of health status: whose values count?’, Health Economics, 9(2): 109126.
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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
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