Valuing Health In Practice

During a research project valuing health states, a heart bypass candidate expressed suicidal intent during two separate interview sessions. This patient had been waiting months for the procedure; he could barely get out of his chair without help, he was unable to read or talk for more than a few minutes at a time, and his responses to the questionnaires registered zero quality of life. The surgeon was told of the researcher’s fear that the patient might kill himself; a few weeks later, the patient received the bypass. Without the two research interviews, this patient might have died before the operation took place; this chance occurrence probably prolonged his life, and improved its quality. Clearly, it would have been better if his quality of life and survival prospects had been assessed on some routine, consistent basis, and compared with the health of other patients who were waiting for the same procedure. This would have brought his very poor quality of life to the surgeon’s notice, without the need for a consultation; it might also have caused the procedure to have gone to someone with the same quality of life, and a better chance of survival. But in either case, his quality of life and survival prospects would have been taken into account as a matter of routine, rather than by chance. This is possible because reliable questionnaires have been developed, which can determine patient quality of life, and measure health outcomes; for a variety of reasons, they have not been routinely applied in health services. Even when formal measures are not being used, health sector choices imply health valuation. Suppose a hospital can, for the same cost, increase either the number of neo-natal intensive care places, or the number of hip joint replacements; selecting one and not the other values its outcomes more, whether or not quality of life information is available. Similarly, the allocation of respite days between carers, when not all can have a break, effectively values the need of some carers more than others. Health valuation is thus the consequence of scarcity and the need for choice.