Prioritizing health care: Is health always an appropriate maximand?

In recent years, a few health economists have begun to question the ethical underpinnings of the standard practice of quality-adjusted life year (QALY) maximization as a ubiquitous decision rule in the allocation of health care resources. Prominent among these is Erik Nord, who conjectures that QALY maximization discriminates against the chronically ill and disabled when prioritizing between different individuals (or groups of individuals) for life-extending interventions. Nord has recommended that life years gained should always be given a weight equal to 1 in these circumstances. This article reports an experiment designed as an initial attempt at eliciting some of the thought processes employed by people when they prioritize life-saving health care interventions between patients who differ only in respect to the presence or absence of a disability. The results show that in the priority-setting contexts used. a majority of the respondents perceived the relative health status of the different patients as irrelevant, providing some tentative support for Nord's argument.