Evaluation of the QALY in Health Care

The QALY does have several limitations; a number of drawbacks have been pointed out regarding the subjective nature of the QALY.  Studies have found that the value of the QALY can change depending on who is asked to make the choices.  The choices made may not reflect the respondent’s true decisions were they to face such a situation in real life as they are only responding to hypothetical model.  The length of the illness and the way in which the question is posed  are the factors which affect the valuation.  The failure to take into consideration the beneficial externalities that family and friends of the individual gain from the medical intervention may lead to the undervaluation of health care.  The life of people suffering from chronic diseases or people with disability could be devalued using the QALY although that is not why the QALY was created.  For example, a person with health problem A is assigned a value of 0.6 (severity value of 0.4) in terms of treatment desirability.  From this the following two interpretations are possible.  Firstly, attempts to prolong the life of a person with problem A could be seen as having less value than a person with full health has.  Secondly the quality of life of those with problem A could be regarded as lower than those in full health.

One more problem with QALY is that it is based on self-report measures as the act of reporting is often affected by aspects of the mental illness, such as impaired judgement, optimistic self-other judgements based on a poor comparison group and the decreasing of expectations which comes about through long-term dependence. Some aspects of life quality which may receive low endorsement by persons with schizophrenia (e.g., medication compliance), if not checked, may endanger both their physical and mental well-being. Such observations have serious implications when we consider the current trend towards increased consumer involvement and responsiveness to consumer demands. The major role which advocacy plays in the delivery of mental health services should not be abandoned too fast. However, there should be ways to preserve individuals’ basic needs for self-determination in light of the “paternalism”  present in some treatment sectors (Munetz, Birnbaum & Wyzik, 1993).

Thus, while QALY methods have inherent value, it should be taken into consideration that the delay between treatment and effect, the costs and expertise needed for adequate rigour, weak sensitivity of global measures, the difficulty equating the meaning of specific treatment effects across patient groups, and the impact of mental impairment on subjects’ self-report ratings persist as some of the most formidable barriers to linking funding with comprehensive program evaluation initiatives.