Discrimination

Abstract

AbstractThis chapter addresses the objection that cost-effectiveness is discriminatory. It identifies three discrimination complaints and distinguishes these complaints from the fair chances and severity objections. It argues that the discrimination derives both from the way in which health measurement systems assign values to morbidity and mortality and from the way that cost-effective allocation makes use of those values. The chapter considers what makes some kinds of discrimination acceptable, even desirable, whereas other instances are intolerable. It scrutinizes an alternative way of valuing health improvements, healthy years in total, that assigns equal value to life-saving and thereby avoids the most egregious discrimination that is implicit in measures of the effectiveness of health care. However, the chapter also points to flaws in the alternative and argues that the discrimination criticism of cost-effectiveness cannot be resolved by changing the measure of effectiveness. The chapter concludes with a way to avoid the wrongful discrimination that c-e allocation may involve.