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Ration roulette: researcher says Australia lacks informed processes for allocating funds

Australia’s healthcare system is not making best use of available funding when deciding on allocating money to different services, a researcher has argued.

Further, the Queensland University of Technology’s Elizabeth Martin, who wrote the brief Rationing in Healthcare for the Deeble Institute for Health Policy Research, said Australia lacked consistent, explicit and evidence-informed rationing processes – such as economic evaluation evidence – to inform decisions on allocation of health funds.

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One comment

  1. The problem with this is that economic analysis of health care and use of QALY’s will always discriminate against the elderly. I cannot imagine anything worse than economists directing treatment. However if Australian government is going to ration it needs to be explicit and obvious, not the covert rationing that is currently excluding the elderly from basic treatment.

    Wikipedia: The method of ranking interventions on grounds of their cost per QALY gained ratio (or ICER) is controversial because it implies a quasi-utilitarian calculus to determine who will or will not receive treatment.[16] However, its supporters argue that since health care resources are inevitably limited, this method enables them to be allocated in the way that is approximately optimal for society, including most patients. Another concern is that it does not take into account equity issues such as the overall distribution of health states – particularly since younger, healthier cohorts have many times more QALYs than older or sicker individuals. As a result, QALY analysis may undervalue treatments which benefit the elderly or others with a lower life expectancy. Also, many would argue that all else being equal, patients with more severe illness should be prioritised over patients with less severe illness if both would get the same absolute increase in utility.[17] Recently the results of a European Commission Project, ECHOUTCOME[18] recommended to not use QALYs in health decision making after surveying 1361 subjects in the UK, Belgium, France and Italy and establishing that the four theoretical assumptions underlying QALYs are invalid (quality of life should be measured in consistent intervals; life years and QOL should be independent; people should be neutral about risk; and willingness to sacrifice life years should be constant over time), explaining why divergent QALY results can be generated using the same dataset.[19][20]