Access to health care: the QALY
and its alternatives
'Health care systems, irrespective of how they are financed, present the paradox that to some observers they appear as a major component of social benefits, while to other observers they seem both excessively costly and limited in their effectiveness.' 1
Advances in medical knowledge, skills and technology have made it possible to treat or prevent a number of diseases previously associated with a high mortality, resulting in a trend towards an increased proportion of elderly individuals within the population. Bury 2 has projected that there will be a two-thirds increase in the number of over 85 year olds in the UK between 1985 and the millennium. Concerns have been expressed that the development of measures, such as the QALY (quality adjusted life year), may limit their access to health care resources 3. What is the basis for resource allocation and how could such a state of affairs arise?