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Biomedical subjects

A J Culyer

Publications and source records attributed to A J Culyer.

At least 19 recordsLinked to original sources
PubMed2006

Wickedness or folly? The ethics of NICE's decisions.

A rebuttal is provided to each of the arguments adduced by John Harris, an Editor-in-Chief of the Journal of Medical Ethics, in two editorials in the journal in support of the view that National Institute for Health and Clinical Excellence's procedures and methods for making recommendations about healthcare procedures for use in the National Health Service in England and Wales are the product of "wickedness or folly or more likely both", "ethically illiterate as well as socially divisive", responsible for the "perversion of science as well as of morality" and are "contrary to basic morality and contrary to human rights".

Academies and Institutes↗
PubMed2001

Equity - some theory and its policy implications.

This essay seeks to characterise the essential features of an equitable health care system in terms of the classical Aristotelian concepts of horizontal and vertical equity, the common (but ill-defined) language of "need" and the economic notion of cost-effectiveness as a prelude to identifying some of the more important issues of value that policy-makers will have to decide for themselves; the characteristics of health (and what determines it) that can cause policy to be ineffective (or have undesired consequences); the information base that is required to support a policy directed at securing greater equity, and the kinds of research (theoretical and empirical) that are needed to underpin such a policy.

Cost-Benefit Analysis↗
PubMed1993

Equity and equality in health and health care.

This paper explores four definitions of equity in health care: equality of utilization, distribution according to need, equality of access, and equality of health. We argue that the definitions of 'need' in the literature are inadequate and propose a new definition. We also argue that, irrespective of how need and access are defined, the four definitions of equity are, in general, mutually incompatible. In contrast to previous authors, we suggest that equality of health should be the dominant principle and that equity in health care should therefore entail distributing care in such a way as to get as close as is feasible to an equal distribution of health.

Cost-Benefit Analysis↗
PubMed1993

QALYs (quality-adjusted life-years) versus HYEs (healthy years equivalents)

This paper explores the claim that QALYs are liable to misrepresent consumer preferences and hence lead to decision-makers choosing options which are not those preferred by the public. It also considers the claim that HYEs do not suffer from this defect. We argue that none of the examples offered to date demonstrate the alleged tendency of QALYs to misrepresent preferences. We also show that HYEs are identical to QALY scores obtained from a time tradeoff experiment and therefore that the assumptions about preferences underlying HYEs are just as restrictive as those underlying TTO-based QALYs.

Consumer Behavior↗
PubMed1992

The morality of efficiency in health care--some uncomfortable implications.

There are some general considerations which have implications for the delivery and finance of health care in all countries, not only Canada and the USA. Beginning with two propositions: that access to health care is a right of citizenship, which should not depend on individual income and wealth; and that the objective of health services is to maximise the impact on the nation's health of the resources available; the paper examines the ethical justification for pursuing efficiency in health care provision. The different meanings of efficiency are discussed in detail, and the use of quantitative indicators of health benefit, such as the QALY, placed in context. It is argued that the determination of health care resource allocations should take account of costs at both the macro planning level and the micro level of the individual doctor-patient relationship. Given the starting points the overall conclusion is that it is ethical to be efficient, since to be inefficient implies failure to achieve the ethical objective of maximising health benefits from available resources.

Canada↗
PubMed1992

The United Kingdom: effective, efficient, equitable?

The British National Health Service (NHS) has, since its inception, aimed to make health care available to all regardless of income, and it has managed to achieve this goal while keeping costs lower as a proportion of the gross domestic product than many Western countries and at the same time assuring equitable distribution of resources regionally. Until the reforms introduced by the 1989 White Paper, the NHS was characterized by centralized financing and regulation; despite some problems in the delivery and management of care, the system was a popular one. The new reforms hope to enhance efficiency in the NHS by stimulating competition and further decentralizing the management of health care. However, it is not at all certain that in practice the reforms will have the desired effect. Initial costs will be high, people may not respond to incentives as predicted, and the quality of care and access to it could well deteriorate. Nations planning to use the U.K. system as a model are advised to use caution.

Community Health Services↗
PubMed1989

Cost containment in Europe.

Health care cost containment is not in itself a sensible policy objective, because any assessment of the appropriateness of health care expenditure in aggregate, as of that on specific programs, requires a balancing of costs and benefits at the margin. International data on expenditures can, however, provide indications of the likely impact on costs and expenditures of structural features of health care systems. Data from the Organization for Economic Cooperation and Development for both European countries and a wider set are reviewed, and some current policies in Europe that are directed at controlling health care costs are outlined.

Cost Control↗
PubMed1985

A health economist on medical sociology: reflections by an unreconstructed reductionist.

Eleven papers in medical sociology, recommended as representative by the Medical Sociology Group of the British Sociology Association, are evaluated by a health economist using five criteria: appeal of intellectual content, insights into political philosophy, explanatory power, predictive power and opportunities for social improvements. The paper concludes that the medical sociology literature is quite weak when judged by these criteria, though stronger on some than others. Sociologists often seem to confuse issues that involve value judgements with ones that do not, and generally seem to display a disconcerting obsession with methodological issues of the most fundamental kind that has inhibited medical sociology from developing interesting analyses of many issues on which, in principle, it ought to have much to offer.

Economics, Medical↗
PubMed1985

Caring for the elderly: a European perspective on today and tomorrow.

There is always a temptation to suppose that one's own problems (whether personal or national) are unique. They rarely are. The "problem" of the elderly is no exception and so there is no particular point in looking to the specific characteristics of one's own health, social service, and social security systems for causes. There is, however, every reason to be looking at them for the consequences. They can also exacerbate the causes. In this paper we sketch the principal features (economic, social, and demographic) that have contributed to the "problem" of the elderly in Europe and then outline the main intellectual issues that need to be explored and resolved. That sounds a bit pompous but, if one is to avoid an intellectual morass consisting of the various assertions about needs, obligations, and so on that emanate from rival concerned parties and various professional interests on the one hand, and simplistic political slogans whose only virtue is that they cut the Gordian Knot (but provide no real enlightenment) on the other, then we need to be doing just this. We shall take a few things for granted: that cost-containment is not the be-all-and-end-all of policy; that value for money depends equally on what you get as on what you spend; that overall expenditure per head is mainly determined by income per head (though some countries have managed to get and stay below the regression line); and that it "ain't so" that all one needs to do is to "leave it to the market." To have justified each of these would have taken too much space so we can only assert them and trust that, in swallowing these camels, you won't strain at the gnats to come.

Aged↗