By:
Kelly Israel, Policy Analyst, Autistic Self Advocacy Network
Sara van Geertruyden, Executive Director, Partnership to Improve Patient Care
People with disabilities are consistently told they are too expensive to treat when compared to other groups. A metric of determining cost effectiveness of treatments and health services called the quality-adjusted life year (QALY) is yet another tool to make that argument on a larger scale. The QALY is often used to compare the benefits and costs of healthcare interventions. Cost effectiveness analyses based on the QALY are largely developed with intent for their use by insurers and payers to inform the treatments and services that may or may not be covered or subjected to utilization management practices. Advocates have long pushed for consideration of better metrics by payers that reflect the priorities of patients and people with disabilities, hoping to reduce hurdles to appropriate and timely care. As advocates work to understand how the concept of value is defined and used by states and health systems, it is imperative to understand why the QALY metric is discriminatory.
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