Research project There is increasing need for the evaluation and prioritisation of welfare policies, guided both by effectiveness and equity considerations. In health care and public health, the sophisticated cost per QALY gained measure is widely used. Other parts of the welfare state have, in theory, to rely on cost-benefit analysis - CBA.
However, CBA is rarely used. Rather, a very simple cost-saving analysis has become increasingly more popular, particularly among municipalities. The main weakness of cost-saving analysis is the lack of independent valuation of the quality of life consequences. It introduces a bias in favour of actions that ‘save’ resources, so that actions that bring about better quality of life but consume resources will consequently be given low priority. To provide methods for more accurate evaluation, we intend to develop and test a measure called ‘capability adjusted life years’ or CALYs.
CALYs can be used to estimate cost-effectiveness, but also to rank social problems. The fewer the lifetime CALYs a certain group can expect, the more severe the problem.
A recent Swedish public investigation suggested that quality of life could be measured in terms of capabilities, and went on to suggest a list of capabilities relevant to Sweden. To have capabilities equates to good years, to lack capabilities means bad years. Selection of the most relevant capabilities for our model will be placed in the hands of 'fair minded people', i.e. wise people from different backgrounds.
We plan to conduct a population survey on a representative sample. Statistical methods developed to estimate QALYs and DALYs are also appropriate for CALYs. An interval scale for capability weights will be established through 'pairwise comparisons', a method used by WHO in the Global Burden of Disease Study. Basically, two hypothetical persons are described as having the same capability dimensions but on two different levels. Respondents must judge who has the better quality of life.