What level of cost-effective health care is adequate?
After the preceding primer on the allocation of real and financial resources in health care and the idea of cost effectiveness, we may now return to the question of whether it is possible to provide adequate care to everyone. The exhibit (on the next page) illustrates the conceptual issues raised by that question. The upward-sloping line represents the quality of life supply curve offered by a nation’s health system to its citizens. QALYs are represented on the horizontal axis. This number can rise even if a medical intervention does not prolong the patient’s actual life, so long as that intervention at least enhances the quality of the patient’s expected remaining life years. The vertical axis shows the incremental costs associated with supplying ever more expensive QALYs. Thus, immunization during childhood can supply more QALYs quite cheaply (point A on the line), while additional life years (or months) bought for terminally ill patients with highly expensive drugs can be quite cost
