Doctors and healthcare providers play a pivotal role in safeguarding public health through diagnosing illnesses, performing surgeries, and administering vaccinations. However, they frequently encounter barriers in fulfilling their obligation to maintain the health of Americans due to the profit-driven nature of the healthcare system. Corporate ownership, cost-cutting initiatives, and discriminatory practices pose significant obstacles that impede healthcare providers from adequately addressing the health needs of their patients. One such discriminatory practice is the utilization of Quality-Adjusted Life Years (QALYs), which further exacerbates disparities in healthcare access and perpetuates discrimination within the healthcare system.
QALYs are a measure of the value of health outcomes, including both the quality and quantity of life lived. They are used in economic evaluation to assess the value of medical interventions. One QALY equates to one year in perfect health, with scores ranging from 1 (perfect health) to 0 (dead). QALYs inform health insurance coverage determinations, treatment decisions, program evaluations, and priorities for future programs. Patients living with disabilities and older adults have a lower QALY by default and thus are disadvantaged in all medical opportunities. Under cost-effectiveness tactics like QALY, healthcare providers are often forced to dedicate less time and resources on such patients because they are economically worth less than a younger or healthier patient receiving the same treatment.
The reality is that doctors are often forced to see more patients in less time, which often conflicts with the best delivery of care entrusted to them by their patients. The use of cost-effectiveness practices and other discriminatory utilization management tactics by health insurers, aimed at saving money for a health plan, is placing unnecessary burdens on healthcare providers. Consequently, healthcare is becoming inaccessible for vulnerable patients, while also interfering with the trusted relationship between a patient and provider.
The American Medical Association’s Declaration of Professional Responsibility requires physicians to “[treat] the sick and injured with competence and compassion and without prejudice.” However, the use of QALYs place a lower value on the lives and patient preferences of aging populations and people with disabilities—the very populations who need continued support from their healthcare providers.
The Hippocratic oath emphasizes the physician’s obligation to act in the best interest of the patient. As advocates for patients, physicians have a moral, ethical, and legal duty to challenge discriminatory cost-effectiveness strategies. Otherwise, we will continue to see marginalized patients lose out on treatments and care that can transform their lives. H.R. 485, the Protecting Care for All Patients Act, bans the use of discriminatory measures such as QALYs. The House has already passed this critical legislation, and it is now incumbent upon the Senate to follow suit and uphold the principles of fairness and equality in healthcare.
Robert Bitonte, MD, JD, LLM is the president at the American Academy of Legal Medicine. He resides in California.
