Chapter 7: Utility
Ends are problematic where the success indicators are as objective as illnesses cured, life-expectancy extended, five-year survival met, blood pressure reduced, asymptomatic bacteriuria detected. They are even more problematic where the clinical outcomes are equal but the subjective meanings are not. Individuals have preferences. It would be a mistake to concentrate on the sick days never taken, the throats swabbed, the splints stuck on, the human capital accumulated, the internal rates made equal while neglecting the passionate stakeholder’s personal satisfaction from life. There are three constituencies that expect to be consulted. These are the patient, the practitioner and the public. This chapter, in three successive sections, analyses the contribution of each to the identification of the health-related quality of life. The chapter is about cost-effectiveness and value for money. More like the psychologist than the engineer, however, it quantifies its desiderata through the perceptions of thinking human beings who think they have a need to be heard. The mind speaks and the accountant listens. The product of the health care production-function must be – or must also be – the psychic wellbeing that all three constituencies experience when medical intervention solves a problem that to them had been a blight. 7.1. The Patient Liberal democracy is imbued with individualism. Welfare is in the eye of the beholder. Rational choice, revealed preference and consumer sovereignty can be trusted to produce an optimum that no doctor and no dictator can ever know or impose. The greatest felt happiness to the liberal democrat is the...
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