Cost-Effectiveness and Non-Discrimination in Health Care

Rationing between health care needs is unavoidable. Such rationing ought to be
morally justified. In order to be morally justified rationing must be
nondiscriminatory and cost-effective. However, generally resources spent on old
and disabled people are spent less cost-effectively, ceteris paribus, than resources
spent on young and non-disabled people, since they can expect to enjoy fewer,
extra qualityadjusted life-years. As giving lower priority to such groups can be
discriminatory, we must either: 1) accept that a morally justified scheme of health
care rationing discriminates against some groups; 2) deny that a morally justified
scheme of health care rationing is cost-effective; or/and 3) define a non-standard
notion of cost-effectiveness which does not disadvantage old and disabled people.
We explore resolving this trilemma by accepting 1) in cases where discrimination is
compatible with equality of opportunity and 2) by embracing, e.g., distributive
constraints on efficiency.