Oregon Passes Senate Bill 1508-A to Ban Quality-Adjusted Life-Years in Oregon!
QALY stands for Quality-Adjusted Life-Years, a flawed scoring system economists use to determine cost-effectiveness of proposed medical treatments. Payers—including the Oregon Health Plan—use QALY scores to determine who is eligible for healthcare resources. The problem is the scores are calculated in inherently discriminatory ways. These types of scores have no place influencing what conditions and treatments the Oregon Health Plan will cover.
Our Position
QALY assigns unfair and offensive “quality of life” values to patients, intentionally devaluing treatments for older people, those with chronic illnesses or disabilities, and people of color. When calculating QALY, a year of “perfect health” is worth 1, while a year of “less than perfect” health—such as living with a disability or chronic illness—is worth less.
QALYs are clearly discriminatory. The controversial metric intentionally devalues treatments for older people, those with chronic illnesses or disabilities, and people of color to determine whether a treatment is cost-effective enough to be paid for by the Oregon Health Plan.
The illegalities of QALY use are well documented, and The National Council on Disability has repeatedly warned it undermines and violates major U.S. disability and civil rights laws—including the Rehabilitation Act and the Americans with Disabilities Act.
The U.S. Department of Health and Human Services criticized Oregon’s use of QALY because it ‘‘in substantial part values the life of an individual with a disability less than the life of an individual without a disability. This premise is discriminatory and inconsistent with the Americans with Disabilities Act.”
Meghan Moyer, Public Policy Director, Oral Testimony to the House Committee on Behavioral Health and Health Care on February 21, 2024
Why is QALY Being Used in Oregon?
Using the QALY formula, the Oregon Health Authority currently considers this little girl’s life as less valuable than the life of another child without a disability.
Oregon has used a Quality-Adjusted Life-Year (QALY) formula over the last 30 years to determine what would and would not be covered by the Oregon Health Plan.
In 1992, the State submitted a Medicaid waiver application relying on QALY to prioritize coverage and services for those whose lives were deemed of “higher value.”
In 2017, Oregon removed an explicit reference to QALY from its cost-effectiveness framework—but the Health Evidence Review Commission, which guides the Oregon Health Plan’s benefit decisions, continues to rely upon QALY-driven prioritization scores.
What are Impacts of QALY?
QALYs expand existing healthcare inequities by perversely impacting or denying care to people with chronic disease or disabilities, and older adults.
Because of the greater value QALY places on medical treatments that extend the lives of people without disabilities than on those that benefit people with disabilities, these groups are deemed “less worthy” to receive insurance coverage for new medicines or treatments.
How to best care for a patient can be negatively impacted as well, since physicians consider QALY resource allocations when making care decisions.
Chief Sponsors:
Senate Interim Committee on Health Care
Committee:
Senate Committee On Health Care
