Graduation Year


Date of Submission


Document Type

Open Access Senior Thesis

Degree Name

Bachelor of Arts



Reader 1

S. Andrew Schroeder

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© 2014 Tess Hubbeling


This paper will examine specific processes involved within the decision-making process of how to allocate limited health care resources. I will start by discussing how in order to compare and differentiate between health states, we have created ranking systems, based on the health state’s impact on people’s quality of life, which health states need more care, and which can be most effectively treated. We evaluate impact on quality of life by assigning quality weights to years of life lived with that health state, which we call quality-adjusted life years, or QALYs.

Next, I will discuss the problems with assigning quality weights to health states; specifically, the disability paradox, meaning the distinct differences between quality weights assigned by non-patients versus patients.

After that, I will explain how depression defies the trend of the disability paradox, and causes our prior arguments about why patients and non-patients rate health states different to contradict themselves., This leads me to suggest that we should consider a different way of deciding between different quality weights. I examine the arguments for choosing higher or lower quality weights, and conclude that because we have a moral imperative to provide health care resources to those in need, particularly those who are disadvantaged, we should take the lower quality weights and err on the side of overspending on health states. Ultimately, this will create the greatest change in funding for health states like depression that go against the disability paradox. Finally, I address the economic trade-offs we have to consider if we make the decision to spend more on treating health states.