SAFEGUARDING AGAINST DISCRIMINATION IN HEALTHCARE.
BECAUSE EVERY LIFE IS VALUABLE.
The passing of the Americans with Disability Act (ADA) in 1990, pioneered and championed by former congressman Toney Coehlo (D-CA), has had a profound impact on protecting the rights of individuals with hearing losses and other disabilities. Much of this impact can be accredited to Title II of the ADA, which prohibits federal and state health care programs, including Medicare and Medicaid, from engaging in discriminatory practices that prevent those with disabilities, including individuals with hearing losses and veterans, from being able to access the appropriate health services and interventions they need. Similarly, Sections 1557 of the Affordable Care Act (ACA) and Section 504 of the Rehabilitation Act, also contain provisions prohibiting federal and state healthcare programs, as well as medical providers and insurers, from engaging in discriminatory practices against individuals with hearing losses within health care settings.
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Understanding how these important protections apply to current issues in healthcare today, such as the debate around the use of quality-adjusted life-years (QALYs) and its' impact on influencing reimbursement and coverage decisions in private and public programs, is crucial to protecting the rights of individuals with hearing losses and ensuring their access to the care they need.
WHAT ARE VALUE ASSESSMENTS?
As policymakers seek to address rising healthcare costs in the U.S., there has been increasing focus on the use of value assessments and cost-effectiveness analyses (CEA) to determine the 'value' of health interventions, including both medical devices and treatments. Value assessments are often conducted to determine whether the benefits of a health intervention is worth the cost. Traditional value assessments often rely on quality-adjusted life-years (QALYs), a controversial and discriminatory metric that de-values the lives of patients with hearing losses and other disabilities compared to healthier patients. If QALY-based value assessments are used to determine coverage and reimbursement decisions, patients with hearing losses will be less likely to access the health interventions they may need more than others.
WHAT IS THE QALY?
Quality-Adjusted Life-Years (QALYs) is a metric value assessors use when conducting cost-effectiveness analyses to measure and compare the benefits of health interventions. Medical ethicists, disability rights organizations, and patient advocates have long argued against QALY-based value assessments, as it is well known that QALY-based CEA falls short in measuring health preferences for patients with disabilities, such as those with hearing losses, individuals with chronic diseases, and the elderly. This is in part because the QALY metric places greater value on years lived in full health, or on interventions that prevent loss of perfect health while discounting gains in health for individuals with hearing losses.
