Does allocating scarce health-system resources by a QALY-based cost-effectiveness threshold structurally undervalue treatment for people with disabilities, who by definition can rarely reach the "perfect health" baseline a QALY is scored against?

Disability-rights advocates argue the QALY's own arithmetic discriminates: a treatment that moves a person with a permanent disability from a lower baseline toward the best health realistically available to them will almost always generate fewer QALYs than the identical intervention given to someone who can reach a full 1.0 score, so a strict per-QALY funding threshold systematically ranks disabled patients' care lower regardless of how much the treatment actually helps them. Health economists who defend the measure argue any health system faces a finite budget, that QALYs are the least-bad common currency for comparing wildly different interventions on relative value for money, and that the alternative, funding decisions with no explicit metric at all, is not more fair, only less transparent about the trade-offs it is already making. Both positions appear across the literature and in real policy: the United Kingdom's National Institute for Health and Care Excellence has used a pound-p