INTEGRATING INDIVIDUAL PREFERENCES INTO T HERAPEUTIC AND COLLECTIVE CHOICES

The objectives of contemporary medecine are basically to attenuate the consequences of chronic diseases and to improve the quality of life o f the patient. All medical disciplines tend now to elicit therapeutic protocols directly from the general appreciation of the patients. The community is trying to obtain a transnosographic indicator which would allow the effects of its strategic choices between different areas of the health care system to be measured, taking into account the implic ations on the quality of life of the population. Individual preference s are now at the center of the decision-making process. Different expe rimental methods are beeing used to reveal them. Psychometricians use direct observation of a subject's reactions in a particular pathologic al situation : patients are asked to arrange the intensity of the impa cts on bipolar numeric scales, but an actual metrical measure is not y et available. Traditionally, economists believe that in a market, only the consumer's choices enable us to estimate his level of satisfactio n. In the health care field, where market mechanisms are not fully ope rational, they tend to extract the patients preferences through forced choices between hypothetical health states. A real metrical measure i s thus obtained The objective of this article is to exhibit these two methods : psychometric and economic, and to show how they have been im plemented in French field research to obtain quality adjusted life yea rs indicators : QALY's.