Beyond QALYs: Why Productivity-Adjusted Life Years are the Future of Healthcare Evaluation

The primary distinction lies in their focus. **QALYs** concentrate on health improvements, combining the quality and quantity of life, and often disregard productivity aspects. Conversely, **PALYs** prioritize productivity gains, quantifying health output by considering factors like absenteeism and presenteeism. **QALYs** aim to measure health benefits in terms of quality and quantity of life, while **PALYs** aim to measure health output by multiplying a productivity index by years lived. This means **QALYs** may overlook economic contributions, and **PALYs** may neglect quality-of-life impacts, highlighting the need for a more comprehensive evaluation framework integrating both.

Integrating **QALYs** and **PALYs** offers a more complete perspective by acknowledging the interplay between health and productivity. **QALYs** alone may miss the economic benefits of interventions, while **PALYs** may overlook broader health improvements. By combining these measures, decision-makers can better assess the comprehensive impact of healthcare interventions and workplace safety policies, leading to more effective, equitable, and socially beneficial outcomes. This integrated approach allows for a more nuanced understanding, accounting for both the length and quality of life, as well as the productive capacity of individuals. The ultimate aim is to promote interventions that not only extend life but also enhance its quality and productive capacity, taking into consideration both health and productivity.

Presenteeism refers to the phenomenon of employees being present at work but experiencing reduced productivity due to illness or other health issues. It is a key factor considered in the **PALY** framework. Unlike absenteeism, which measures time away from work, presenteeism quantifies the decrease in productivity while at work. By including presenteeism in the productivity index, **PALYs** provide a more accurate assessment of the impact of health and workplace interventions on overall productivity. This allows for a comprehensive understanding of how interventions affect employee output, going beyond just whether an employee is present or absent.

Productivity is becoming increasingly important in healthcare evaluation due to shifting demographics, including an aging population and a shrinking working-age population. These factors place significant demands on healthcare resources. With fewer economically active individuals supporting a growing number of retirees, maintaining the health and productivity of the workforce is crucial. Considering productivity through measures like **PALYs** helps in making informed decisions about healthcare interventions and occupational safety policies, ensuring that resources are allocated effectively to support both individual well-being and economic stability. This focus on productivity helps in optimizing the use of resources and ensuring the long-term sustainability of healthcare systems.

The shift towards **PALYs** in evaluating workplace safety policies signifies a move towards valuing productivity as a primary outcome. Traditional evaluations using **QALYs** may not fully capture the benefits of interventions that improve employee productivity. **PALYs**, on the other hand, directly measure the impact of workplace safety on factors like absenteeism, presenteeism, and premature workforce exit. By quantifying productivity gains, **PALYs** provide a more comprehensive assessment of the economic benefits of workplace safety interventions, which can inform cost-benefit analyses and resource allocation decisions. This approach helps employers assess if the costs of interventions are covered by improved productivity, leading to better decisions regarding occupational health and safety.