Economic evaluation of health care services for the elderly. Do they discriminate against health promotion and preventive services?

Background. Demographic change and accretive health service utilization result in an increasing need of rational criteria for resource allocation. Health economic evaluation is seen as an explicit and transparent option, to be preferred to more controversial criteria like age-based rationing. Aims. This article pursues the question of whether the application of health economic evaluation especially in the field of prevention and health promotion is as egalitarian as assumed and not more disadvantageous for the elderly than for younger people. Results. Resource allocation following health economic evaluation can be age de- pendent. But this is consistent with admissible normative positions whereas implicit age rationing is not. When based on methodologically sound concepts without substituting more arbitrary forms of rationing, health economic evaluation can therefore be regarded as an allocation mechanism that induces welfare gains.