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The role of adaptation to disability and disease in health state valuation: a preliminary normative analysis

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  • Menzel, Paul
  • Dolan, Paul
  • Richardson, Jeff
  • Olsen, Jan Abel

Abstract

Chronically ill and disabled patients generally rate the value of their lives in a given health state more highly than do hypothetical patients imagining themselves to be in such states. Much of this difference may be due to actual patients' adaptation to their health states, a phenomenon that would not typically affect the ratings of persons who only hypothetically imagine themselves to be patients. This article pursues a non-empirical, normative question: does such adaptation render actual patients' ratings of quality of life morally questionable for purposes of resource allocation? Distinguishing the different basic elements in patient adaptation reveals why, and in what respects, people are pulled strongly in opposite directions in responding to this question. Several more explicit moral arguments against using adapted patients' ratings have been articulated by economists and philosophers, and others are developed by the authors. While most of these arguments do not survive careful analysis, several do. Given the subsequent complexity of the matter, it is argued that: (1) Neither solely actual nor solely hypothetical patient perspectives should be used for rating quality of life. (2) Even if representatives of the general public acting as hypothetical patients provide ultimately the best perspective from which to discern societal values about health states, patients' values that are often influenced by adaptation must still be conveyed to and clearly understood by public representatives as a critically important fact about health-related quality of life. The article also points to the need for much additional work on adaptation, both empirical research and normative analysis.

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Bibliographic Info

Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 55 (2002)
Issue (Month): 12 (December)
Pages: 2149-2158

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Handle: RePEc:eee:socmed:v:55:y:2002:i:12:p:2149-2158

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Related research

Keywords: Adaptation Cost-effectiveness analysis Discrimination Health state valuation QALYs;

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Cited by:
  1. Graham, Liam & Oswald, Andrew J., 2006. "Hedonic Capital," The Warwick Economics Research Paper Series (TWERPS) 745, University of Warwick, Department of Economics.
  2. Rachel Mann & John Brazier & Aki Tsuchiya, 2009. "A comparison of patient and general population weightings of EQ-5D dimensions," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 363-372.
  3. Michael Lokshin & Martin Ravallion, 2008. "Testing for an economic gradient in health status using subjective data," Health Economics, John Wiley & Sons, Ltd., vol. 17(11), pages 1237-1259.
  4. Oswald, Andrew J. & Powdthavee, Nattavudh, 2006. "Does Happiness Adapt? A Longitudinal Study of Disability with Implications for Economists and Judges," IZA Discussion Papers 2208, Institute for the Study of Labor (IZA).
  5. Begoña Álvarez & Eva Rodríguez-Míguez, 2009. "Patients’ self-interest bias: Empirical evidence from a priority-setting experiment," Working Papers, Universidade de Vigo, Departamento de Economía Aplicada 0903, Universidade de Vigo, Departamento de Economía Aplicada.
  6. Al-Janabi, Hareth & Keeley, Thomas & Mitchell, Paul & Coast, Joanna, 2013. "Can capabilities be self-reported? A think aloud study," Social Science & Medicine, Elsevier, Elsevier, vol. 87(C), pages 116-122.
  7. Dolan, Paul & Kavetsos, Georgios & Tsuchiya, Aki, 2013. "Sick but satisfied: The impact of life and health satisfaction on choice between health scenarios," Journal of Health Economics, Elsevier, vol. 32(4), pages 708-714.
  8. Carbone, Jared C. & Kverndokk, Snorre & Rogeberg, Ole Jorgen, 2005. "Smoking, health, risk, and perception," Journal of Health Economics, Elsevier, vol. 24(4), pages 631-653, July.
  9. McTaggart-Cowan, H & O'Cathain, A & Tsuchiya, A & Brazier, J, 2009. "A qualitative study exploring the general population’s perception of rheumatoid arthritis after being informed about disease adaptation," MPRA Paper 29836, University Library of Munich, Germany.
  10. Andrew J. Oswald & Nattavudh Powdthavee, 2008. "Death, Happiness, and the Calculation of Compensatory Damages," The Journal of Legal Studies, University of Chicago Press, University of Chicago Press, vol. 37(S2), pages S217-S251, 06.
  11. Frijters, Paul & Johnston, David W. & Shields, Michael A., 2008. "Happiness Dynamics with Quarterly Life Event Data," IZA Discussion Papers 3604, Institute for the Study of Labor (IZA).
  12. Carbone, Jared & Kverndokk, Snorre & Røgeberg, Ole-Jørgen, 2009. "Smoking and Health Investments: Impacts of Health Adaptation and Damage Reversibility," HERO On line Working Paper Series, Oslo University, Health Economics Research Programme 2003:12, Oslo University, Health Economics Research Programme.
  13. Brazier, J, 2005. "Current state of the art in preference-based measures of health and avenues for further research," MPRA Paper 29762, University Library of Munich, Germany.
  14. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39.
  15. Jon Gjerde & Sverre Grepperud & Snorre Kverndokk, 2005. "On adaptation and the demand for health," Applied Economics, Taylor & Francis Journals, Taylor & Francis Journals, vol. 37(11), pages 1283-1301.
  16. Paul Dolan & Jan Abel Olsen & Paul Menzel & Jeff Richardson, 2003. "An inquiry into the different perspectives that can be used when eliciting preferences in health," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 545-551.
  17. Lokshin, Michael & Ravallion, Martin, 2005. "Searching for the economic gradient in self-assessed health," Policy Research Working Paper Series 3698, The World Bank.
  18. Bradford, W. David & Dolan, Paul, 2010. "Getting used to it: The adaptive global utility model," Journal of Health Economics, Elsevier, vol. 29(6), pages 811-820, December.
  19. Thébaut, Clémence, 2013. "Dealing with moral dilemma raised by adaptive preferences in health technology assessment: The example of growth hormones and bilateral cochlear implants," Social Science & Medicine, Elsevier, Elsevier, vol. 99(C), pages 102-109.

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