Advanced Search
MyIDEAS: Login to save this article or follow this journal

Valuing the benefits and costs of health care programmes: where's the 'extra' in extra-welfarism?


Author Info

  • Birch, Stephen
  • Donaldson, Cam
Registered author(s):


    The application of Sen's notion of capabilities to problems of the allocation of resources to health in the form of an extra-welfarist framework underlies the justification of quality adjusted life years (QALYs) as the method for valuing the benefits of health care. In this paper we critically appraise this application from both conceptual and empirical perspectives. We show that the alleged limitations of the welfarist approach are essentially limitations in its application, not in the capacity of the approach to accommodate the concerns of extra-welfarists. Moreover, the arguments used to justify the application of the extra-welfarist framework are essentially welfarist. We demonstrate that the methods used to measure QALYs share their basic theoretical roots with welfarist valuation methods, such as willingness to pay (WTP). Although QALYs and WTP share many challenges, we argue that WTP provides a method which performs better with respect to those challenges. In the context of evaluating alternative allocations of health care resources we are left asking what is 'extra' in extra-welfarism?

    Download Info

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

    Bibliographic Info

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

    Volume (Year): 56 (2003)
    Issue (Month): 5 (March)
    Pages: 1121-1133

    as in new window
    Handle: RePEc:eee:socmed:v:56:y:2003:i:5:p:1121-1133

    Contact details of provider:
    Web page:

    Order Information:

    Related research

    Keywords: Economic evaluation Welfarism Extra-welfarism;


    No references listed on IDEAS
    You can help add them by filling out this form.


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. The potential of the super QALY to reconcile the key contentions in health economics
      by Chris Sampson in The Academic Health Economists' Blog on 2013-05-20 06:54:41
    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as in new window

    Cited by:
    1. Richard D. Smith & Tracey H. Sach, 2009. "Contingent valuation: (still) on the road to nowhere?," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 863-866.
    2. Sanghera, Sabina & Frew, Emma & Kai, Joe & Gupta, Janesh & Elizabeth Roberts, Tracy, 2013. "An assessment of economic measures used in menorrhagia: A systematic review," Social Science & Medicine, Elsevier, Elsevier, vol. 98(C), pages 149-153.
    3. David Whynes & Emma Frew & Jane Wolstenholme, 2005. "Willingness-to-Pay and Demand Curves: A Comparison of Results Obtained Using Different Elicitation Formats," International Journal of Health Care Finance and Economics, Springer, Springer, vol. 5(4), pages 369-386, December.


    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.


    Access and download statistics


    When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:56:y:2003:i:5:p:1121-1133. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Zhang, Lei).

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.