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Social welfare and the Affordable Care Act: Is it ever optimal to set aside comparative cost?

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  • Mortimer, Duncan
  • Peacock, Stuart
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    Abstract

    The creation of the Patient-Centered Outcomes Research Institute (PCORI) under the Affordable Care Act has set comparative effectiveness research (CER) at centre stage of US health care reform. Comparative cost analysis has remained marginalised and it now appears unlikely that the PCORI will require comparative cost data to be collected as an essential component of CER. In this paper, we review the literature to identify ethical and distributional objectives that might motivate calls to set priorities without regard to comparative cost. We then present argument and evidence to consider whether there is any plausible set of objectives and constraints against which priorities can be set without reference to comparative cost. We conclude that – to set aside comparative cost even after accounting for ethical and distributional constraints – would be truly to act as if money is no object.

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    Bibliographic Info

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

    Volume (Year): 75 (2012)
    Issue (Month): 7 ()
    Pages: 1156-1162

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    Handle: RePEc:eee:socmed:v:75:y:2012:i:7:p:1156-1162

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    Related research

    Keywords: Comparative effectiveness research; Cost-effectiveness research (CER); Cost; Patient-centred outcomes; Social welfare; Equity; Liberty; USA;

    References

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    1. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Who cares about cost? Does economic analysis impose or reflect social values?," Health Policy, Elsevier, vol. 34(2), pages 79-94, November.
    2. Coast, Joanna & Smith, Richard D. & Lorgelly, Paula, 2008. "Welfarism, extra-welfarism and capability: The spread of ideas in health economics," Social Science & Medicine, Elsevier, vol. 67(7), pages 1190-1198, October.
    3. Birch, Stephen & Gafni, Amiram, 1993. "Changing the problem to fit the solution: Johannesson and Weinstein's (mis) application of economics to real world problems," Journal of Health Economics, Elsevier, vol. 12(4), pages 469-476, December.
    4. Lancsar, Emily & Wildman, John & Donaldson, Cam & Ryan, Mandy & Baker, Rachel, 2011. "Deriving distributional weights for QALYs through discrete choice experiments," Journal of Health Economics, Elsevier, vol. 30(2), pages 466-478, March.
    5. Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208.
    6. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Maximizing health benefits vs egalitarianism: An Australian survey of health issues," Social Science & Medicine, Elsevier, vol. 41(10), pages 1429-1437, November.
    7. Culyer, A J, 1971. "Medical Care and the Economics of Giving," Economica, London School of Economics and Political Science, vol. 38(151), pages 295-303, August.
    8. Gold, Marthe Rachel & Franks, Peter & Siegelberg, Taryn & Sofaer, Shoshanna, 2007. "Does providing cost-effectiveness information change coverage priorities for citizens acting as social decision makers?," Health Policy, Elsevier, vol. 83(1), pages 65-72, September.
    9. Coast, Joanna, 2009. "Maximisation in extra-welfarism: A critique of the current position in health economics," Social Science & Medicine, Elsevier, vol. 69(5), pages 786-792, September.
    10. Johannesson, Magnus & Weinstein, Milton C., 1993. "On the decision rules of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 12(4), pages 459-467, December.
    11. Lindsay, Cotton M, 1969. "Medical Care and the Economics of Sharing," Economica, London School of Economics and Political Science, vol. 36(144), pages 351-62, November.
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