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Valuing health: a new proposal

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  • Daniel M. Hausman

Abstract

After criticizing existing systems of health measurement for their unargued commitment to evaluating health states in terms of preferences or well‐being, this essay argues that public rather than private values of health states should help guide the allocation of health‐related resources. Private evaluation of health states is relative to a prior individual choice of specific activities and goals, while public evaluation is relative to the whole range of important activities and goals. Public evaluation is concerned with securing a wide range of choices as well as with success given one's choice. A reasonable simplification from the public perspective is to focus on just two features of health states: the subjective feelings attached to health states and the limitations that health states imply on the range of important activities that individuals can pursue. Focusing on just these two dimensions permits the construction of a parsimonious classification of health states with regard to what matters most from the public perspective. This classification, which resembles those in the HALex and the Rosser and Kind Disability and Distress Index, might best be built on top of existing health‐state classifications, by mapping the health states they define to activity‐limitation/feeling pairs. To assign values to these pairs, I propose relying on deliberative groups to make comparisons among the pairs with respect to the relation ‘is a more serious limitation on the range of objectives and good lives available to members of the population’. A ranking according to this property, is not a preference ranking, because it is not a ranking in terms of everything that matters to individuals. Working back from the weights attached to the activity‐limitation/feeling pairs, one can impute weights for the health states in other classification systems that were mapped to those pairs. If those weights coincide roughly with current weights, then one legitimizes current weights and provides a vehicle for their public discussion and possible revision. If those weights do not coincide, then one has both an argument for revising current views of the cost effectiveness of treatments and policies and a method to carry out such a revision. Copyright © 2009 John Wiley & Sons, Ltd.

Suggested Citation

  • Daniel M. Hausman, 2010. "Valuing health: a new proposal," Health Economics, John Wiley & Sons, Ltd., vol. 19(3), pages 280-296, March.
    • Handle: RePEc:wly:hlthec:v:19:y:2010:i:3:p:280-296
    DOI: 10.1002/hec.1474
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    References listed on IDEAS

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    2. Rachel Baker & Angela Robinson, 2004. "Responses to standard gambles: are preferences ‘well constructed’?," Health Economics, John Wiley & Sons, Ltd., vol. 13(1), pages 37-48, January.
    3. David Parkin & Nancy Devlin, 2006. "Is there a case for using visual analogue scale valuations in cost‐utility analysis?," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 653-664, July.
    4. Hausman,Daniel M. & McPherson,Michael S., 2006. "Economic Analysis, Moral Philosophy and Public Policy," Cambridge Books, Cambridge University Press, number 9780521608664, December.
    5. Brazier, John & Roberts, Jennifer & Deverill, Mark, 2002. "The estimation of a preference-based measure of health from the SF-36," Journal of Health Economics, Elsevier, vol. 21(2), pages 271-292, March.
    6. Hausman,Daniel M. & McPherson,Michael S., 2006. "Economic Analysis, Moral Philosophy and Public Policy," Cambridge Books, Cambridge University Press, number 9780521846295.
    7. Ken Buckingham & Nancy Devlin, 2006. "A theoretical framework for TTO valuations of health," Health Economics, John Wiley & Sons, Ltd., vol. 15(10), pages 1149-1154, October.
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    1. Marco Ricardo Téllez Cabrera, 2018. "Giving arguments to operationalize health capabilities in economic evaluations of health interventions," Journal of Social and Economic Development, Springer;Institute for Social and Economic Change, vol. 20(2), pages 240-255, October.
    2. Mathias Kifmann, 2010. "Indikationsspezifische Kosten-Nutzen-Bewertung auf Grundlage eines sozialen Gesundheitsindexes," Discussion Paper Series 310, Universitaet Augsburg, Institute for Economics.
    3. Al-Janabi, Hareth & Keeley, Thomas & Mitchell, Paul & Coast, Joanna, 2013. "Can capabilities be self-reported? A think aloud study," Social Science & Medicine, Elsevier, vol. 87(C), pages 116-122.
    4. Richard Cookson & Ieva Skarda & Owen Cotton‐Barratt & Matthew Adler & Miqdad Asaria & Toby Ord, 2021. "Quality adjusted life years based on health and consumption: A summary wellbeing measure for cross‐sectoral economic evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 30(1), pages 70-85, January.
    5. Schneider, Paul, 2019. "Social tariffs and democratic choice – do population-based health state values reflect the will of the people?," SocArXiv 2qvjb, Center for Open Science.
    6. 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, vol. 99(C), pages 102-109.
    7. Paul Peter Schneider, 2021. "Social tariffs and democratic choice—Do population‐based health state values reflect the will of the people?," Health Economics, John Wiley & Sons, Ltd., vol. 30(1), pages 104-112, January.
    8. Paul Mark Mitchell & Hareth Al-Janabi & Jeff Richardson & Angelo Iezzi & Joanna Coast, 2015. "The Relative Impacts of Disease on Health Status and Capability Wellbeing: A Multi-Country Study," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-15, December.

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