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Maximisation in extra-welfarism: A critique of the current position in health economics

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  • Coast, Joanna

Abstract

This paper explores critically the use of 'maximisation' as a decision rule within extra-welfarism. Although extra-welfarism in theory focuses on a broader evaluative space than that of utility, in practice there is a narrowing to a focus on health alone; this clear disjoint is one of the factors that makes discussion of extra-welfarism difficult. In this paper we focus on the reality of extra-welfarism as currently practiced (that is, as health maximisation). The paper questions whether a change (from welfarism to extra-welfarism) of the evaluative space from utility to health, automatically implies a change in the rule for decision making from utility maximisation to health maximisation. Both theoretical and empirical grounds are considered. It is reasoned here that the separation of efficiency and equity associated with welfarism is no longer possible within a health evaluative space. Thus any maximisation of health is instead aligned with Bentham's felicific calculus, and implies the acceptance of an ethical basis of utilitarianism. Empirical grounds for maximisation, based on the views of members of society, do not seem to support such a utilitarian ethical basis for the production and distribution of health. This leaves health economists very much relying on perceptions of decision makers' values in their support of health maximisation.

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  • 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.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:5:p:786-792
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    Cited by:

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    2. Herlitz, Anders & Horan, David, 2016. "Measuring needs for priority setting in healthcare planning and policy," Social Science & Medicine, Elsevier, vol. 157(C), pages 96-102.
    3. Richard Smith & Paula Lorgelly & Hareth Al-Janabi & Sridhar Venkatapuram & Joanna Coast, 2012. "The Capability Approach: An Alternative Evaluation Paradigm for Health Economics?," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 39, Edward Elgar Publishing.
    4. Luyten, Jeroen & Beutels, Philippe & Vandermeulen, Corinne & Kessels, Roselinde, 2022. "Social preferences for adopting new vaccines in the national immunization program: A discrete choice experiment," Social Science & Medicine, Elsevier, vol. 303(C).
    5. Philip Kinghorn & Angela Robinson & Richard Smith, 2015. "Developing a Capability-Based Questionnaire for Assessing Well-Being in Patients with Chronic Pain," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 120(3), pages 897-916, February.
    6. Joan Costa-i-Font & Frank Cowell, 2019. "Incorporating Inequality Aversion in Health-Care Priority Setting," CESifo Working Paper Series 7503, CESifo.
    7. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    8. Paul Mark Mitchell & Sridhar Venkatapuram & Jeff Richardson & Angelo Iezzi & Joanna Coast, 2017. "Are Quality-Adjusted Life Years a Good Proxy Measure of Individual Capabilities?," PharmacoEconomics, Springer, vol. 35(6), pages 637-646, June.
    9. Mortimer, Duncan & Peacock, Stuart, 2012. "Social welfare and the Affordable Care Act: Is it ever optimal to set aside comparative cost?," Social Science & Medicine, Elsevier, vol. 75(7), pages 1156-1162.
    10. Mitchell, Paul Mark & Roberts, Tracy E. & Barton, Pelham M. & Coast, Joanna, 2015. "Assessing sufficient capability: A new approach to economic evaluation," Social Science & Medicine, Elsevier, vol. 139(C), pages 71-79.

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