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Utilitarian or Quantile-Welfare Evaluation of Health Policy?

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  • Charles F. Manski
  • John Mullahy

Abstract

This paper considers quantile-welfare evaluation of health policy as an alternative to utilitarian evaluation. Manski (1988) originally proposed and studied maximization of quantile utility as a model of individual decision making under uncertainty, juxtaposing it with maximization of expected utility. That paper's primary motivation was to exploit the fact that maximization of quantile utility requires only an ordinal formalization of utility, not a cardinal one. This paper transfers these ideas from analysis of individual decision making to analysis of social planning. We begin by summarizing basic theoretical properties of quantile welfare in general terms rather than related specifically to health policy. We then turn attention to health policy and propose a procedure to nonparametrically bound the quantile welfare of health states using data from binary-choice time-tradeoff (TTO) experiments of the type regularly performed by health economists. After this we assess related econometric considerations concerning measurement, using the EQ-5D framework to structure our discussion.

Suggested Citation

  • Charles F. Manski & John Mullahy, 2025. "Utilitarian or Quantile-Welfare Evaluation of Health Policy?," Papers 2509.05529, arXiv.org, revised Oct 2025.
    • Handle: RePEc:arx:papers:2509.05529
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    References listed on IDEAS

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    1. Manski, Charles F., 1986. "Ordinal Utility Models Of Decision Making Under Uncertainty," SSRI Workshop Series 292682, University of Wisconsin-Madison, Social Systems Research Institute.
    2. Charles F. Manski, 1997. "Monotone Treatment Response," Econometrica, Econometric Society, vol. 65(6), pages 1311-1334, November.
    3. Charles F. Manski & Elie Tamer, 2002. "Inference on Regressions with Interval Data on a Regressor or Outcome," Econometrica, Econometric Society, vol. 70(2), pages 519-546, March.
    4. Amemiya, Takeshi, 1973. "Regression Analysis when the Dependent Variable is Truncated Normal," Econometrica, Econometric Society, vol. 41(6), pages 997-1016, November.
    5. Arie Beresteanu & Francesca Molinari, 2008. "Asymptotic Properties for a Class of Partially Identified Models," Econometrica, Econometric Society, vol. 76(4), pages 763-814, July.
    6. John Mullahy, 2021. "Discovering treatment effectiveness via median treatment effects—Applications to COVID‐19 clinical trials," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1050-1069, May.
    7. J. A. Mirrlees, 1971. "An Exploration in the Theory of Optimum Income Taxation," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 38(2), pages 175-208.
    8. Powell, James L., 1986. "Censored regression quantiles," Journal of Econometrics, Elsevier, vol. 32(1), pages 143-155, June.
    9. Levy, Haim & Kroll, Yoram, 1978. "Ordering Uncertain Options with Borrowing and Lending," Journal of Finance, American Finance Association, vol. 33(2), pages 553-574, May.
    10. Bas Janssen & Mark Oppe & Matthijs Versteegh & Elly Stolk, 2013. "Introducing the composite time trade-off: a test of feasibility and face validity," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 5-13, July.
    11. Sen, Amartya K, 1977. "On Weights and Measures: Informational Constraints in Social Welfare Analysis," Econometrica, Econometric Society, vol. 45(7), pages 1539-1572, October.
    12. Marzena Rostek, 2010. "Quantile Maximization in Decision Theory ," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 77(1), pages 339-371.
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