Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T13:55:14.823Z Has data issue: false hasContentIssue false

6 - Prioritarianism and Health Policy

Published online by Cambridge University Press:  09 June 2022

By
Richard Cookson ,
Ole F. Norheim  and
Ieva Skarda
Edited by
Matthew D. Adler  and
Ole F. Norheim
Matthew D. Adler
Affiliation:
Duke University, North Carolina
Ole F. Norheim
Affiliation:
Universitetet i Bergen, Norway
Get access

Summary

This chapter aims to present a practical prioritarian approach to economic evaluation of health programmes, taking into account impacts on income as well as health, with an illustrative application. We propose applying the prioritarian transform to lifetime well-being, defined as the sum of current period well-being over the lifetime. We first describe two simple ways of combining individual-level information on income and health to generate an index of well-being, based on the equivalent life and equivalent income approaches respectively. We then illustrate how these two metrics can be used to conduct lifetime prioritarian evaluation using a simple hypothetical comparison of two funding options for cancer treatment in a low-income country – out-of-pocket payment (OOP) and universal public funding (UPF) via taxes or compulsory insurance premiums proportional to income. We compare the findings of lifetime prioritarian evaluation with those of utilitarian evaluation and benefit-cost analysis.We find that standard cost-effectiveness analysis and benefit-cost analysis are not sensitive to income redistribution, while lifetime prioritarian evaluation is sensitive not only to total effects on health and income but also to progressive redistribution of lifetime income, health and well-being favouring the worse-off.

Keywords

healthincomepriority settinghealth financingeconomic evaluationprioritarian social welfare functionsbenefit-cost analysiscost-effectiveness analysis
Type
Chapter
Information
Prioritarianism in Practice , pp. 260 - 316
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adler, M. (2012). Well-Being and Fair Distribution: Beyond Cost-Benefit Analysis. New York: Oxford University Press.Google Scholar
Adler, M. (2016). Benefit–cost analysis and distributional weights: An overview. Review of Environmental Economics and Policy, 10, 264–285.Google Scholar
Adler, M. (2019). Measuring Social Welfare: An Introduction. New York: Oxford University Press.CrossRefGoogle Scholar
Adler, M. (2020). Social Welfare Functions. In Norheim, O.F., Emanuel, E., and Millum, J. (eds.), Global Health Priority-Setting: Beyond Cost-Effectiveness. New York: Oxford University Press.Google Scholar
Adler, M., and Holtug, N. (2019). Prioritarianism: A response to critics. Politics, Philosophy & Economics, 18 101–144.CrossRefGoogle Scholar
Anand, S. (2002). The concern for equity in health. Journal of Epidemiology and Community Health, 56, 485–487.CrossRefGoogle ScholarPubMed
Anand, S., Diderichsen, F., Evans, T., Shkolnikov, V.M., and Wirth, M. (2001). Measuring disparities in health: methods and indicators. In Evans, T., Whitehead, M., Diderichsen, F., Bhuiya, A., and Wirth, M. (eds.), Challenging Inequities in Health: From Ethics to Action, pp. 49–67. Oxford: Oxford University Press.Google Scholar
Anand, S., and Nanthikesan, N. (2001). A compilation of length-of-life distribution measures for abridged life tables. Working paper. Harvard Center for Population and Development Studies.Google Scholar
Asaria, M., Griffin, S., and Cookson, R. (2016). Distributional cost-effectiveness analysis: A tutorial. Medical Decision Making, 36, 8–19.Google Scholar
Asaria, M., Griffin, S., Cookson, R., Whyte, S., and Tappenden, P. (2015). Distributional cost-effectiveness analysis of health care programmes – a methodological case study of the UK Bowel Cancer Screening Programme. Health Economics, 24, 742–754.Google Scholar
Bleichrodt, H., Diecidue, E., and Quiggin, J. (2004). Equity weights in the allocation of health care: the rank-dependent QALY model. Journal of Health Economics, 23, 157–171.CrossRefGoogle ScholarPubMed
Bleichrodt, H., Doctor, J., and Stolk, E. (2005). A nonparametric elicitation of the equity-efficiency trade-off in cost-utility analysis. Journal of Health Economics, 24, 655–678.Google Scholar
Bleichrodt, H., and Gafni, A. (1996). Time preference, the discounted utility model and health. Journal of Health Economics, 15, 49–66.CrossRefGoogle ScholarPubMed
Boadway, R.W. (2016). Cost-Benefit Analysis. In Adler, M.D., and Fleurbaey, M. (eds.), The Oxford Handbook of Well-Being and Public Policy, pp. 47–81. New York: Oxford University Press.Google Scholar
Boardman, A.E., Greenberg, D.H., Vining, A., and Weimer, D.L. (2018). Cost-Benefit Analysis: Concepts and Practice, 5th ed. Boston: Cambridge University Press.Google Scholar
Bobinac, A., van Exel, N.J., Rutten, F.F., and Brouwer, W.B. (2012). Inquiry into the relationship between equity weights and the value of the QALY. Value in Health, 15, 1119–1126.CrossRefGoogle ScholarPubMed
Canning, D. (2013). Axiomatic foundations for cost‐effectiveness analysis. Health Economics, 22, 1405–1416.Google Scholar
Chang, A., Horton, S., and Jamison, D.T. (2018). Chapter 9. Benefit-Cost Analysis in Disease Control Priorities, 3rd ed. In Jamison, D.T., Gelband, H., Horton, S., Jha, P., Laxminarayan, R., Mock, C.N., et al. (eds.), Disease Control Priorities: Improving Health and Reducing Poverty. Disease Control Priorities (3rd ed.), Volume 9. Washington, DC.: World Bank.Google Scholar
Claxton, K., Paulden, M., Gravelle, H., Brouwer, W., and Culyer, A.J. (2011). Discounting and decision making in the economic evaluation of health‐care technologies. Health Economics, 20, 2–15.Google Scholar
Cookson, R. (2015). Justice and the NICE approach. Journal of Medical Ethics, 41, 99–102.CrossRefGoogle ScholarPubMed
Cookson, R., Griffin, S., Norheim, O.F., and Culyer, A.C. (eds.) (2020). Distributional Cost-Effectiveness Analysis.  Quantifying Health Equity Impacts and Trade-Offs. Oxford: Oxford University Press.Google Scholar
Cookson, R., Griffin, S., Norheim, O.F., Culyer, A.J., and Chalkidou, K. (2021a). Distributional cost-effectiveness analysis comes of age. Value in Health, 24, 118–120.Google Scholar
Cookson, R., Mirelman, A.J., Griffin, S., et al. (2017). Using cost-effectiveness analysis to address health equity concerns. Value in Health, 20, 206–212.Google Scholar
Cookson, R., Skarda, I., Cotton-Barratt, O., Adler, M., Asaria, M., and Ord, T. (2021b). Quality adjusted life years based on health and consumption: A summary wellbeing measure for cross-sectoral economic evaluation. Health Economics, 30, 70–85.CrossRefGoogle ScholarPubMed
Culyer, A.J. (2016). Cost-effectiveness thresholds in health care: A bookshelf guide to their meaning and use. Health Economics, Policy and Law, 11, 415–432.CrossRefGoogle Scholar
Deaton, A. and Muellbauer, J. (1980). Economics and Consumer Behavior. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Dolan, P., Shaw, R., Tsuchiya, A., and Williams, A. (2005). QALY maximisation and people’s preferences: A methodological review of the literature. Health Economics, 14, 197–208.Google Scholar
Dolan, P., and Tsuchiya, A. (2012). It is the lifetime that matters: Public preferences over maximising health and reducing inequalities in health. Journal of Medical Ethics, 38, 571–573.Google Scholar
Drummond, M.F., Sculpher, M., Claxton, K., Stoddart, G.L., and Torrance, G.W. (2015). Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press.Google Scholar
Faria, R.O. J., and Lomas, J. (2020). Opportunity costs, marginal productivity, and cost-effectiveness thresholds: what are they and how are they related https://aheblog.com/2020/09/23/opportunity-costs-marginal-productivity-and-cost-effectiveness-thresholds-what-are-they-and-how-are-they-related/ (accessed January 4, 2020).Google Scholar
Fleurbaey, M. and Blanchet, D. (2013). Beyond GDP: Measuring Welfare and Assessing Sustainability. Oxford: Oxford University Press.Google Scholar
Fleurbaey, M. and Maniquet, F.A. (2011). Theory of Fairness and Social Welfare. Cambridge: Cambridge University Press.Google Scholar
Fleurbaey, M., and Schokkaert, E. (2009). Unfair inequalities in health and health care. Journal of Health Economics, 28, 73–90, 28, 73-90.CrossRefGoogle ScholarPubMed
Fujiwara, D. (2010). The Department for Work and Pensions Social Cost- Benefit Analysis framework Methodologies for estimating and incorporating the wider social and economic impacts of work in Cost- Benefit Analysis of employment programmes.  A report of research carried out by the Department for Work and Pensions.  Working Paper No 86. London.Google Scholar
Garber, A.M., and Phelps, C.E. (1997). Economic foundations of cost-effectiveness analysis. Journal of Health Economics, 16, 1–31.Google Scholar
Gold, M.R., Stevenson, D., and Fryback, D.G. (2002). HALYS and QALYS and DALYS, Oh My: similarities and differences in summary measures of population Health. Annual Review of Public Health, 23, 115–134.Google Scholar
Hammitt, J.K. (2002). QALYs versus WTP. Risk Analysis, 22, 985–1001.Google Scholar
Hammitt, J.K. (2013). Admissible Utility Functions for Health, Longevity, and Wealth: Integrating Monetary and Life-Year Measures. Journal of Risk and Uncertainty, 47, 311–325.CrossRefGoogle Scholar
Hammitt, J.K. (2017). Valuing Non-Fatal Health Risks: Monetary and Health-Utility Measures. Revue Économique, 68, 335–356.Google Scholar
Hernæs, U.J.V., Johansson, K.A., Ottersen, T., and Norheim, O.F. (2017). Distribution-weighted cost-effectiveness analysis using lifetime health loss. Pharmacoeconomics, 35, 965–974.CrossRefGoogle ScholarPubMed
HM Treasury. (2018). The Green Book. Central Government Guidance on Appraisal and Evaluation. London: Crown copyright.Google Scholar
Jamison, D.T., Jamison, J., Norheim, O.F., and Verguet, S. (2020). Inequality in Survival. In Norheim, O.F., Emanuel, E., and Millum, J. (eds.), Global Health Priority-Setting: Beyond Cost-Effectiveness. New York: Oxford University Press.Google Scholar
Johansson, Kjell Arne et al. (2020) Health by disease categories. In Cookson, Richard, Griffin, Susan, Norheim, Ole F., and Culyer, Anthony, (eds.), Distributional Cost-Effectiveness Analysis: Quantifying Health Equity Impacts and Trade-Offs. Oxford: Oxford University Press.Google Scholar
Johansson, K.A., and Norheim, O.F. (2011). Problems with prioritization: exploring ethical solutions to inequalities in HIV care. American Journal of Bioethics, 11, 32–40.Google Scholar
Johri, M., and Norheim, O.F. (2012). Can cost-effectiveness analysis integrate concerns for equity? Systematic review. International Journal of Technology Assessment in Health Care, 28, 125–132.Google Scholar
Lal, A., Moodie, M., Peeters, A., and Carter, R. (2018). Inclusion of equity in economic analyses of public health policies: systematic review and future directions. Australian and New Zealand Journal of Public Health, 42, 207–213.Google Scholar
Layard, R., Mayraz, G., and Nickell, S. (2008). The marginal utility of income. Journal of Public Economics, 92, 1846–1857.Google Scholar
McIntosh, E., Clarke, P., Frew, E., and Louviere, J. (eds.) (2010). Applied Methods of Cost-Benefit Analysis in Health Care. London: Oxford University Press.Google Scholar
Neumann, P.J., Sanders, G.D., Russell, L.B., Siegel, J.E. and Ganiats, T.G. (eds.) (2017). Cost-Effectiveness in Health and Medicine.  2nd ed. New York: Oxford University Press.Google Scholar
Nord, E. (1993). [Health care politicians are not concerned about maximum health gain per crown]. [Norwegian]. Tidsskrift for Den Norske Laegeforening, 113, 1371–1373.Google ScholarPubMed
Nord, E. (1999). Cost-Value Analysis in Health Care. Cambridge: Cambridge University Press.CrossRefGoogle ScholarPubMed
Nord, E., Pinto, J.L., Richardson, J., Menzel, P., and Ubel, P. (1999). Incorporating societal concerns for fairness in numerical valuations of health programmes. Health Economics, 8, 25–39.Google Scholar
Norheim, O.F. (2013). Atkinson’s index applied to health: can measures of economic inequality help us understand trade-offs in health care priority setting? In Eyal, N., Hurst, S., Norheim, O.F., and Wikler, D. (eds.), Inequalities in Health: Ethics and Measurement, pp. 214–230. New York: Oxford University Press.Google Scholar
Norheim, O.F., Asaria, M., Johansson, K.A., Ottersen, T., and Tsuchiya, A. (2020). Chapter 13: Level-dependent equity weights. In Cookson, R., Culyer, A.J., Griffin, S., and Norheim, O.F. (eds.), Distributional Cost-Effectiveness Analysis.  Quantifying Health Equity Impacts and Trade-Offs, pp. 253–274. Oxford: Oxford University Press.Google Scholar
Norheim, O.F., Ottersen, T., Tolla, M.T., Memirie, S.T., and Johansson, K.A. (2019). Incorporating distributional concerns into practical tools for priority setting. In Norheim, O.F., Emanuel, E., and Millum, J. (eds.), Global Health Priority-Setting: Beyond Cost-Effectiveness. New York: Oxford University Press.Google Scholar
O’Donnel, O., and Van Ourti, T. (2020). Chapter 11: Dominance analysis. In Cookson, R., Griffin, S., Norheim, O.F., and Culyer, A.C. (eds.), Distributional Cost-Effectiveness Analysis. Quantifying Health Equity Impacts and Trade-Offs. Handbooks in Health Economic Evaluation. Oxford: Oxford University Press.Google Scholar
O’Donnell, O., and Van Ourti, T. (2020). Chapter 12: Rank-dependent equity weights. In Cookson, R., Griffin, S., Norheim, O.F., and Culyer, A.C. (eds.), Distributional Cost-Effectiveness Analysis. Quantifying Health Equity Impacts and Trade-Offs. Handbooks in Health Economic Evaluation. Oxford: Oxford University Press.Google Scholar
Onder, H., Pestieau, P., and Ponthière, G. (2019). Equivalent income versus equivalent lifetime: does the metric matter? Paris School of Economics, Working Paper No. 41. halshs-02187803Google Scholar
Ottersen, T. (2013). Lifetime QALY prioritarianism in priority setting. Journal of Medical Ethics, 39, 175–180.Google Scholar
Ottersen, T., Mæstad, O., and Norheim, O.F. (2014). Lifetime QALY prioritarianism in priority setting: quantification of the inherent trade-off. Cost-Effectiveness and Resource Allocation, 12, 2.Google Scholar
Robberstad, B. (2005). QALYs vs DALYs vs LYs gained: What are the differences, and what difference do they make for health care priority setting? Norsk Epidemiologi, 15, 183–191.Google Scholar
Robinson, L., Hammitt, J., Cecchini, M., et al. (2019a). Reference Case Guidelines for Benefit-Cost Analysis in Global Health and Development  (accessed December 16, 2020).Google Scholar
Robinson, L., Hammitt, J., Jamison, D., and Walker, D. (2019b). Conducting benefit-cost analysis in low- and middle-income countries: introduction to the special issue. Journal of Benefit-Cost Analysis, 10, 1–14.Google Scholar
Robinson, L.A., and Hammitt, J.K. (2016). Valuing reductions in fatal illness risks: implications of recent research. Health Economics, 25, 1039–1052.Google Scholar
Robinson, L.A., Hammitt, J.K., and Hammitt, M.D. A. (2018). Assessing the Distribution of Impacts in Global Benefit-Cost Analysis, Guidelines for Benefit‐Cost Analysis Project, Working Paper No. 3.Google Scholar
Robinson, L.A., Hammitt, J.K., and Zeckhauser, R.J. (2016). Attention to distribution in U.S. regulatory analyses. Review of Environmental Economics and Policy, 10, 308–328.Google Scholar
Samson, A.L., Schokkaert, E., Thébaut, C., et al. (2018). Fairness in cost-benefit analysis: A methodology for health technology assessment. Health Economics, 27, 102–114.Google Scholar
Sanders, G.D., Neumann, P.J., Basu, A., et al. (2016). Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. Journal of the American Medical Association, 316, 1093–1103.Google Scholar
Sassi, F., Archard, L., and Le Grand, J. (2001). Equity and the economic evaluation of healthcare. Health Technology Assessment, 5.Google Scholar
US Department of Health and Human Services. (2016). Guidelines for Regulatory Impact Analysis.Google Scholar
Verguet, S., and Norheim, O.F. (2021). Estimating and comparing health and financial risk protection outcomes in economic evaluations: Value in Health (in press).CrossRefGoogle Scholar
Wagstaff, A. (1991). QALYs and the equity-efficiency trade-off. Journal of Health Economics, 10, 21–41.Google Scholar
Wailoo, A., Tsuchiya, A., and McCabe, C. (2009). Weighting must wait: Incorporating equity concerns into cost-effectiveness analysis may take longer than expected. Pharmacoeconomics, 27, 983–989.Google Scholar
Woods, B., Revill, P., Sculpher, M., and Claxton, K. (2016). Country-level cost-effectiveness thresholds: Initial estimates and the need for further research. Value in Health, 19, 929–935.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×