Valuing Health. Well-Being, Freedom, and Suffering

About this Book

• the first book-length examination of the many philosophical problems that are raised by the measurement of "generic" or "overall" health and the use of those measures to guide health policy
• explores timely questions relevant to discussions of healthcare allocation, such as: What is health? Can generic health be measured? Should the value of health can be measured by its contribution to well-being?
• the first book to provide philosophical examinations of generic health measurement

In Valuing Health Daniel M. Hausman provides a philosophically sophisticated overview of generic health measurement that suggests improvements in standard methods and proposes a radical alternative. He shows how to avoid relying on surveys and instead evaluate health states directly. Hausman goes on to tackle the deep problems of evaluation, offering an account of fundamental evaluation that does not presuppose the assignment of values to the properties and consequences of alternatives.

After discussing the purposes of generic health measurement, Hausman defends a naturalistic concept of health and its relations to measures such as quality-adjusted life-years (QALYs) and disability-adjusted life years (DALYs). In examining current health-measurement systems, Valuing Health clarifies their value commitments and the objections to relying on preference surveys to assign values to health states. Relying on an interpretation of liberal political philosophy, Hausman argues that the public value of health states should be understood in terms of the activity limits and suffering that health states impose.

Hausman also addresses the moral conundrums that arise when policy-makers attempt to employ the values of health states to estimate the health benefits of alternative policies and to adopt the most cost-effective. He concludes with a general discussion of the difficulties of combining consequentialist and non-consequentialist moral considerations in policy-making.

Readership: The audience will be comprised of: DT Professionals concerned with health measurement DT Those who work on health policy and health administrators in general DT Applied social and political philosophers DT Applied political scientists and policy analysts DT Public health officials, educators, and students

Table of Contents

Introduction
Acknowledgments
1. Why Measure Health?
1.1 Clinical and research uses
1.2 Epidemiological or demographic uses
1.3 Allocational use
1.4 What a generic health measure should be
2. Health
2.1 Functional efficiency
2.2 Pathological vs. healthy part function
2.3 Should generic health measures quantify theoretical health?
2.4 Functional efficiency without statistical normality
2.5 Tentative Conclusions
3. Normative Conceptions of Health and its Measurement
3.1 Evaluative views of health
3.2 Criticism of evaluative theories
3.3 Concepts of health and generic health measurement
3.4 Conclusions
4. Can Health Be Measured?
4.1 Measuring overall functional efficiency
4.2 What measurement requires
4.3 Categorizing health states
4.4 Is the <"at least as healthy as>" relation complete?
4.5 Does the value of health reflect the quantity of health?
5. Health Measurement Systems
5.1 Quality and disability weights
5.2 Health-related quality of life (HRQoL)
5.3 Assigning disability weights in GBD 2010
5.4 GBD 2010: Interpreting the paired comparisons
5.5 Conclusions: Why are health economists measuring attitudes?
6. Well-Being and the Value of Health
6.1 Well-being and the value of life
6.2 Theories of well-being
6.3 Can the value of health states be measured?
6.4 Measuring average and standard values of health states
6.5 What good are average or standard health-state values?
7. Preferences
7.1 What do economists take preferences to be?
7.2 Preference and well-being: evaluative competence and the evidential view
7.3 Preferences and other attitudes
7.4 Preferences, attitudes, and feelings
7.5 Can health be measured by preferences?
8. Valuing Health by Eliciting Preferences
8.1 Critique of preference elicitation practices
8.2 Preference measurement and cognitive limits
8.3 Whose preferences?
8.4 Averaging
8.5 Why rely on informants to value health states?
8.6 Conclusions
9. Health and Happiness
9.1 Dolan and Kahneman's argument for subjective evaluation
9.2 Subjective evaluation
9.3 What matters, mood or subjective appraisal?
9.4 Subjective evaluation of health
9.5 Conclusions
10. Qualms about Valuing Health by Well-Being
10.1 Well-being and the value of health
10.2 Can well-being be measured?
10.3 Subjective experiences as a measure of well-being
10.4 Measuring well-being by preferences
11. What Makes Well-Being Measurable?
11.1 Fundamental evaluation and Hume's position
11.2 A more thoroughgoing subjectivist response and its problems
11.3 What makes states of affairs better for people?
12. Should Health Be Valued by its Contribution to Well-Being?
12.1 The pitfalls and advantages of valuing health by its impact on well-being
12.2 How else can health be valued?
12.3 Is a scalar measure needed?
12.4 Should health states be valued by their contribution to well-being?
13. The Public Value of Health
13.1 The <"social value>" of health states
13.2 Liberalism and the value of health
13.3 The two dimensions of the public value of health
13.4 Public vs. private value and liberal state policy
13.5 Conclusion: the public value of health
14. Measuring the Public Value of Health States
14.1 Ordering distress
14.2 Ordering activity limitations
14.3 Classifying health states for public evaluation
14.4 Valuing limitation/distress pairs
14.5 Conclusions: public evaluation
15. Putting Health Measures to Work: Population Health and Cost-effectiveness
15.1 Cost-effectiveness analysis
15.2 Technical problems and conceptual problems in measuring effectiveness
15.3 Should effectiveness be measured by increases in well-being or health?
15.4 Further normative questions concerning what to measure
15.5 Moral objections to rationing by cost-effectiveness and the relevance of public
values
15.6 Conclusions
16. How Health Policy Should Meet the Ethical Challenges
16.1 Can the fair chances objection be justified?
16.2 Severity: compassion and priority
16.3 Non-aggreggation: respect or compassion
16.4 Discrimination and fairness
16.5 Rationing fairly and humanely
16.6 Freedom, fairness, compassion, and markets
17. Restricted Consequentialism and Public Policy
17.1 Restricted consequentialism
17.2 Coping with the measurement demands of restricted consequentialism
17.3 Why not just ask?
17.4 Conclusions
17.5 A brief recap
References

Author

Daniel M. Hausman is the Herbert A. Simon and Hilldale Professor of Philosophy at the University of Wisconsin-Madison. A founding editor of Economics and Philosophy, his research has centered on epistemological, metaphysical, and ethical issues at the boundaries between economics and philosophy. His most recent book is Preference, Value, Choice and Welfare (Cambridge University Press, 2012).