Discounting, Preferences, and Paternalism in Cost-Effectiveness Analysis

Health Care Analysis 20 (3):297-318 (2012)
Abstract
When assessing the cost effectiveness of health care programmes, health economists typically presume that distant events should be given less weight than present events. This article examines the moral reasonableness of arguments advanced for positive discounting in cost-effectiveness analysis both from an intergenerational and an intrapersonal perspective and assesses if arguments are equally applicable to health and monetary outcomes. The article concludes that behavioral effects related to time preferences give little or no reason for why society at large should favour the present over the future when making intergenerational choices regarding health. The strongest argument for discounting stems from the combined argument of diminishing marginal utility in the presence of growth. However, this hinges on the assumption of actual growth in the relevant good. Moreover, current modern democracy may be insufficiently sensitive to the concerns of future generations. The second part of the article categorises preference failures (which justify paternalistic responses) into two distinct groups, myopic and acratic. The existence of these types of preference failures makes elicited time preferences of little normative relevance when making decisions regarding the social discount rate, even in an intrapersonal context. As with intergenerational discounting, the combined arguments of growth and diminishing marginal utility offer the strongest arguments for discounting in the intrapersonal context. However, there is no prima facie reason to assume that this argument should apply equally to health and monetary values. To be sure, selecting an approach towards discounting health is a complex matter. However, the life-or-death implications of any approach require that the discussion not be downplayed to merely a technical matter for economists to settle
Keywords Discounting  Cost-effectiveness analysis  Paternalism  Preference failures  Time preferences
Categories (categorize this paper)
Options
 Save to my reading list
Follow the author(s)
My bibliography
Export citation
Find it on Scholar
Edit this record
Mark as duplicate
Revision history Request removal from index
 
Download options
PhilPapers Archive


Upload a copy of this paper     Check publisher's policy on self-archival     Papers currently archived: 11,404
External links
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
Through your library
References found in this work BETA
Gerald Dworkin, Paternalism. Stanford Encyclopedia of Philosophy.
Bill New (1999). Paternalism and Public Policy. Economics and Philosophy 15 (01):63-.

View all 9 references

Citations of this work BETA
Similar books and articles
Geoffrey Brennan (2007). Discounting the Future, yet Again. Politics, Philosophy and Economics 6 (3):259-284.
Greg Bognar (2011). Impartiality and Disability Discrimination. Kennedy Institute of Ethics Journal 21 (1):1-23.
Analytics

Monthly downloads

Added to index

2011-09-10

Total downloads

4 ( #259,127 of 1,102,977 )

Recent downloads (6 months)

2 ( #183,254 of 1,102,977 )

How can I increase my downloads?

My notes
Sign in to use this feature


Discussion
Start a new thread
Order:
There  are no threads in this forum
Nothing in this forum yet.