David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
Learn more about PhilPapers
Health Care Analysis 20 (3):297-318 (2012)
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)|
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
Derek Parfit (1984). Reasons and Persons. Oxford University Press.
John Rawls (2009/2005). A Theory of Justice. In Steven M. Cahn (ed.), Philosophy and Rhetoric. Oxford University Press 133-135.
Harry G. Frankfurt (1971). Freedom of the Will and the Concept of a Person. Journal of Philosophy 68 (1):5-20.
Gerald Dworkin, Paternalism. The Monist.
Henry Sidgwick (1907/1996). The Methods of Ethics. Thoemmes Press.
Citations of this work BETA
Stephan Dickert, Daniel Västfjäll, Janet Kleber & Paul Slovic (2012). Valuations of Human Lives: Normative Expectations and Psychological Mechanisms of (Ir)Rationality. Synthese 189 (S1):95-105.
Similar books and articles
Geoffrey Brennan (2007). Discounting the Future, yet Again. Politics, Philosophy and Economics 6 (3):259-284.
Dan W. Brock (1999). Ethical Issues in the Construction of Cost-Effectiveness Analyses for the Prioritization and Rationing of Healthcare. The Proceedings of the Twentieth World Congress of Philosophy 1:215-229.
Madison Powers & Ruth R. Faden (2000). Inequalities in Health, Inequalities in Health Care: Four Generations of Discussion About Justice and Cost-Effectiveness Analysis. Kennedy Institute of Ethics Journal 10 (2):109-127.
E. Wesley & F. Peterson (1993). Time Preference, the Environment and the Interests of Future Generations. Journal of Agricultural and Environmental Ethics 6 (2):107-126.
Greg Bognar (2010). Does Cost Effectiveness Analysis Unfairly Discriminate Against People with Disabilities? Journal of Applied Philosophy 27 (4):394-408.
Greg Bognar (2011). Impartiality and Disability Discrimination. Kennedy Institute of Ethics Journal 21 (1):1-23.
Lars Bernfort (2003). Decisions on Inclusion in the Swedish Basic Health Care Package—Roles of Cost-Effectiveness and Need. Health Care Analysis 11 (4):301-308.
NG Yew-Kwang (2005). Intergenerational Impartiality: Replacing Discounting by Probability Weighting. [REVIEW] Journal of Agricultural and Environmental Ethics 18 (3):237-257.
Shepley W. Orr (2007). Values, Preferences, and the Citizen-Consumer Distinction in Cost-Benefit Analysis. Politics, Philosophy and Economics 6 (1):107-130.
Added to index2011-09-10
Total downloads8 ( #266,667 of 1,724,750 )
Recent downloads (6 months)1 ( #349,121 of 1,724,750 )
How can I increase my downloads?