David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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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|
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References found in this work BETA
Gerald Dworkin, Paternalism. Stanford Encyclopedia of Philosophy.
Harry G. Frankfurt (1971). Freedom of the Will and the Concept of a Person. Journal of Philosophy 68 (1):5-20.
Christine M. Korsgaard (1989). Personal Identity and the Unity of Agency: A Kantian Response to Parfit. Philosophy and Public Affairs 18 (2):103-31.
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Derek A. Parfit (1984). Reasons and Persons. Oxford University 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.
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