Title: The measurement of preferences over the distribution of benefits: the importance of the reference point
Authors: Dolan, Paul and Robinson, Angela
Publisher: European economic review, 45 (9). pp. 1697-1709
Abstract: This paper uses the Atkinson method, which was initially developed to measure the shape of the social welfare function (SWF) in the domain of income, to measure the shape of the SWF with respect to the distribution of health benefits. Two separate studies were conducted involving a total of 71 respondents. A comparison of the results across the two studies suggests that reference point effects play an important role in determining responses. Thus, more research is needed on the role that reference point effects ought to and do play in determining the nature and extent of the efficiency – equity trade-off before the results of studies of this kind can be interpreted as ‘equity parameters’ which may simply be ‘plugged into’ an appropriately specified SWF.
Title: Equity in health: the importance of different health streams
Authors: Dolan, Paul and Olsen, Jan Abel
Publisher: Journal of health economics, 20 (5). pp. 823-834
Abstract: This paper develops a conceptual framework in which preferences about the distribution of future health gains depend on differences in four ‘health streams’. These are as follows: (1) the amount of health to be gained; (2) the no-treatment profiles; (3) the amount of health experienced thus far; and (4) the amount of health gained previously as a result of public health interventions. This classification puts the well-established concerns for severity (stream 2) and age weights (stream 3) into a more complete analytical framework. Stream 4 has not been discussed to date and the paper suggests some moral arguments about the distributive relevance of this stream of health.
Title: Utilitarianism and the measurement and aggregation of quality: adjusted life years
Authors: Dolan, Paul
Publisher: Health care analysis, 9 (1). pp. 65-76
Abstract: It is widely accepted that one of the main objectives of government expenditure on health care is to generate health. Since health is a function of both length of life and quality of life, the quality-adjusted life-year (QALY) has been developed in an attempt to combine the value of these attributes into a single index number. The QALY approach – and particularly the decision rule that healthcare resources should be allocated so as to maximise the number of QALYs generated – has often been equated with the utilitarian philosophy of maximising `the greatest happiness of the greatest number’. This paper considers the extent to which the measurement and aggregation of QALYs really is utilitarian by developing a new taxonomy in order to classify utilitarianism and the different aspects of the QALY approach.It is shown that the measurement of QALYs is consistent with a number of different moral positions and that QALYs do not have to be aggregated according to the maximisation rule. Therefore it is inappropriate to necessarily equate QALYs with utilitarianism. It is shown that much turns on what in principle the QALY represents and how in practice it can be operationalised. The paper highlights the category confusion that is often present here and suggests possible avenues for future theoretical and empirical research.