Economic evaluation of services for a National Health Scheme: The case for a fairness-based framework

Richardson, Jeffrey Ralph James; McKie, John

doi:10.1016/j.jhealeco.2006.11.004

Cited by 26 publications

(30 citation statements)

References 60 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This argument may well be true as it is very likely that people's interest in health improvement will vary with their circumstances. As argued in Richardson and McKie [31] and more explicitly in Richardson et al [32] orthodox theory implicitly assumes that disembodied health benefits may be redistributed to compensate losers (the Kaldor-Hicks criterion). As this is untrue the social or individual benefits of health gains that are embodied in a particular individual become subject to a range of other considerations.…”

Section: Discussionmentioning

confidence: 99%

Severity as an independent determinant of the social value of a health service

et al. 2010

Self Cite

View full text Add to dashboard Cite

This paper has two objectives, first to review the relevant literature concerning the social importance of severity of pre-treatment condition, and second to present the results of a new analysis of the relationship between social value, individual assessment of health improvement and the severity of illness. The present study differs methodologically from others reported in the literature. The underlying hypothesis is that members of the public have an aversion to patients being in a severe health state irrespective of the reason for their being there, and that this aversion will affect the social valuation of a health program after taking account of the magnitude of the health improvement. This effect will be observable in a program which (compared to another) takes a person out of a severe health state--the usual case discussed in the literature--or in a program which (compared to another) leaves a person in a severe health state. The present study tests this second implication of the hypothesis. We present data consistent with the view that after taking account of health improvement, health programs are preferred which do not leave people in severe health states. Alternative explanations are considered and particularly the possibility that data reflect a social preference for individuals achieving their health potential. Both explanations imply the need to reconsider the rules for prioritizing programs. In this analysis, Person Trade-Off (PTO) scores are used to measure social preferences ('value' or 'social utility') and Time Trade-Off (TTO) scores are used to measure individual assessments of health improvement and initial severity. Econometric results suggest that severity is highly significant and may more than double the index of social value of a health service.

show abstract

Section: Discussionmentioning

confidence: 99%

Severity as an independent determinant of the social value of a health service

et al. 2010

Self Cite

View full text Add to dashboard Cite

show abstract

“…They tend to take more risks in the context of choosing in their private capacity, to be more prudent when choosing in their capacity of being a government official, or advising on government policy, Krzysztofowicz (1983). Fifth, normatively, context ought to influence decisions, McKie and Richardson (2003), Richardson and McKie (2007a). Sixth, empirically, how others frame the context alters choices, Tversky and Kahneman (1981), Arrow (1982).…”

Section: Methodological Purity Dogmasmentioning

confidence: 99%

Exchange rate determination: a theory of the decisive role of central bank cooperation and conflict

Pope

Selten

Kaiser

et al. 2012

Int Econ Econ Policy

View full text Add to dashboard Cite

Economists' faith that variable exchange rates benevolently equilibrate has been empirically disconfirmed. That faith is here tackled at its theoretical core with an exchange rate model that although ultra abstract, includes the undeniable fundamentals of market power and differential goals of central bankers and large-scale private players. It permits a game theoretic analysis under the assumption that all agents maximize their payoffs. The paper then relaxes the assumption of maximising agents, allowing for a more complex and thus realistic second version of the model that is interpretable within SKAT, the Stages of Knowledge Ahead Theory of risk and The text is written by Robin Pope, with valued improvements on successive drafts from comments of Johannes Kaiser and Reinhard Selten. The participants' instructions here reported are based on those written by Sebastian Kube and translated into English by Reinhard Selten, with minor improvements on these from Robin Pope. The calculations requested by Robin Pope were kindly furnished by Johannes Kaiser. The particular model within the central bank conflict co-operation theory of exchange rate determination is that of Robin Pope and Reinhard Selten, with valued input from Juergen von Hagen on allowing for the distinct input of the government sector. The operationalisation of the model into a computer-programmed set-up is

show abstract

“…On the contrary, there is a rapidly growing body of studies that collectively show that this assumption is “empirically flawed” 34 – 36. Controversy revolves around (but is not limited to) a higher social priority for interventions when the severity of the patient’s condition increases, with life-saving interventions most highly valued (this is sometimes referred to as “the rule of rescue”37 – 41), and for people in so called double jeopardy (ie, with more than one condition causing impairment) who have less QALYs to gain from successful interventions compared to otherwise healthy individuals 42 – 45.…”

Section: The Logic Of Cost-effectivenessmentioning

confidence: 99%

“…In the absence of codified criteria for fairness and with its heavy (albeit not exclusive) reliance on cost-effectiveness benchmarks, the NICE approach may be characterised as an “efficiency-first” strategy, with “efficiency” defined according to the logic of cost-effectiveness 11 36 87. The NICE priority for “efficiency” is demonstrated by its expectation that adopting a cost-per-QALY threshold, even if interpreted somewhat flexibly,1 88 89 will “maintain consistency across the many different types of healthcare technologies that NICE appraises” 1.…”

Section: Nice’s Use Of Cost-effectiveness As An Exemplar Of a Delibermentioning

confidence: 99%

The use of cost-effectiveness by the National Institute for Health and Clinical Excellence (NICE): no(t yet an) exemplar of a deliberative process

Schlander¹

2008

Journal of Medical Ethics

View full text Add to dashboard Cite

Democratic societies find it difficult to reach consensus concerning principles for healthcare distribution in the face of resource constraints. At the same time the need for legitimacy of allocation decisions has been recognised. Against this background, the National Institute for Health and Clinical Excellence (NICE) aspires to meet the principles of procedural justice, specifically the conditions of accountability for reasonableness as espoused by Daniels and Sabin, that is, publicity, relevance, revisions and appeal, and enforcement. Although NICE has adopted a highly standardised approach and continuously publishes key documents on its website, its technology appraisal programme does not fulfil the publicity condition of accountability for reasonableness. Economic models are not made sufficiently transparent to enable public scrutiny, and decision criteria other than cost-effectiveness remain enigmatic. NICE's reliance on cost-utility analysis and ''plausible'' cost-per-quality-adjusted life year (QALY) benchmarks further raises serious issues with regard to the relevance condition of accountability for reasonableness. This is illustrated by counterintuitive costper-QALY rankings that are difficult to justify using reflective equilibrium methods, and by the current debate surrounding expensive therapies for rare diseases (''orphan'' treatments). In addition, an excessive focus on QALYs may stand in the way of exploiting the best available effectiveness evidence. The NICE mechanism for revision and appeals is also more restrictive than provided in accountability for reasonableness. As to the enforcement condition, no effective quality assurance processes are in place for technology assessments, and implementation of guidance remains imperfect. NICE, despite impressive efforts, appears to have a long way to go before meeting the conditions of accountability for reasonableness.NICE's multiple technology appraisal process is broadly considered a role model for health technology assessments that include economic evaluation. [1][2][3] A review team of the World Health Organization (WHO) described key principles of the NICE approach as ''the use of best available evidence in decision-making, transparency, consultation, inclusion of all key stakeholders, and responsiveness to change''. 4 They concluded that, ''in all of these areas, it is clear that NICE is setting a new, international benchmark, for which it can and should be congratulated''. 4 Further, NICE has assumed a leading role internationally by fostering methodological advances such as the use of probabilistic sensitivity analyses (designed to capture decision uncertainty) and mixed treatment comparison techniques (in order to enable indirect comparisons of technologies in the absence of head-to-head studies). THE LOGIC OF COST-EFFECTIVENESSThe logic of cost-effectiveness, as adopted by NICE and in contrast to traditional cost-benefit analysis, does not represent an orthodox application of economic welfare theory. [5][6][7][8][9] The development o...

show abstract

Economic evaluation of services for a National Health Scheme: The case for a fairness-based framework

Cited by 26 publications

References 60 publications

Severity as an independent determinant of the social value of a health service

Severity as an independent determinant of the social value of a health service

Exchange rate determination: a theory of the decisive role of central bank cooperation and conflict

The use of cost-effectiveness by the National Institute for Health and Clinical Excellence (NICE): no(t yet an) exemplar of a deliberative process

Contact Info

Product

Resources

About