Evaluation as institution: a contractarian argument for needs-based economic evaluation

Rogowski, W.

doi:10.1186/s12910-018-0294-1

Cited by 4 publications

(4 citation statements)

References 52 publications

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“…Recently, this idea has been developed to show how using cost-effectiveness in decisions about funding new health technologies like the fitness tracker app can be interpreted as an institution to overcome societal conflicts within a social statutory health insurance contract [ 73 ]. Both disadvantaged patients and affluent healthy individuals can be argued to share interests in a societal contract to provide healthcare technologies based on progressive funding.…”

Section: Preferences As Fairness Judgmentsmentioning

confidence: 99%

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Preferences as fairness judgments: a critical review of normative frameworks of preference elicitation and development of an alternative based on constitutional economics

Rogowski,

John

2024

Cost Eff Resour Alloc

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Preference elicitation is widely used within health economic evaluations to inform coverage decisions. However, coverage decisions involve questions of social justice and it is unclear what role empirical evidence about preferences can play here. This study reviews the prevalent normative frameworks for using population-based preference elicitation and the criticisms they face, and proposes an alternative based on constitutional economics. The frameworks reviewed include a supposedly value-neutral framework of preferences as predictors of choice, preference utilitarian frameworks that aim to maximize preference satisfaction, and substantive consequentialist frameworks that aim to maximize happiness, health, or capabilities. The proposed alternative implements the idea that indices of social value are tools for conflict resolution, rather than tools for maximization. Preference elicitation is used for validating values generated by multi-criteria decision analysis results within representative processes of stakeholder deliberation.

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Section: Preferences As Fairness Judgmentsmentioning

confidence: 99%

“…In this view, the economic analysis does not focus on the question of how to aggregate individual preferences, or how to specify a social value function based on some consequentialist ethical considerations. Instead, it aims at searching for a rule that can find consent by all covered under the rule [ 73 ].…”

Section: Preferences As Fairness Judgmentsmentioning

confidence: 99%

Preferences as fairness judgments: a critical review of normative frameworks of preference elicitation and development of an alternative based on constitutional economics

Rogowski,

John

2024

Cost Eff Resour Alloc

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“…However, both players have incentives to defect. Therefore, benefit maximization leads them both toward situation (III), representing an equilibrium in dominant strategies toward a Pareto-inferior social state (Backhaus 2005, p. 233;Homann and Suchanek 2000, p. 37;Rogowski 2018).…”

Section: Prisoner's Dilemmamentioning

confidence: 99%

The Prisoner’s Dilemma: An Adequate Concept for Ethical Analysis in Healthcare? A Systematic Search and Critical Review

Rogowski

Lange

2020

J Bus Ethics

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Schools of economic ethics inspired by Buchanan propose viewing ethical conflicts as prisoners’ dilemmas (PDs) to facilitate solutions based on Pareto-improving institutional changes. Given that healthcare is determined by complex institutional arrangements, it has been claimed that this approach is also suitable for business ethics in healthcare. To scrutinize this claim, this research systematically searched for studies reporting PD structures in healthcare. PubMed, EconLit, and EconBiz were searched to find articles in German and English. Study type, characteristics of the game, and the proposed means to overcome the dilemma (if mentioned) were extracted and analyzed for aspects supporting or challenging the claim. Across 53 studies, 68 descriptions of various dilemmas in healthcare and public health were identified. Many authors successfully developed proposals for institutional change to overcome these dilemmas. However, many of these analyses exhibited limitations such as oversimplifications or inconsistencies. Also, the quality of evidence on both the characteristics of dilemmas and the effectiveness of proposed solutions was very poor. The subsamples of studies that explicitly cited the ethical approach were disjunct from those that applied empirical methods to analyze the dilemmas (frequently applying empirically richer frameworks than rational choice only). The large number of identified PDs indicates that economic ethics is relevant to healthcare. However, there is a need for further evidence to substantiate both the descriptive and prescriptive claims of this ethical theory. It should thus be seen as a complement that needs justification, rather than a substitute superior to other ethical frameworks.

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“…In part, this is due to the fact that consequentialist principles like health maximization conflict with the deontological fairness considerations which guide constitutional and social law. Recently, it has been argued that these concerns could be addressed by analyzing health economic evaluation as a tool for conflict resolution rather than as a tool for maximizing any unit of outcome like health [9]. To further develop a methodology of health economic evaluation which is consistent with this theoretical framework, there is a need that all methodological elements can find consensus among those who are affected by coverage decisions.…”

Section: Introductionmentioning

confidence: 99%

MCDA-based deliberation to value health states: lessons learned from a pilot study

Gansen

Klinger

Rogowski

2019

Health Qual Life Outcomes

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Background Health economists have shown a growing interest in deliberation and multi-criteria decision analysis (MCDA) as possible pathways to transparently integrate value judgments in cost-utility analyses. In line with these developments, this study piloted a consensus process to derive a German value set for the Short-Form Six-Dimension (SF-6D). In a conference setting, a group was tasked to deliberate on scores and weights for the SF-6D from the perspective of a self-determined and independent life. Methods The one-day consensus conference was based on a deliberative process in combination with the MCDA method MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique). According to MACBETH, participants were asked to qualitatively rate pairwise comparisons of SF-6D health states. The scoring within each dimension was conducted in parallel group sessions. Final agreement on the scores as well as weights for the SF-6D dimensions were derived in a subsequent plenary assembly. Results were analyzed using the software M-MACBETH and qualitative content analysis. Results A total of 34 participants were recruited. While each of the 6 small groups presented a consented score, the plenary assembly reached consensus on all dimensions apart from pain. Concerning dimension weights, some participants favored prioritizing pain and mental health. Others disputed that trade-offs between dimensions and thus assigning weights were not acceptable in a context where this may involve withholding care from someone. As a consequence, no consensus on a value set was reached. Participants identified the group size of the plenary session and the applied weighting procedure as main obstacles to the process. Conclusions This pilot study presents a consensus-based approach for valuing health-related quality of life. However, further research is needed on deliberative processes that yield quantifiable results. Future conferences should explore smaller group sizes, longer durations of the deliberative process and alternatives to the additive value function applied in MACBETH. Electronic supplementary material The online version of this article (10.1186/s12955-019-1189-7) contains supplementary material, which is available to authorized users.

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Evaluation as institution: a contractarian argument for needs-based economic evaluation

Cited by 4 publications

References 52 publications

Preferences as fairness judgments: a critical review of normative frameworks of preference elicitation and development of an alternative based on constitutional economics

Preferences as fairness judgments: a critical review of normative frameworks of preference elicitation and development of an alternative based on constitutional economics

The Prisoner’s Dilemma: An Adequate Concept for Ethical Analysis in Healthcare? A Systematic Search and Critical Review

MCDA-based deliberation to value health states: lessons learned from a pilot study

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