The distribution problem in economic evaluation: income and the valuation of costs and consequences of health care programmes.
To date, a common view in the health economics literature is that the applicability of cost-benefit analysis (CBA) is limited, due to the distribution problem which underlies its main method of valuation (e.g. willingness to pay). One view is that cost effectiveness analysis (CEA) overcomes these problems. We show that the same distributional concerns apply to non-monetary valuations of health consequences, to measurement of costs and to the decision rules of CEA. Hence adopting CEA over CBA cannot be justified on the basis of "avoiding" distributional considerations. The implications of our results are discussed, including alternative strategies for the use of "income-based" research findings in social decision-making.
Donaldson
Cam
C
Department of Economics, Centre for Health and Policy Studies, University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada T2N 1N4. cdonalds@ucalgary.edu
Birch
Stephen
S
Gafni
Amiram
A
D003258:Consumer Behavior / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000379:methods / Q000706:statistics & numerical data*; D003657:Decision Making; D005382:Financing, Personal; D015276:Health Care Rationing; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008017:Life Expectancy; D017059:Models, Econometric; D015397:Program Evaluation / Q000379:methods; D019057:Quality-Adjusted Life Years; D026712:Value of Life / Q000191:economics*