title: To count or not to count deaths: reranking effects in health distribution evaluation.
abstract: Populations' structures and sizes can be a result of healthcare policy decisions. We use a two-period theoretical framework and a dynamic microsimulation model to examine the consequences of this assertion on the appraisal of alternative health policy options. Results show that standard welfare-in-health measures are sensitive to changes in populations' sizes, in that taking into account the (virtual) existence of the dead can alter the ranking of policy options. Disregarding differences in the survivals induced by alternative policies can bias programmes' ranking in favour of less live-saving policies. The paper alerts on the risk of policy misranking by the use of ex-post cross-sectional analyses, neglecting deaths occurring in the past as well as counterfactual deaths in alternative policy scenarios.
authors.affiliation: Aix-Marseille University (Aix-Marseille School of Economics - GREQAM UMR CNRS 7316), Marseille, France; SESSTIM - Inserm UMR912, Marseille, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Arrighi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abu-Zaineh
authors.forename: Bruno
authors.initials: B
authors.lastname: Ventelou
mesh_terms: D000293:Adolescent; D000328:Adult; D003198:Computer Simulation; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000628:therapy*; D020276:HIV Long-Term Survivors / Q000706:statistics & numerical data*; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015203:Reproducibility of Results; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
keywords: HIV/AIDS; developing countries; health outcomes; health programmes; microsimulation; moral philosophy; mortality; population issues; social choice; utilitarianism