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Social tariffs and democratic choice—Do population‐based health state values reflect the will of the people?
Author(s) -
Schneider Paul Peter
Publication year - 2021
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/hec.4179
Subject(s) - tariff , public economics , economics , social choice theory , quality adjusted life year , preference , product (mathematics) , quality (philosophy) , population , set (abstract data type) , democracy , actuarial science , microeconomics , political science , medicine , cost effectiveness , politics , computer science , international trade , environmental health , operations management , law , philosophy , geometry , mathematics , epistemology , programming language
In economic evaluations of health technologies, health outcomes are commonly measured in terms of quality‐adjusted life years (QALYs). QALYs are the product of time and health‐related quality of life. Health‐related quality of life, in turn, is determined by a social tariff, which is supposed to reflect the public's preference over health states. This study argues that, because of the tariff's role in the societal decision‐making process, it should not be understood as merely an operational (statistical) definition of health, but as a major instrument of democratic participation. I outline what implications this might have for both the method used to aggregate individual preferences, and the set of individuals whose preferences should count. Alternative tariff specifications and decision rules are explored, and future research directions are proposed.