The Value of Health

Economic evaluations of health care can help to make better medical decisions. Decisions about life and death. Our current methods are wrong. Reality is different from what we did believe. Policy decisions based on our current tools are not at all in the best interests of patients. We, scientists, have the responsibility to bridge the gap between theory and reality. Prospect theory respects reality. Now, we have all the opportunity to reliably value health. And, these values can even be obtained free of charge: we do not have to collect additional data. We can apply prospect theory immediately. What remains is to spread the word

QALYs and HYEs: Under what conditions are they equivalent?

The paper examines what restrictions have to be imposed on the individual's preference structure for QALYs and HYEs to yield identical results. It is shown that using QALYs involves imposing three additional restrictions. Empirical evidence suggests that these restrictions cannot be expected to hold in all applications. The main problem in using HYEs appears to be practical. An alternative index is proposed, that may help to bridge the gap between QALYs and HYEs by combining to some extent the advantages of the two measures

Prospect Theory with Reference Points in the Opportunity Set

Many empirical studies have shown that preferences are reference-dependent, implying loss aversion. Because reference-dependence is a relatively new concept, there exists little theory on it. The theories that are available generally take the reference point as given and then impose the traditional assumptions such as completeness of preferences. Reference-dependence raises, however, new problems that do not occur in reference-independent theories. This paper argues that in the empirically realistic cas

Eliciting Gul’s Theory of Disappointment Aversion by the Tradeoff Method

Gul’s (1991) theory of disappointment aversion (DA) has several attractive features, being intuitive, analytically tractable, and parsimonious. In spite of this, the DA model has received little attention in practical applications, which may be partly due to the absence of a procedure to elicit the model. We show how the trade-off method, developed by Wakker and Deneffe (1996), can be used to elicit DA. Our elicitation method is parameter-free: it requires no assumption about utility and/or disappointment aversion. Quantitative tests of DA in three outcome domains, monetary gains, monetary losses, and life-years, suggest that the DA model is too parsimonious. Of the other models of disappointment aversion that have been proposed in the literature, our data are most consistent with the model of Loomes and Sugden (1986)

Standard gamble, time trade-off and rating scale: Experimental results on the ranking properties of QALYs

This paper compares the relative performance of quality adjusted life years (QALYs) based on quality weights elicited by rating scale (RS), time trade-off (TTO) and standard gamble (SG). The standard against which relative performance is assessed is individual preference elicited by direct ranking. The correlation between predicted and direct ranking is significantly higher for TTO-QALYs than for RS-QALYs and SG-QALYs. This holds both based on mean Spearman rank correlation coefficients calculated per individual and based on two social choice rules: the method of majority voting and the Borda rule. Undiscounted TTO-QALYs are more consistent with direct ranking than discounted TTO-QALY

Time preference, the discounted utility model and health

The constant rate discounted utility model is commonly used to represent intertemporal preferences in health care program evaluations. This paper examines the appropriateness of this model, and argues that the model fails both normatively and descriptively as a representation of individual intertemporal preferences for health outcomes. Variable rate discounted utility models are more flexible, but still require restrictive assumptions and may lead to dynamically inconsistent behaviour. The paper concludes by considering two ways of incorporating individual intertemporal preferences in health care program evaluations that allow for complementarity of health outcomes in different time periods

Do financial professionals behave according to prospect theory? An experimental study

Prospect theory is increasingly used to explain deviations from the traditional paradigm of rational agents. Empirical support for prospect theory comes mainly from laboratory experiments using student samples. It is obviously important to know whether and to what extent this support generalizes to more naturally occurring circumstances. This article explores this question and measures prospect theory for a sample of private bankers and fund managers. We obtained clear support for prospect theory. Our financial professionals behaved according to prospect theory and violated expected utility maximization. They were risk averse for gains and risk seeking for losses and their utility was concave for gains and (slightly) convex for losses. They were also averse to losses, but less so than commonly observed in laboratory studies and assumed in behavioral finance. A substantial minority focused on gains and largely ignored losses, behavior reminiscent of what caused the current financial crisis

A New Preference Reversal in Health Utility Measurement

A central assumption in health utility measurement is that preferences are invariant to the elicitation method that is used. This assumption is challenged by preference reversals. Previous studies have observed preference reversals between choice and matching tasks and between choice and ranking tasks. We present a new preference reversal that is entirely choice-based. Because choice is the basic primitive of economics and utility theory, this preference reversal is more fundamental and troubling. The preference reversal was observed in two studies regarding health states after stroke. Both studies involved large representative samples from the Spanish population, interviewed professionally and face-to-face. Possible explanations for the preference reversal are the anticipation of disappointment and elation in risky choice and the impact of ethical considerations about the value of life

A welfare economics foundation for health inequality measurement

The empirical literature on the measurement of health inequalities is vast and rapidly expanding. To date, however, no foundation in welfare economics exists for the proposed measures of health inequality. This paper provides such a foundation for commonly used measures like the health concentration index, the Gini index, and the extended concentration index. Our results indicate that these measures require assumptions that appear restrictive. One way forward may be the development of multi-dimensional extensions

A Quantitative Measurement of Regret Theory

This paper introduces a choice-based method that for the first time makes it possible to quantitatively measure regret theory, one of the most popular models of decision under uncertainty. Our measurement is parameter-free in the sense that it requires no assumptions about the shape of the functions reflecting utility and regret. The choice of stimuli was such that event-s