Valuing Health: Well-Being, Freedom, & Suffering
|Author||Hausman, Daniel M|
In Valuing Health Daniel M. Hausman provides a philosophically sophisticated overview of generic health measurement that suggests improvements in standard methods and proposes a radical alternative. He shows how to avoid relying on surveys and instead evaluate health states directly. Hausman goes on to tackle the deep problems of evaluation, offering an account of fundamental evaluation that does not presuppose the assignment of values to the properties and consequences of alternatives. After discussing the purposes of generic health measurement, Hausman defends a naturalistic concept of health and its relations to measures such as quality-adjusted life-years (QALYs) and disability-adjusted life years (DALYs). In examining current health-measurement systems, Valuing Health clarifies their value commitments and the objections to relying on preference surveys to assign values to health states. Relying on an interpretation of liberal political philosophy, Hausman argues that the public value of health states should be understood in terms of the activity limits and suffering that health states impose. Hausman also addresses the moral conundrums that arise when policy-makers attempt to employ the values of health states to estimate the health benefits of alternative policies and to adopt the most cost-effective. He concludes with a general discussion of the difficulties of combining consequentialist and non-consequentialist moral considerations in policy-making.
Table of Contents
Introduction Acknowledgments 1. Why Measure Health? 1.1 Clinical and research uses 1.2 Epidemiological or demographic uses 1.3 Allocational use 1.4 What a generic health measure should be 2. Health 2.1 Functional efficiency 2.2 Pathological vs. healthy part function 2.3 Should generic health measures quantify theoretical health? 2.4 Functional efficiency without statistical normality 2.5 Tentative Conclusions 3. Normative Conceptions of Health and its Measurement 3.1 Evaluative views of health 3.2 Criticism of evaluative theories 3.3 Concepts of health and generic health measurement 3.4 Conclusions 4. Can Health Be Measured? 4.1 Measuring overall functional efficiency 4.2 What measurement requires 4.3 Categorizing health states 4.4 Is the "at least as healthy as" relation complete? 4.5 Does the value of health reflect the quantity of health? 5. Health Measurement Systems 5.1 Quality and disability weights 5.2 Health-related quality of life (HRQoL) 5.3 Assigning disability weights in GBD 2010 5.4 GBD 2010: Interpreting the paired comparisons 5.5 Conclusions: Why are health economists measuring attitudes? 6. Well-Being and the Value of Health 6.1 Well-being and the value of life 6.2 Theories of well-being 6.3 Can the value of health states be measured? 6.4 Measuring average and standard values of health states 6.5 What good are average or standard health-state values? 7. Preferences 7.1 What do economists take preferences to be? 7.2 Preference and well-being: evaluative competence and the evidential view 7.3 Preferences and other attitudes 7.4 Preferences, attitudes, and feelings 7.5 Can health be measured by preferences? 8. Valuing Health by Eliciting Preferences 8.1 Critique of preference elicitation practices 8.2 Preference measurement and cognitive limits 8.3 Whose preferences? 8.4 Averaging 8.5 Why rely on informants to value health states? 8.6 Conclusions 9. Health and Happiness 9.1 Dolan and Kahneman's argument for subjective evaluation 9.2 Subjective evaluation 9.3 What matters, mood or subjective appraisal? 9.4 Subjective evaluation of health 9.5 Conclusions 10. Qualms about Valuing Health by Well-Being 10.1 Well-being and the value of health 10.2 Can well-being be measured? 10.3 Subjective experiences as a measure of well-being 10.4 Measuring well-being by preferences 11. What Makes Well-Being Measurable? 11.1 Fundamental evaluation and Hume's position 11.2 A more thoroughgoing subjectivist response and its problems 11.3 What makes states of affairs better for people? 12. Should Health Be Valued by its Contribution to Well-Being? 12.1 The pitfalls and advantages of valuing health by its impact on well-being 12.2 How else can health be valued? 12.3 Is a scalar measure needed? 12.4 Should health states be valued by their contribution to well-being? 13. The Public Value of Health 13.1 The "social value" of health states 13.2 Liberalism and the value of health 13.3 The two dimensions of the public value of health 13.4 Public vs. private value and liberal state policy 13.5 Conclusion: the public value of health 14. Measuring the Public Value of Health States 14.1 Ordering distress 14.2 Ordering activity limitations 14.3 Classifying health states for public evaluation 14.4 Valuing limitation/distress pairs 14.5 Conclusions: public evaluation 15. Putting Health Measures to Work: Population Health and Cost-effectiveness 15.1 Cost-effectiveness analysis 15.2 Technical problems and conceptual problems in measuring effectiveness 15.3 Should effectiveness be measured by increases in well-being or health? 15.4 Further normative questions concerning what to measure 15.5 Moral objections to rationing by cost-effectiveness and the relevance of public values 15.6 Conclusions 16. How Health Policy Should Meet the Ethical Challenges 16.1 Can the fair chances objection be justified? 16.2 Severity: compassion and priority 16.3 Non-aggreggation: respect or compassion 16.4 Discrimination and fairness 16.5 Rationing fairly and humanely 16.6 Freedom, fairness, compassion, and markets 17. Restricted Consequentialism and Public Policy 17.1 Restricted consequentialism 17.2 Coping with the measurement demands of restricted consequentialism 17.3 Why not just ask? 17.4 Conclusions 17.5 A brief recap References
"In an analysis unmatched for its comprehensiveness and care, Hausman challenges two dominant assumptions in health economics: that the value of health resides in its bearing on well-being, and that health economists should measure that value through the expressed preferences of patients or citizens. Hausman carves out his own highly original, different position on both the nature and measurement of health's value. Nuanced and philosophically acute, his view cannot be ignored." --Paul T. Menzel, Professor emeritus, Pacific Lutheran University
"Dan Hausman's Valuing Health: Well-Being, Freedom, and Suffering is a scholarly work of exceptional clarity and erudition. Thoroughly researched and beautifully written, it is a remarkable achievement that caps a decade and a half of thinking and writing on these topics. While ostensibly a book about measuring and valuing health, it covers a much broader intellectual terrain, as Hausman navigates confidently between psychometrics, economics, and political philosophy." --Joshua Salomon, Harvard School of Public Health
"In this enjoyable and superbly readable book Hausman distinguishes between measuring health and measuring the value of health, and argues that the value of health should be judged by its contribution to well-being, suggesting ways in which current instruments can be refined in order to do so more accurately. A second vital distinction concerns the private value of health to an individual, and its public value, which should inform health-related resource allocation. Hausman's proposal draws on the theory of 'liberal facilitation' in which the state's main role in relation to health is to provide people with opportunities and to exercise compassion for their suffering. His sketch of a resource allocation mechanism devised on this basis will be a focus of debate for many years to come. This book cements Hausman's standing as one of the leading philosophers of health of our time." --Jonathan Wolff, University College London