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6 - Prioritarianism and Health Policy

Published online by Cambridge University Press:  09 June 2022

By
Richard Cookson ,
Ole F. Norheim  and
Ieva Skarda
Edited by
Matthew D. Adler  and
Ole F. Norheim
Matthew D. Adler
Affiliation:
Duke University, North Carolina
Ole F. Norheim
Affiliation:
Universitetet i Bergen, Norway
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Summary

This chapter aims to present a practical prioritarian approach to economic evaluation of health programmes, taking into account impacts on income as well as health, with an illustrative application. We propose applying the prioritarian transform to lifetime well-being, defined as the sum of current period well-being over the lifetime. We first describe two simple ways of combining individual-level information on income and health to generate an index of well-being, based on the equivalent life and equivalent income approaches respectively. We then illustrate how these two metrics can be used to conduct lifetime prioritarian evaluation using a simple hypothetical comparison of two funding options for cancer treatment in a low-income country – out-of-pocket payment (OOP) and universal public funding (UPF) via taxes or compulsory insurance premiums proportional to income. We compare the findings of lifetime prioritarian evaluation with those of utilitarian evaluation and benefit-cost analysis.We find that standard cost-effectiveness analysis and benefit-cost analysis are not sensitive to income redistribution, while lifetime prioritarian evaluation is sensitive not only to total effects on health and income but also to progressive redistribution of lifetime income, health and well-being favouring the worse-off.

Keywords

healthincomepriority settinghealth financingeconomic evaluationprioritarian social welfare functionsbenefit-cost analysiscost-effectiveness analysis
Type
Chapter
Information
Prioritarianism in Practice , pp. 260 - 316
Publisher: Cambridge University Press
Print publication year: 2022

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