Valuing Health

Daniel M. Hausman is the Herbert A. Simon and Hilldale Professor of Philosophy at the University of Wisconsin-Madison. A founding editor of Economics and Philosophy, his research has centered on epistemological, metaphysical, and ethical issues at the boundaries between economics and philosophy. His most recent book is Preference, Value, Choice and Welfare (Cambridge University Press, 2012).

• 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.