Reassessing how society prioritizes the health of young people

Health Affairs

Volumn 26, Issue 2, 2007, Pages 345-354

  Eisenberg, Daniel ^a   Freed, Gary L ^b  

^a UNIVERSITY OF MICHIGAN   (United States)

^b Department of General Pediatrics ^*

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; AGE; ARTICLE; CHILD; CHILD HEALTH CARE; CHILD WELFARE; COST BENEFIT ANALYSIS; ECONOMICS; FEMALE; HEALTH CARE ORGANIZATION; HEALTH CARE PLANNING; HEALTH CARE POLICY; HUMAN; MALE; MANAGEMENT; PRESCHOOL CHILD; RESOURCE ALLOCATION; RISK FACTOR; SOCIAL PSYCHOLOGY; STANDARD; UNITED STATES;

ADOLESCENT; AGE FACTORS; CHILD; CHILD HEALTH SERVICES; CHILD WELFARE; CHILD, PRESCHOOL; COST-BENEFIT ANALYSIS; FEMALE; HEALTH CARE RATIONING; HEALTH POLICY; HEALTH PRIORITIES; HUMANS; MALE; POLICY MAKING; RESOURCE ALLOCATION; RISK FACTORS; SOCIAL VALUES; UNITED STATES;

EID: 33947329620     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.2.345     Document Type: Article

References (33)

1. See D. Callahan, "Controlling the Cost of Health Care for the Elderly - Fair Means and Foul," New England Journal of Medicine 335, no. 10 (1996): 744-746.
2. E.K. Browning, "Why the Social Insurance Budget Is Too Large in a Democracy," Economic Enquiry 13 (September 1975): 373-388.
3. R.H. Binstock, "Older People and Voting Participation: Past and Future," Gerontologist 40, no. 1 (2000): 18-31.
4. Formore details, see, for example, C. Schmidt, "Subjective Science: Environmental Cost-Benefit Analysis," Environmental Health Perspectives 111, no. 10 (2003): A530-A532.
5. The U.S. Preventive Services Task Force panel recommended considering the increasing value of health over time in sensitivity analysis. The WHO's guide to cost-effectiveness analysis recommended considering this issue as well as age preferences. See M.L. Gold et al., eds., Cost-Effectiveness in Health and Medicine: The Report of the Panel on Cost-Effectiveness in Health and Medicine (New York: Oxford University Press, 1996);
6. and World Health Organization, Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis, ed. T. Tan-Torres Edejer et al. (Geneva: WHO, 2003).
7. Bibliographical details about these studies are available in an online supplement at http://content/healthaffairs.org/cgi/content/full/26/2/345/DC1.
8. A. Tsuchiya, P. Dolan, and R. Shaw, "Measuring People's Preferences Regarding Ageism in Health: Some Methodological Issues and Some Fresh Evidence," Social Science and Medicine 57, no. 4 (2003): 687-696.
9. M.L. Cropper, S.K. Aydede, and P.R. Portney, "Preferences for Life-Saving Programs: How the Public Discounts Time and Age," Journal of Risk and Uncertainty 8, no. 3 (1994): 243-265.
10. E.Nord et al., "Maximizing Health Benefits versus Egalitarianism: An Australian Survey of Health Issues," Social Science and Medicine 41, no. 10 (1995): 1429-1437.
11. E. Nord et al., "The Significance of Age and Duration of Effect in Social Evaluation of Health Care," Health Care Analysis 4, no. 2 (1996): 103-111.
12. For a systematic review of many of these studies, see W.K. Viscusi and J.E. Aldy, "The Value of a Statistical Life: A Critical Review of Market Estimates throughout the World," Journal of Risk and Uncertainty 27, no. 1 (2003): 5-76. Many of these studies are based on observing wage premiums paid to workers in riskier jobs. This might be a biased method for reflecting age-related values of health, because some unobservable aspects of riskier jobs (such as physical exertion, loud noises, extreme temperatures, and polluted air) might be more unpleasant to people of certain ages than they are to others.
13. See J.K. Hammitt, "QALYs versus WTP," Risk Analysis 22, no. 5 (2002): 985-1001.
14. Viscusi and Aldy, "The Value of a Statistical Life."
15. D.L. Costa and M.E. Kahn, "Changes in the Value of Life, 1940-1980," Journal of Risk and Uncertainty 29, no. 2 (2004): 159-180;
16. and J.K. Hammitt, J. Liu, and J. Liu, "Survival Is a Luxury Good: The Increasing Value of a Statistical Life" (Working paper, Harvard University, 2002).
17. H. Gravelle and D. Smith, "Discounting for Health Effects in Cost-Benefit and Cost-Effectiveness Analysis," Health Economics 10, no. 7 (2001): 587-599;
18. R. Hall and C.I. Jones, "The Value of Life and the Rise in Health Spending," Quarterly Journal of Economics (forthcoming);
19. and B.A. van Hout, "Discounting Costs and Effects: A Reconsideration," Health Economics 7, no. 7 (1998): 581-594.
20. We chose the function derived by Rodríguez and Pinto because the methods and sample used to generate the weights were described in greater detail in a peer-reviewed publication. E. Rodríguez and J.L. Pinto, "The Social Value of Health Programmes: Is Age a Relevant Factor?" Health Economics 9, no. 7 (2000): 611-621. The differences between the functions are slight, in any case, and make little difference for our results. We also acknowledge that with the collection in the future of more-nuanced information regarding age preferences for health, more-flexible functional forms for age-weighting might become preferable.
21. C.J.L. Murray and A.D. Lopez, eds., The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020 (Cambridge, Mass.: Harvard University Press, 1996);
22. and J. Jelsma et al., "Preferences of Urban Zimbabweans for Health and Life Lived at Different Ages," Bulletin of the World Health Organization 80, no. 3 (2002): 204-209.
23. 2.
24. Murray and Lopez, eds., The Global Burden of Disease, 1996.
25. The choice of a reference age for the normalization is inherently arbitrary and does not affect the relative cost-effectiveness of different interventions. We chose sixty as the reference age to highlight that whereas age-weighting generally improves the cost-effectiveness of interventions focused on children and younger adults, it generally does the opposite to the cost-effectiveness of interventions focused on the near-elderly or elderly.
26. t, where x = increasing value of health (0.02 in our main analysis) and r = discount rate (0.03 in our analysis).
27. P.A. Ubel et al., "What Is the Price of Life and Why Doesn't It Increase at the Rate of Inflation?" Archives of Internal Medicine 163, no. 14 (2003): 1637-1641.
28. In the standard approach, we used a 3 percent discount rate, as recommended by the U.S. Preventive Services Task Force panel. Combining the two adjustments is only redundant if the preferences used to construct the age weights took into account society's increasing value of health. This seems unlikely, considering that the qualitative data from related survey studies contained no mention of respondents' being aware of this justification for age preferences. Also note that we did not incorporate net resource use into our analysis, because it only affects cost-effectiveness ratios substantially for interventions that extend life at greatly reduced health states, which is not generally applicable to vaccines. See D. Meltzer, "Accounting for Future Costs in Medical Cost-Effectiveness Analysis," Journal of Health Economics 16, no. 1 (1997): 33-64.
29. For the two studies for which we were unable to obtain the necessary data, in one we were unable to make contact with the authors, and in the other the authors said that they no longer had the necessary data.
30. For a brief discussion of related guidelines from a U.S. task force and the WHO, see Gold et al., eds., Cost-Effectiveness in Health and Medicine;
31. and WHO, Making Choices in Health.
32. L.K. Altman, "An Official Puts Focus on Children at AIDS Talks," New York Times, 16 August 2006.
33. D.M. Cutler, A.B. Rosen, and S. Vijan, "The Value of Medical Spending in the United States, 1960-2000," New England Journal of Medicine 355, no. 9 (2006): 920-927.