A New Axiomatic Approach to the Evaluation of Population Health

Abstract

We explore in this paper the implications of ethical and operational principles for the evaluation of population health. We formalize those principles as axioms for social preferences over distributions of health for a given population. We single out several focal population health evaluation functions, which represent social preferences, as a result of combinations of those axioms. Our results provide rationale for popular theories in health economics (such as the unweighted aggregation of QALYs or HYEs, and generalizations of the two, aimed to capture concerns for distributive justice) without resorting to controversial assumptions over individual preferences. AbstractWe explore in this paper the implications of ethical and operational principles for the evaluation of population health. We formalize those principles as axioms for social preferences over distributions of health for a given population. We single out several focal population health evaluation functions, which represent social preferences, as a result of combinations of those axioms. Our results provide rationale for popular theories in health economics (such as the unweighted aggregation of QALYs or HYEs, and generalizations of the two, aimed to capture concerns for distributive justice) without resorting to controversial assumptions over individual preferences.

Analysis and determination the efficiency of the European health systems

“…The authorities have allocated large amounts of resources to increase the health infrastructure and the implementation of policies for prevention and care to achieve full health coverage for the entire population . The main goal objective of these policies is to improve the health of the population, which is equivalent, in measurable results, to an increase in life expectancy and quality of life …”

A normative foundation for equity‐sensitive health evaluation: The role of relative comparisons of health gains

“…Let us start introducing the following two axioms, which were also part of the analysis in Hougaard et al . (), for the model considered therein. The first axiom says that the ranking of a pair of population health distributions does not reverse when all lifetimes are multiplied by a common positive constant.…”

“…The previous two results are of a different nature to Theorems and in Hougaard et al . (), which characterize the Power QALYs and HYEs population health evaluation functions in the domain allowing for zero lifetimes. This is due to the fact that the other two functional forms in the above statements do not pass the test of imposing (right) continuity at zero lifetimes.…”

“…Theorem is the counterpart of theorem in Hougaard et al . (), which characterizes in the model allowing for zero lifetimes the population health evaluation functions satisfying the first five basic axioms considered here, as well as the social zero condition and the axiom of positive life desirability.…”

“…This seemingly innocuous aspect turns out to make a difference in both analyses. In Hougaard et al (2013a), the so-called social zero condition, which says that if an agent gets zero lifetime then her health state does not influence the social desirability of the health distribution, played an important role in simplifying the analysis. Such a condition, which is reminiscent of a widely used condition for individual utility functions on health (e.g., Bleichrodt, Wakker, & Johannesson, 1997;Miyamoto, Wakker, Bleichrodt, & Peters, 1998;Østerdal, 2005) is controversial, because the concept of health, in real life, is not properly understood with zero lifetime.…”