Social tariffs and democratic choice – do population-based health state values reflect the will of the people?

Abstract

In economic evaluations of health technologies, health outcomes are commonly measured in terms of QALYs. QALYs are the product of time and health-related quality of life. Health-related quality of life, in turn, is determined by a social tariff, which is supposed to reflect the public’s preference over health states. This paper argues that, because of the tariff’s role in the societal decision making process, it should not be understood as merely a statistical model, but as a major instrument of democratic participation. I outline what implications this might have for both the method used to aggregate individual preferences, and the set of individuals whose preferences should count. Alternative tariff specifications are explored, and future research directions are proposed.