HTA - lecture 10 - theoretical foundations of HTA

Question 1

utility Bentham

Answer 1

• Utility: contributing to happiness
• Utility: the extent to which something produces happiness or prevents unhappiness

Question 2

utilitarianism Mill

Answer 2

o Dimensions of pleasure and suffering (intensity, duration, certainty or uncertainty, propinquity (something being near to you) or remoteness, fecundity, purity, and extent.
o Intellectual and sophisticated pleasure rated higher than simpler and physical pleasures
o Room for internal sanctions (guilt, remorse). People can be virtuous. Can feel guilt.

Question 3

welfarism - Neo-classical framework for deciding whether a particular policy is desirable

Answer 3

1. Utility maximisation (maximise pleasure, minimise suffering)
2. Only utility counts, no other outcomes are relevant
3. Only outcomes matter (consequentialism)
4. Individual sovereignty (independent from others)

Question 4

1. Utility maximisation (maximise pleasure, minimise suffering)

Answer 4

• Welfarism: right/wrong depends on effect on utility
• Social welfare is a function of individual utilities
• Utilitarianism: sum of utilities counts
• Utilitarianism assumes welfarism, but not vice versa

Sum of individual utilities

Question 5

2. Only utility counts, no other outcomes are relevant

Answer 5

• Health is not a goal in itself for welfarists
• Rather, utility derived from healthcare consumption
• What is the primary goal of healthcare?

Question 6

3. Only outcomes matter (consequentialism)

Answer 6

• Intentions do not matter
• Actions are not intrinsically right or wrong it depends on the actions
• Contrary to virtue ethics (Aristotle, Nietzsche, Foucault, Nussbaum…)
• No religious considerations
• Adam Smith (1776) An inquiry into the nature and causes of the wealth of nations: ‘It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest.’

Question 7

4. Individual sovereignty (independent from others)

Answer 7

• In essence welfarist economics confines evaluative space to individual utilities only (Brouwer et al. JHE 2008)
• Taken together, ‘. . .these four tenets require that any policy be judged solely in terms of resulting utilities achieved by individuals, as assessed by the individuals themselves’ (Hurley, 1998, p. 377).
• Ordinal or cardinal utility
• Pareto optimal, since interpersonal comparison impossible  impossible to increase happiness without reducing someone else’s

Something brings different utilities to different people

Question 8

the fixed budget assumption

Answer 8

• Extra costs somewhere have to lead to savings elsewhere
• Health gains somewhere have to lead to health losses elsewhere
• Without the assumption, effects spill over to other sectors of society