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Operant Protocols for Assessing the Cost-benefit Analysis During Reinforced Decision Making by Rodents

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Discounting, preferences, and paternalism in cost-effectiveness analysis.

Gustav Tinghög¹

¹Department of Management and Engineering, Division of Economics, Linköping University, 581 83 Linköping, Sweden. gustav.tinghog@liu.se

Health Care Analysis : HCA : Journal of Health Philosophy and Policy

|September 13, 2011

Summary

Discounting future health benefits is morally complex. Behavioral factors offer little justification for favoring the present over the future in intergenerational health decisions.

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Area of Science:

Health Economics
Moral Philosophy
Public Health Policy

Background:

Health economists commonly discount future health outcomes in cost-effectiveness analysis.
Discounting assigns less value to distant events compared to present ones.
This practice raises ethical questions regarding intergenerational and intrapersonal equity.

Purpose of the Study:

To examine the moral justification for discounting in health economic evaluations.
To assess the applicability of discounting arguments to both health and monetary outcomes.
To analyze the ethical implications of discounting for present and future generations.

Main Methods:

Philosophical examination of arguments for positive discounting.
Analysis of intergenerational and intrapersonal perspectives on time preferences.
Categorization of preference failures (myopic and acratic) influencing time preferences.

Main Results:

Behavioral arguments provide weak justification for discounting future health.
Diminishing marginal utility with growth offers the strongest argument for discounting, but requires assumptions of actual growth.
Preference failures undermine the normative relevance of elicited time preferences for social discount rates.

Conclusions:

Societal discounting of future health lacks strong moral basis from behavioral perspectives.
Growth and diminishing marginal utility arguments for discounting are strongest but context-dependent.
Discounting health outcomes requires careful ethical consideration beyond purely economic technicalities.