Evaluation as institution: a contractarian argument for needs-based economic evaluation.

Area of Science:

• Health economics
• Medical ethics
• Public policy

Background:

• A gap exists between health economic evaluation methods and coverage decision-makers' values, particularly in Germany.
• Current methods often disregard fairness concerns or medical need.
• Existing approaches fail to reconcile preference satisfaction with non-consequentialist fairness.

Purpose of the Study:

• To propose a novel contractarian argument for justifying needs-based health economic evaluation.
• To reconcile fairness concerns with resource allocation in healthcare.
• To provide a framework for improving the acceptability of economic evaluations.

Main Methods:

• Conceptual analysis drawing on contractarian ethics and constitution economics.
• Reconstruction of healthcare resource allocation as a social dilemma.
• Justification of needs-based evaluation through Pareto-superiority and consent.

Main Results:

• Health economic evaluation can be framed as an institution for resolving societal conflicts over scarce resources.
• A societal contract, based on progressive funding, can benefit both disadvantaged patients and healthy individuals.
• Needs-based evaluation methods, using consented criteria, ensure social contract sustainability and avoid implicit rationing.

Conclusions:

• The proposed contractarian view helps incorporate fairness into economic evaluation methods.
• Focusing on consent and addressing concerns of non-consenting parties increases acceptability.
• This approach shifts the focus from maximizing a value unit to ensuring social contract sustainability.