Chr. Michelsen Institute, Bergen, Norway.
Soc Sci Med. 2012 Nov;75(10):1836-43. doi: 10.1016/j.socscimed.2012.07.001. Epub 2012 Jul 20.
The literature on how to combine efficiency and equity considerations in the social valuation of health allocations has borrowed extensively from applied welfare economics, including the literature on inequality measurement. By so doing, it has adopted normative assumptions that have been applied for evaluating the allocation of welfare (or income) rather than the allocation of health, including the assumption of a monotonically declining social marginal value of welfare/income/health. At the same time, empirical studies that have elicited social preferences for allocation of health have reported results that are seemingly incompatible with this assumption. There are two ways of addressing this inconsistency; we may censor the stated preferences by arguing that they cannot be supported by normative arguments, or we may reject or modify the analytical framework in order to accommodate the stated preferences. We argue that the stated preferences can be supported by normative reasoning and therefore conclude that one should be cautious in applying the standard welfare economic framework to the allocation of health.
关于如何在健康分配的社会效益评估中兼顾效率和公平的文献，广泛借鉴了应用福利经济学，包括不平等衡量标准的文献。通过这种方式，它采用了规范性假设，这些假设已经被用于评估福利（或收入）的分配，而不是健康的分配，包括福利/收入/健康的社会边际价值单调递减的假设。与此同时，对于健康分配的社会偏好的实证研究报告的结果似乎与这一假设不一致。解决这种不一致有两种方法；我们可以通过争论说这些表述的偏好不能得到规范性论点的支持来审查这些表述的偏好，或者我们可以拒绝或修改分析框架，以适应表述的偏好。我们认为这些表述的偏好可以得到规范性推理的支持，因此我们得出结论，在将标准福利经济框架应用于健康分配时应该谨慎。
