Centre for Health Policy and Department of Surgery and Cancer, Imperial College London.
Department of Clinical Neurosciences, University of Cambridge, Addenbrookes Hospital.
Health Psychol. 2014 Jan;33(1):66-76. doi: 10.1037/a0030372. Epub 2012 Nov 12.
A standard view in health economics is that, although there is no market that determines the "prices" for health states, people can nonetheless associate health states with monetary values (or other scales, such as quality adjusted life year [QALYs] and disability adjusted life year [DALYs]). Such valuations can be used to shape health policy, and a major research challenge is to elicit such values from people; creating experimental "markets" for health states is a theoretically attractive way to address this. We explore the possibility that this framework may be fundamentally flawed-because there may not be any stable values to be revealed. Instead, perhaps people construct ad hoc values, influenced by contextual factors, such as the observed decisions of others.
The participants bid to buy relief from equally painful electrical shocks to the leg and arm in an experimental health market based on an interactive second-price auction. Thirty subjects were randomly assigned to two experimental conditions where the bids by "others" were manipulated to follow increasing or decreasing price trends for one, but not the other, pain. After the auction, a preference test asked the participants to choose which pain they prefer to experience for a longer duration.
Players remained indifferent between the two pain-types throughout the auction. However, their bids were differentially attracted toward what others bid for each pain, with overbidding during decreasing prices and underbidding during increasing prices.
Health preferences are dissociated from market prices, which are strongly referenced to others' choices. This suggests that the price of health care in a free-market has the capacity to become critically detached from people's underlying preferences.
健康经济学的一个标准观点认为，尽管没有决定健康状况“价格”的市场，但人们仍然可以将健康状况与货币价值（或其他尺度，如质量调整生命年[QALY]和残疾调整生命年[DALY]）联系起来。这些评估可用于制定卫生政策，而主要的研究挑战是从人们那里得出这些价值；创建健康状况的实验“市场”是解决此问题的一种理论上有吸引力的方法。我们探讨了这种框架可能存在根本缺陷的可能性，因为可能没有任何稳定的价值可以揭示。相反，人们可能会根据上下文因素（例如其他人的观察到的决策）构建临时价值。
参与者在基于交互式第二价格拍卖的实验性健康市场中出价购买腿部和手臂同样疼痛的电击缓解。 30 名参与者被随机分配到两个实验条件下，其中“他人”的出价被操纵为遵循一种疼痛的价格上涨或下降趋势，而不是另一种疼痛。拍卖结束后，偏好测试要求参与者选择他们愿意经历更长时间的哪种疼痛。
参与者在整个拍卖过程中对两种疼痛类型均保持中立。但是，他们的出价被其他人对每种疼痛的出价吸引，在价格下降时出价过高，在价格上涨时出价过低。
健康偏好与市场价格脱钩，而市场价格与他人的选择密切相关。这表明，自由市场中的医疗保健价格有可能严重脱离人们的基本偏好。
