Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia.
Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia.
Value Health. 2018 Jul;21(7):850-857. doi: 10.1016/j.jval.2017.10.022. Epub 2017 Nov 28.
To test the hypothesis that the "severity effect"-the preference for more than utility-maximizing expenditure on severe health states-may be the result of, or exacerbated by, the uncertainty associated with the chance of contracting the illness that causes the severe health state.
Survey respondents were asked to imagine that they will contract one of two illnesses and asked to allocate a budget between two insurance policies, each of which provides services for the treatment of one of the illnesses. A person's final health state varied with the amount of insurance purchased for the illness that occurred and therefore with the level of treatment. The relative cost of the two policies was altered and the selected levels of insurance compared with the levels that would be provided by a health authority that sought to maximize total utility or quality-adjusted life-years from its own budget.
Respondents selected more than utility-maximizing insurance for protection against severe health states. A number of psychological factors that affect measurement under uncertainty do not affect utility as currently measured. This difference may explain the present results and also explain the "severity paradox" that personal preferences as presently measured imply less expenditure on severe health states than do "social preferences" for the treatment of strangers.
Uncertainty alters preferences. Incorporating these preferences in decision making would result in greater spending on severe health states.
检验下述假设，即“严重程度效应”——即人们更倾向于为严重健康状况支付超过效用最大化的费用——可能是由与罹患导致严重健康状况的疾病的可能性相关的不确定性导致的，或者由其加剧。
调查对象被要求想象自己将罹患两种疾病中的一种，并被要求在两种保险计划之间分配预算，每种保险计划都为治疗其中一种疾病提供服务。一个人的最终健康状况取决于为所发生疾病购买的保险金额，从而取决于治疗水平。改变了两种政策的相对成本，并将选定的保险水平与旨在从自身预算中实现总效用或调整后生命年最大化的卫生当局提供的保险水平进行了比较。
受访者选择了超过效用最大化的保险来防范严重健康状况。一些影响不确定性下测量的心理因素不会影响当前的效用衡量。这种差异可能解释了目前的结果，也解释了“严重程度悖论”，即根据目前的衡量标准，个人偏好意味着在严重健康状况上的支出低于对陌生人的“社会偏好”。
不确定性改变了偏好。在决策中纳入这些偏好将导致在严重健康状况上的支出增加。
