Departments of Economics and Public Health Sciences, University of Rochester, Rochester, NY, USA.
Value Health. 2023 Nov;26(11):1601-1607. doi: 10.1016/j.jval.2023.08.001. Epub 2023 Aug 18.
While welfarist economics (WE) methods rely wholly on individuals' valuations, extra-welfarist (EW) methods seek alternative measures of value. Major reviews of the EW literature conclude that EW studies almost universally replace "utility" with "health" as the maximand. This analysis seeks to understand what conclusions are necessary and sufficient to make EW and WE methods concurrent and discusses implications for measuring social value.
Using standard WE methods, I demonstrate that EW is equivalent to WE with 2 key restrictions-individuals have constant returns to health in producing utility and health budgets are fixed. Fixing budgets removes a key WE step, determining the marginal rate of substitution between consumption and health, the willingness to pay for health gains.
Because EW methods equate with WE with these 2 restrictions, I show how formal models to construct aggregated social welfare functions (SWFs) in WE frameworks lead directly to SWF models using EW models of value. I also show that, in fixed-budget health systems, when SWFs place different values for improving health of different subpopulations, aggregate health output fails as a SWF criterion. I demonstrate how different societal values can and should enter EW SWF models using WE criteria. I also discuss the implications when either of these key restrictions does not properly represent people's preferences.
Once EW methods are shown to be a restricted form of WE methods, those WE methods can illuminate how best to measure SWFs in EW environments.
虽然福利主义经济学（WE）方法完全依赖于个人的评估，但超福利主义（EW）方法则寻求替代价值衡量标准。对 EW 文献的主要综述得出结论，EW 研究几乎普遍将“效用”替换为“健康”作为目标。本分析旨在理解使 EW 和 WE 方法同时使用所必需和充分的结论，并讨论对衡量社会价值的影响。
我使用标准 WE 方法证明 EW 等同于 WE，具有 2 个关键限制——个人在产生效用时具有健康的恒常回报，并且健康预算是固定的。预算固定消除了 WE 方法的一个关键步骤，即确定消费和健康之间的边际替代率，即对健康收益的支付意愿。
由于 EW 方法具有这 2 个限制，因此我展示了如何在 WE 框架中构建聚合社会福利函数（SWF）的正式模型直接导致使用 EW 价值模型的 SWF 模型。我还表明，在固定预算的卫生系统中，当 SWF 对不同亚人群的健康改善赋予不同价值时，总体健康产出不能作为 SWF 标准。我展示了如何使用 WE 标准将不同的社会价值观纳入 EW SWF 模型。我还讨论了当这些关键限制之一不能正确代表人们的偏好时的影响。
一旦 EW 方法被证明是 WE 方法的一种受限形式，那么这些 WE 方法就可以阐明如何在 EW 环境中最好地衡量 SWF。
