Department of Economics, University of Rochester, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester, Rochester, NY, USA; Department of Political Science, University of Rochester, Rochester, NY, USA.
Value Health. 2024 Jul;27(7):830-836. doi: 10.1016/j.jval.2024.02.005. Epub 2024 Feb 22.
Most current methods to value healthcare treatments only incorporate measures such as quality-adjusted life-years, combining gains in health-related quality of life and life expectancy in specific ways. Failure of these methods to recognize other dimensions of value has led to calls for methods to include additional values that are associated with the healthcare treatments but not captured directly by quality-adjusted life-years. This article seeks to provide methodologically sound ways to incorporate additional health-related outcomes, focusing on budget-constrained healthcare systems, in which using standard welfare economics methods are often eschewed.
The analysis develops standard extra-welfarist approaches to maximizing aggregate health, subject to fixed-budget constraints, using Lagrange multiplier methods. Then, additional valuable health-related outcomes, eg, reduced caregiver burden, real option value, and market- and non-market productivity are introduced. The article also introduces a social welfare function approach to illuminate how disability, disease severity and other equity-related issues can be incorporated into complete welfare measures.
Resulting analysis, fully developed in an Appendix in Supplemental Materials found at https://doi.org/10.1016/j.jval.2024.02.005 and summarized in the main text, show that understanding how average and marginal healthcare costs increase with output and how health augments "additional values" provides ways to assess willingness to pay for them in these fixed-budget situations.
In budget-constrained healthcare systems, only from actual budget allocations can values both of health itself and "additional values" be inferred. These methods, combined with methodologically sound social welfare functions, demonstrate how to move from "health" to "welfare" in measuring the value of increased healthcare use.
目前大多数评估医疗保健治疗方法的方法仅纳入了质量调整生命年等措施，以特定方式综合了健康相关生活质量和预期寿命的提高。这些方法未能认识到其他价值维度，导致呼吁采用其他方法来纳入与医疗保健治疗相关但无法直接通过质量调整生命年来衡量的附加价值。本文旨在提供将其他健康相关结果纳入其中的方法，重点是在预算受限的医疗保健系统中，因为在这些系统中，通常避免使用标准福利经济学方法。
分析采用拉格朗日乘数法，针对固定预算约束，制定了最大化总健康的标准额外福利主义方法。然后，引入了额外有价值的健康相关结果，例如减少护理人员负担、实物期权价值以及市场和非市场生产力。本文还介绍了一种社会福利函数方法，阐明如何将残疾、疾病严重程度和其他与公平相关的问题纳入全面福利衡量标准。
在补充材料中可以找到完整的分析结果（网址为 https://doi.org/10.1016/j.jval.2024.02.005），并在正文中进行了总结。分析结果表明，理解平均和边际医疗保健成本如何随产出增加，以及健康如何增强“附加价值”，为在这些固定预算情况下评估对其的支付意愿提供了方法。
在预算受限的医疗保健系统中，只有通过实际预算分配，才能推断出健康本身和“附加价值”的价值。这些方法与方法合理的社会福利函数相结合，展示了如何在衡量增加医疗保健使用的价值时，从“健康”过渡到“福利”。
