van Hout B A
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
Health Econ. 1998 Nov;7(7):581-94. doi: 10.1002/(sici)1099-1050(1998110)7:7<581::aid-hec380>3.0.co;2-u.
Using a simple societal utility function--giving equal weight to current and future generations-it is concluded that costs need to be discounted on the basis of the expected increase in income and the marginal utility of consumption, and that effects need to be discounted on the basis of the expected increase in health and the marginal utility of health. It is derived that both rates need to be equal when assuming a kind of perfect market, where growth rates are determined by the societal utility function. It is argued that this is an extremely heroic assumption and that different discount rates may be needed. Additionally, the traditional 'inconsistency arguments' of Weinstein and Stason and of Keeler and Cretin are reconsidered. Within the context presented earlier, the first inconsistency only emerges when a growth equilibrium is assumed, reinforcing the arguments put forward before. The Keeler and Cretin paradox is reconsidered by showing that absolutely no paradox emerges when programs are not supposed to stop after a year but are supposed to continue indefinitely. The conclusion is drawn that non-believers in market mechanisms assuring an optimal social policy, need to reconsider the use of their discount rates.
使用一个简单的社会效用函数——对当代人和后代人给予同等权重——可以得出,成本需要根据预期的收入增长和消费的边际效用进行贴现,而效果需要根据预期的健康增长和健康的边际效用进行贴现。推导得出,在假设一种完美市场的情况下,当增长率由社会效用函数决定时,这两种贴现率需要相等。有人认为这是一个极其大胆的假设,可能需要不同的贴现率。此外,还重新审视了温斯坦和斯塔森以及基勒和克雷廷的传统“不一致性论点”。在前面提出的背景下,只有在假设增长均衡时才会出现第一种不一致性,这强化了之前提出的论点。通过表明当项目不应该在一年后停止而是应该无限期持续时绝对不会出现悖论,重新审视了基勒和克雷廷悖论。得出的结论是,那些不相信市场机制能确保最优社会政策的人需要重新考虑他们贴现率的使用。