Academic journal article Applied Health Economics and Health Policy

Valuing Health at Different Ages

Academic journal article Applied Health Economics and Health Policy

Valuing Health at Different Ages

Article excerpt

Introduction

There is considerable disagreement about how to account for age when valuing health gains as part of the process to establish priorities among health programmes and services. At one extreme, some organizations and government officials have argued on fairness grounds that a death prevented for an older person should receive the same weight as a death prevented for a younger person, despite the higher remaining life expectancy of the latter.[1] At the other extreme, the WHO's Global Burden of Disease project has endorsed the position that health gains for young people should receive high relative weight that goes even beyond life-expectancy considerations.[2] The most common justifications for this position are that younger people have their most productive years still ahead and that they have not yet had their 'fair share' of life.[3] An intermediate position, which reflects standard practice in cost-effectiveness analysis, is that health gains should be valued in proportion to gains in life expectancy, but age does not otherwise factor into the valuation of health gains.

One likely reason for the disagreement about the role of age in priority setting is the mixed empirical evidence on societal preferences related to this issue. As Dolan et al.[4] note, most survey studies on this issue have found community preferences in line with the WHO's position of weighting health for young people even beyond life-expectancy considerations, but a number of other studies have contradicted this conclusion. Furthermore, after extensive deliberation, most members of a National Institute for Health and Clinical Excellence (NICE) Citizens Council concluded that age should not be a criterion for allocating health resources.[5]

There will always be disagreement across individuals about a value-laden issue such as using age for priority setting, but it is important to resolve the ambiguities about the distribution of societal preferences on this matter. Because diseases, programmes and policies often disproportionately affect specific age groups, prioritizing by age group regularly occurs, even if it is not explicitly stated. In this brief report we provide new empirical evidence on age preferences related to health programmes affecting survival as well as programmes affecting non-fatal illnesses. This is the first study of these issues, to our knowledge, that uses a nationally representative sample in the US. We conclude this report with a brief discussion of the open questions regarding various methods to measure societal preferences about age prioritization, as well as possible next steps to reconcile the apparently contradictory findings.

Methods

Our sample is from the C.S. Mott Children's Hospital National Poll on Children's Health,[6] fielded in January 2009 (n = 2132; completion rate = 64%). The participants in the poll were selected from KnowledgePanel® , a nationally representative online panel in the US of adults aged ≥18 years recruited through random-digit dialing of listed and unlisted numbers. Panel members are provided Internet access and a computer if they do not already have these. For any particular survey, a set of panel members is randomly selected and then invited to participate via an email invitation and reminders. By completing a survey, panel members accrue points that can be exchanged for small cash rewards. KnowledgePanel® has served as the sampling frame for other national peer-reviewed survey studies on health topics.[7-10] The survey data collection was approved by the University of Michigan's Institutional Review Board.

Age preferences for preventing mortality and morbidity were measured using binary choice questions reflecting the person trade-off method described by Erik Nord.[11] These types of questions have been used in many previous studies of age-related preferences.[12,13] First, participants were asked, "The government can plan programs to prevent accidents and diseases. …

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