Re-thinking “the different perspectives that can be used when eliciting preferences in health”
Presenter: Aki Tsuchiya
st
Date: 21 July 2015
Abstract: The 2003 Health Economics paper by Dolan, Olsen, Menzel and Richardson on “An inquiry
into the different perspectives that can be used when eliciting preferences in health” presents a
conceptual framework of six perspectives along two axes: preferences (personal, social, and socially
inclusive personal) and context (ex ante and ex post). The paper has been particularly influential in
setting the scene for empirical work on social value judgements, which typically aim to elicit a social
preference. The objective of our paper is to re-think this framework. Building on examples from
monetary valuations, health state valuations and social value judgements, we offer two ways in which
the framework can be improved substantially. First, along the preference axis, the major shortcoming
of the framework is that it is incomplete. The framework defines the move from the personal to the
social perspective in terms of who it is that becomes ill, leaving aside the consideration of who it is
that bears the cost of the alternative. We argue that there are two different types of social
preferences that should be distinguished from each other: one on non-use values, and the other on
social value judgements. Second, along the context axis, the operationalisation of the ex ante context
is based on the introduction of risk. We show that an ex ante context can be constructed as
equivalent variation, with no reference to risk. Risk (and inequality) can then be introduced
separately. We propose an alternative framework.