Can we compare health states when our standards change?

Abstract

AbstractAmong health economists, who think that preferences are the correct standard of the value of health states, it is common to assume, at least implicitly, that the correct criterion of this value takes the following schematic form: H1 is a better health state than H2 iff the members of group S prefer (on average) being in H1 to being in H2. Various candidates for members of S have been proposed, including medical experts, the general public, H1-patients, H2-patients, former H1-patients, former H2-patients, or combinations of these groups. I shall argue that criteria of this form run into serious problems, if we consider cases where people’s fundamental preferences change from one health state to another. I shall also show that these problems afflict hybrid views, according to which preferences are only one determinant of the value of health, the objective value of health states being another. Finally, I shall argue that a better subjectivist criterion would be something like this: H1 is a better health state than H2 iff the H1-patients would want to be in H1 more than the H2-patients would want to be in H2. According to this criterion, the value of a health state is determined by the absolute attitudes (favouring, disfavouring, neutrality) people would have towards a health state were they to be in it. Along the way, I will also present and make use of an attitude matrix framework that enables us to represent in a simple way complex information about attitudes. With this framework at hand, we can easily see the advantages and disadvantages of different subjectivist accounts of the value of health.