Re-thinking “the different perspectives that can be used when eliciting preferences in health”

A Tsuchiya, V Watson

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 dimensions: preferences (personal, social, and socially inclusive personal) and context (ex ante and ex post). The paper has been influential in setting the scene for empirical work which aims to elicit a social preference. The objective of our paper is to re-think this framework. Building on examples using monetary and non-monetary valuations (i.e health state valuation), we ask a few key questions: who is the beneficiary of the health improvement (i.e. the user)? Who pays for it (i.e. the payer) ? Who decides and in what capacity (i.e. the assessor)? Is there a correlation between the probabilities for people to become ill? These questions refine the preference and context dimensions, and identify perspectives not classified by the original framework. We propose an extended framework with 20 possible perspectives and present 11 of these formally to clearly distinguish between them.