Such an interesting and well constructed piece, thanks Deena.
"...at least in the abstract...people treat an extra year of life less like a priceless treasure and more like a durable good: valuable, yes, but bounded." i would hypothesise that it's the case that rather than treating life like a durable good, respondents are implying that the treatment itself is the durable good (within the context of the various surveys you reference). Baked into the responses are the real world costs and the perceived probabilities those costs imply. Are Danes sceptical of more expensive treatments because they have good faith in the ones that are available to them at a lower price? (sorry to ramble)
Really interesting point! If you're used to good medicine being cheap, perhaps you'd never even consider that you might pay more for it if needed. If that's true, the responses wouldn't be capturing a 'true ceiling' but the most they could realistically imagine being called on to pay. It may also be hard to pretend you truly have no outside option other than the one presented in the survey if that's never been your experience.
There aren't enough cross-national studies to do this (or indeed countries that are identical but for their healthcare system), but it'd be interesting to look at differences by a person's typical healthcare costs while controlling for factors like income.
I’d be interested to know if there’s any research that looks at how much people are willing to pay for a QALY when it relates not to themselves, but to their families. I suspect it might be higher.
Great question - there are fewer studies on this, but you're right that people often report higher valuations for health gains when it comes to family members.
A study in Iran (Moradi et. al, 2020) found ~18% higher willingness to pay when health benefits were described as going to an unspecified family member, though it's unclear who respondents were picturing. One in Poland (Bartczak et. al 2023) found adults were most willing to pay for reducing their children’s health risks, but about the same for health gains to themselves or to their elderly parents. Of course, the usual grain of salt to self-reported results applies here: these findings just tell us what people say.
Thank you for this thoughtful comment. And, yes, understood re: self-reported results.
I wonder if you have a point-of-view on this recent NBER research.
It doesn't tell us QALY for our families/loved ones, but it does suggest it's higher.
According to the research, the three things most important to us are: 1) family well-being; 2) financial security; and 3) personal health.
In other words, health of family/loves ones was most important and personal health was third most important suggesting that the QALY for family/loved ones is higher than for oneself.
Also self-reported but asks respondents to make trade-offs..."we estimate marginal utilities of different aspects of life by surveying respondents about what they would choose when making trade-offs between improvements (or between worsenings) in the aspects"
Such an interesting and well constructed piece, thanks Deena.
"...at least in the abstract...people treat an extra year of life less like a priceless treasure and more like a durable good: valuable, yes, but bounded." i would hypothesise that it's the case that rather than treating life like a durable good, respondents are implying that the treatment itself is the durable good (within the context of the various surveys you reference). Baked into the responses are the real world costs and the perceived probabilities those costs imply. Are Danes sceptical of more expensive treatments because they have good faith in the ones that are available to them at a lower price? (sorry to ramble)
Really interesting point! If you're used to good medicine being cheap, perhaps you'd never even consider that you might pay more for it if needed. If that's true, the responses wouldn't be capturing a 'true ceiling' but the most they could realistically imagine being called on to pay. It may also be hard to pretend you truly have no outside option other than the one presented in the survey if that's never been your experience.
There aren't enough cross-national studies to do this (or indeed countries that are identical but for their healthcare system), but it'd be interesting to look at differences by a person's typical healthcare costs while controlling for factors like income.
I’d be interested to know if there’s any research that looks at how much people are willing to pay for a QALY when it relates not to themselves, but to their families. I suspect it might be higher.
Great question - there are fewer studies on this, but you're right that people often report higher valuations for health gains when it comes to family members.
A study in Iran (Moradi et. al, 2020) found ~18% higher willingness to pay when health benefits were described as going to an unspecified family member, though it's unclear who respondents were picturing. One in Poland (Bartczak et. al 2023) found adults were most willing to pay for reducing their children’s health risks, but about the same for health gains to themselves or to their elderly parents. Of course, the usual grain of salt to self-reported results applies here: these findings just tell us what people say.
Thank you for this thoughtful comment. And, yes, understood re: self-reported results.
I wonder if you have a point-of-view on this recent NBER research.
It doesn't tell us QALY for our families/loved ones, but it does suggest it's higher.
According to the research, the three things most important to us are: 1) family well-being; 2) financial security; and 3) personal health.
In other words, health of family/loves ones was most important and personal health was third most important suggesting that the QALY for family/loved ones is higher than for oneself.
Link to paper: https://www.nber.org/system/files/working_papers/w33846/w33846.pdf
Method:
Also self-reported but asks respondents to make trade-offs..."we estimate marginal utilities of different aspects of life by surveying respondents about what they would choose when making trade-offs between improvements (or between worsenings) in the aspects"