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Discounting costs and effects: a reconsideration

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  • Ben A. Van Hout

Abstract

Using a simple societal utility function—giving equal weight to current and future generations—it is concluded that costs need to be discounted on the basis of the expected increase in income and the marginal utility of consumption, and that effects need to be discounted on the basis of the expected increase in health and the marginal utility of health. It is derived that both rates need to be equal when assuming a kind of perfect market, where growth rates are determined by the societal utility function. It is argued that this is an extremely heroic assumption and that different discount rates may be needed. Additionally, the traditional ‘inconsistency arguments’ of Weinstein and Stason and of Keeler and Cretin are reconsidered. Within the context presented earlier, the first inconsistency only emerges when a growth equilibrium is assumed, reinforcing the arguments put forward before. The Keeler and Cretin paradox is reconsidered by showing that absolutely no paradox emerges when programs are not supposed to stop after a year but are supposed to continue indefinitely. The conclusion is drawn that non‐believers in market mechanisms assuring an optimal social policy, need to reconsider the use of their discount rates. © 1998 John Wiley & Sons, Ltd.

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  • Ben A. Van Hout, 1998. "Discounting costs and effects: a reconsideration," Health Economics, John Wiley & Sons, Ltd., vol. 7(7), pages 581-594, November.
  • Handle: RePEc:wly:hlthec:v:7:y:1998:i:7:p:581-594
    DOI: 10.1002/(SICI)1099-1050(1998110)7:7<581::AID-HEC380>3.0.CO;2-U
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    1. Michael Parsonage & Henry Neuburger, 1992. "Discounting and health benefits," Health Economics, John Wiley & Sons, Ltd., vol. 1(1), pages 71-76, April.
    2. Olsen, Jan Abel, 1993. "On what basis should health be discounted?," Journal of Health Economics, Elsevier, vol. 12(1), pages 39-53, April.
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    3. Angelina Lazaro & Ramon Barberan & Encarnacion Rubio, 2001. "Private and social time preferences for health and money: an empirical estimation," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 351-356, June.
    4. Brouwer, Werner B. F. & van Exel, N. Job A., 2004. "Discounting in decision making: the consistency argument revisited empirically," Health Policy, Elsevier, vol. 67(2), pages 187-194, February.
    5. Kontodimopoulos, Nick & Niakas, Dimitris, 2008. "An estimate of lifelong costs and QALYs in renal replacement therapy based on patients' life expectancy," Health Policy, Elsevier, vol. 86(1), pages 85-96, April.
    6. Steve Harris & Jan Weinzettel & Gregor Levin, 2020. "Implications of Low Carbon City Sustainability Strategies for 2050," Sustainability, MDPI, vol. 12(13), pages 1-23, July.
    7. Patrick Hofstetter & James K. Hammitt, 2002. "Selecting Human Health Metrics for Environmental Decision‐Support Tools," Risk Analysis, John Wiley & Sons, vol. 22(5), pages 965-983, October.
    8. Cairns, John, 2006. "Developments in discounting: With special reference to future health events," Resource and Energy Economics, Elsevier, vol. 28(3), pages 282-297, August.
    9. Hester V Eeren & Saskia J Schawo & Ron H J Scholte & Jan J V Busschbach & Leona Hakkaart, 2015. "Value of Information Analysis Applied to the Economic Evaluation of Interventions Aimed at Reducing Juvenile Delinquency: An Illustration," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-15, July.
    10. Arthur E. Attema & Han Bleichrodt & Olivier L’Haridon & Patrick Peretti-Watel & Valérie Seror, 2018. "Discounting health and money: New evidence using a more robust method," Journal of Risk and Uncertainty, Springer, vol. 56(2), pages 117-140, April.
    11. Hugh Gravelle & Werner Brouwer & Louis Niessen & Maarten Postma & Frans Rutten, 2007. "Discounting in economic evaluations: stepping forward towards optimal decision rules," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 307-317, March.
    12. Arthur E. Attema & Werner B. F. Brouwer & Karl Claxton, 2018. "Discounting in Economic Evaluations," PharmacoEconomics, Springer, vol. 36(7), pages 745-758, July.
    13. Arthur E. Attema & Han Bleichrodt & Peter P. Wakker, 2012. "A Direct Method for Measuring Discounting and QALYs More Easily and Reliably," Medical Decision Making, , vol. 32(4), pages 583-593, July.
    14. Nancy Thiry & Philippe Beutels & Pierre Damme & Eddy Doorslaer, 2003. "Economic Evaluations of Varicella Vaccination Programmes," PharmacoEconomics, Springer, vol. 21(1), pages 13-38, January.
    15. Kobelt, G., 2013. "Health Economics: An Introduction to Economic Evaluation," Monographs, Office of Health Economics, number 000004.
    16. John Hutton, 2012. "‘Health Economics’ and the evolution of economic evaluation of health technologies," Health Economics, John Wiley & Sons, Ltd., vol. 21(1), pages 13-18, January.
    17. Brouwer, Werner B. F. & Koopmanschap, Marc A., 2000. "On the economic foundations of CEA. Ladies and gentlemen, take your positions!," Journal of Health Economics, Elsevier, vol. 19(4), pages 439-459, July.
    18. Philippe Beutels, 2001. "Economic evaluations of hepatitis B immunization: a global review of recent studies (1994–2000)," Health Economics, John Wiley & Sons, Ltd., vol. 10(8), pages 751-774, December.
    19. James O’Mahony & Anthony Newall & Joost Rosmalen, 2015. "Dealing with Time in Health Economic Evaluation: Methodological Issues and Recommendations for Practice," PharmacoEconomics, Springer, vol. 33(12), pages 1255-1268, December.
    20. Robberstad, Bjarne, 2005. "Estimation of private and social time preferences for health in northern Tanzania," Social Science & Medicine, Elsevier, vol. 61(7), pages 1597-1607, October.
    21. Mareike Schad & Jürgen John, 2012. "Towards a social discount rate for the economic evaluation of health technologies in Germany: an exploratory analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(2), pages 127-144, April.
    22. Ana Bobinac & Werner Brouwer & Job van Exel, 2011. "Discounting future health gains: an empirical enquiry into the influence of growing life expectancy," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 111-119, January.
    23. Hugh Gravelle & Dave Smith, 2001. "Discounting for health effects in cost–benefit and cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(7), pages 587-599, October.
    24. Gretchen B. Chapman, 2002. "Your Money or Your Health: Time Preferences and Trading Money for Health," Medical Decision Making, , vol. 22(5), pages 410-416, October.
    25. Angelina Lazaro & Ramon Barberan & Encarnacion Rubio, 2002. "The economic evaluation of health programmes: why discount health consequences more than monetary consequences?," Applied Economics, Taylor & Francis Journals, vol. 34(3), pages 339-350.

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