+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Discounting in health care decision-making: time for a change?

Discounting in health care decision-making: time for a change?

Journal of Public Health Medicine 14(3): 250-256

Economic appraisal is increasingly being used to inform health care decision-making. To allow comparison, costs and benefits spread over time are weighted according to when they are experienced. The further in the future, the less heavily they are weighted or the more they are discounted. Traditional economic appraisal techniques are based on the view that social decisions should reflect private preferences. The practice of discounting future streams of costs and benefits is principally justified by the fact that individuals have a positive time preference, preferring consumption sooner rather than later. Discounting weights public decision-making in favour of interventions resulting in short-term benefits and against longer-term benefits. This discriminates against preventive and other public health programmes. This paper provides a critique of the foundations of discounting. It is argued that health policy should have a longer time horizon, reflecting social values rather than individual preferences. Factors which make discounting the future rational from the individual's point of view are shown to be irrelevant to a societal perspective. Although uncertainty about the effectiveness of interventions and technological change are good reasons for weighting some future benefits less highly, the routine use of a single discount rate for economic evaluations of health programmes is not justified.

Please choose payment method:

(PDF emailed within 1 workday: $29.90)

Accession: 039840703

Download citation: RISBibTeXText

PMID: 1419202

Related references

Discounting and decision making in the economic evaluation of health-care technologies. Health Economics 20(1): 2, 2011

Economics and the Future: Time and Discounting in Private and Public Decision Making. American Journal of Agricultural Economics 92(5): 1499-1502, 2010

Relationship Power in Health Care: Science of Behavior Change, Decision Making, and Clinician Self-Care. Family Medicine 50(1): 70-71, 2018

Being Kind to Your Future Self: Probability Discounting of Health Decision-Making. Annals of Behavioral Medicine 50(2): 297-309, 2016

Normative and descriptive models of decision making: time discounting and risk sensitivity. Ciba Foundation Symposium 208: 51-67; Discussion 67-70, 1997

Economic decision making in healthcare. A standard approach to discounting health outcomes. Pharmacoeconomics 7(3): 198-205, 1995

Time and decision making: differential contribution of the posterior insular cortex and the striatum during a delay discounting task. Experimental Brain Research 179(4): 643-653, 2007

Adult age differences in decision making across domains: Increased discounting of social and health-related rewards. Psychology and Aging 31(7): 737-746, 2016

New frontiers in health care decision-making: information, decision-making, and divided loyalties. South Carolina Nurse 4(3): 5-6, 1997

DECIDE: a decision-making model for more effective decision making by health care managers. Health Care Manager 27(2): 118-127, 2008

Decision making for health care professionals: use of decision trees within the community mental health setting. Journal of Advanced Nursing 35(3): 349-356, 2001

Bridging health technology assessment (HTA) and efficient health care decision making with multicriteria decision analysis (MCDA): applying the EVIDEM framework to medicines appraisal. Medical Decision Making 32(2): 376-388, 2012

Genetic thrombophilia in patients with VTE in eastern Mediterranean located tertiary care center; is it time to change the algorithm for thrombophilia work up decision making?. Journal of Thrombosis and Thrombolysis 21(3): 267-270, 2006

Justice in health care decision-making: patients' appraisals of health care providers and health plan representatives. Social Justice Research 18(1): 63-81, 2005

Are we ready to use cost-effectiveness analysis in health care decision-making? A health services research challenge for clinicians, patients, health care systems, and public policy. Medical Care 36(5 Suppl): Ms10, 1998