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Concerns for the worse off: fair innings versus severity

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  • Nord, Erik
Abstract
The original fair innings argument is about claims on length of life. Alan Williams has suggested that the argument also should apply to quality of life. His 'generalised fair innings approach' on the one hand, and the severity approach on the other, are two ways of incorporating concerns for fairness in economic evaluation of health care. They are based on different ethical arguments and therefore partly lead to different results. Both approaches incorporate concerns for current and future severity. There is strong support for this in formal theories of justice and government guidelines, and a number of public surveys even indicate the strength of these concerns. The generalised fair innings approach additionally incorporates concerns for past suffering. Intuitively, this is not unreasonable, but there is at this point little ethical theory or empirical evidence to suggest the strength of such concerns. The fair innings argument can be decomposed in an 'equal innings argument' and a 'sufficient innings argument'. When the fair innings argument is applied to quality of life, its sufficient innings component implies that young people should have priority over old people when it comes to functional improvements and symptom relief for non-fatal conditions. This runs counter to both moral intuitions and official goverment guidelines in Norway and Sweden.

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  • Nord, Erik, 2005. "Concerns for the worse off: fair innings versus severity," Social Science & Medicine, Elsevier, vol. 60(2), pages 257-263, January.
    • Handle: RePEc:eee:socmed:v:60:y:2005:i:2:p:257-263
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    References listed on IDEAS

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    1. Unknown, 2000. "Book Review," Research Policy, Elsevier, vol. 29(9), pages 1189-1191, December.
    2. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January.
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    1. Pinto-Prades, Jose-Luis & Sánchez-Martínez, Fernando-Ignacio & Corbacho, Belen & Baker, Rachel, 2014. "Valuing QALYs at the end of life," Social Science & Medicine, Elsevier, vol. 113(C), pages 5-14.
    2. van Exel, Job & Baker, Rachel & Mason, Helen & Donaldson, Cam & Brouwer, Werner, 2015. "Public views on principles for health care priority setting: Findings of a European cross-country study using Q methodology," Social Science & Medicine, Elsevier, vol. 126(C), pages 128-137.
    3. E. Wetering & E. Stolk & N. Exel & W. Brouwer, 2013. "Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 107-115, February.
    4. Mark Pennington & Rachel Baker & Werner Brouwer & Helen Mason & Dorte Gyrd Hansen & Angela Robinson & Cam Donaldson & the EuroVaQ Team, 2015. "Comparing WTP Values of Different Types of QALY Gain Elicited from the General Public," Health Economics, John Wiley & Sons, Ltd., vol. 24(3), pages 280-293, March.
    5. Adler, Matthew D. & Ferranna, Maddalena & Hammitt, James K. & Treich, Nicolas, 2021. "Fair innings? The utilitarian and prioritarian value of risk reduction over a whole lifetime," Journal of Health Economics, Elsevier, vol. 75(C).
    6. Ulrikke J. V. Hernæs & Kjell A. Johansson & Trygve Ottersen & Ole F. Norheim, 2017. "Distribution-Weighted Cost-Effectiveness Analysis Using Lifetime Health Loss," PharmacoEconomics, Springer, vol. 35(9), pages 965-974, September.
    7. Ottersen, Trygve & Mbilinyi, Deogratius & Maestad, Ottar & Norheim, Ole Frithjof, 2008. "Distribution matters: Equity considerations among health planners in Tanzania," Health Policy, Elsevier, vol. 85(2), pages 218-227, February.
    8. E. Wetering & N. Exel & J. Rose & R. Hoefman & W. Brouwer, 2016. "Are some QALYs more equal than others?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(2), pages 117-127, March.
    9. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
    10. John McKie & Bradley Shrimpton & Jeff Richardson & Rosalind Hurworth, 2011. "The monetary value of a life year: evidence from a qualitative study of treatment costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 945-957, August.
    11. Franken, Margreet & Stolk, Elly & Scharringhausen, Tessa & de Boer, Anthonius & Koopmanschap, Marc, 2015. "A comparative study of the role of disease severity in drug reimbursement decision making in four European countries," Health Policy, Elsevier, vol. 119(2), pages 195-202.
    12. Paula González, 2020. "On the design of equity-oriented pharmaceutical copayments," SERIEs: Journal of the Spanish Economic Association, Springer;Spanish Economic Association, vol. 11(2), pages 179-202, June.
    13. Liesbet Wetering & Job Exel & Ana Bobinac & Werner Brouwer, 2015. "Valuing QALYs in Relation to Equity Considerations Using a Discrete Choice Experiment," PharmacoEconomics, Springer, vol. 33(12), pages 1289-1300, December.
    14. Donna Rowen & John Brazier & Clara Mukuria & Anju Keetharuth & Arne Risa Hole & Aki Tsuchiya & Sophie Whyte & Phil Shackley, 2016. "Eliciting Societal Preferences for Weighting QALYs for Burden of Illness and End of Life," Medical Decision Making, , vol. 36(2), pages 210-222, February.
    15. Thomas Ward & Ruben E. Mujica-Mota & Anne E. Spencer & Antonieta Medina-Lara, 2022. "Incorporating Equity Concerns in Cost-Effectiveness Analyses: A Systematic Literature Review," PharmacoEconomics, Springer, vol. 40(1), pages 45-64, January.
    16. Hannu Valtonen, 2009. "Patient characteristics and fairness," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(2), pages 179-186, May.
    17. Anna Nicolet & Antoinette D I van Asselt & Karin M Vermeulen & Paul F M Krabbe, 2020. "Value judgment of new medical treatments: Societal and patient perspectives to inform priority setting in The Netherlands," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-18, July.
    18. Green, Colin, 2009. "Investigating public preferences on 'severity of health' as a relevant condition for setting healthcare priorities," Social Science & Medicine, Elsevier, vol. 68(12), pages 2247-2255, June.
    19. Wouters, S. & van Exel, N.J.A. & Rohde, K.I.M. & Vromen, J.J. & Brouwer, W.B.F., 2017. "Acceptable health and priority weighting: Discussing a reference-level approach using sufficientarian reasoning," Social Science & Medicine, Elsevier, vol. 181(C), pages 158-167.

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