Valuing Health, Healthcare and Health Equality

How should health services best be allocated between citizens in different health conditions and with different socio-economic characteristics? This note contrasts answers to this question based upon a utilitarian conception of the value of healthcare with those derivable from broader pluralist conceptions of value. It seeks to show that only the latter can do justice to our considered intuitions regarding social justice in healthcare allocation. Yet this conclusion should not inhibit use of a Cost Benefit Analytical framework, which can incorporate value pluralism. Under a utilitarian interpretation of “benefit”, a skewing of the allocation of healthcare to favour the deprived is unlikely to be justified. An independent social justice objective is required. Furthermore, the implicit fungibility of all forms of health with other sources of utility is consistent neither with the importance that we accord to provision of health services nor with an objective to narrow specifically health inequalities. An alternative understanding of the value of health services might view health not merely as a consumer good, but also as an “enabling condition” granting the capability to lead a life of value (in Amartya Sen’s terms). Procurement of healthcare to enhance capability is an expression of society’s respect for its members, and is of value as such. Similarly, procurement of health services that mitigate pain expresses society’s compassion. And an egalitarian bias in distribution of these services becomes an expression of society’s equal respect and equal compassion for all its members. There are important methodological implications of these alternative understandings of the value of health and healthcare. Whereas conventional “willingness to pay” surveys could capture the benefits of pain alleviation, alternative methodologies are required to measure impacts upon capability and to gauge the value of healthcare as an expression of equal concern and respect.