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Empirical quantification and parameterization the Achievement Index

QALY-maximization vs. QALE-equality. Empirical quantification and parameterization the Achievement Index. Trygve Ottersen, MD, PhD student University of Bergen Harvard Program in Ethics and Health. Research group in Global health: Ethics, economics and culture. Context. Priority-setting

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Empirical quantification and parameterization the Achievement Index

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  1. QALY-maximization vs. QALE-equality Empirical quantification and parameterization the Achievement Index Trygve Ottersen, MD, PhD student University of Bergen Harvard Program in Ethics and Health Research group in Global health: Ethics, economics and culture

  2. Context • Priority-setting • Cost-effectiveness analysis • Summary measures of population health

  3. Health maximization Equality in health VS World Health Report 2000. Health Systems: Improving Performance

  4. The achievement index Wagstaff 2002. Inequality aversion, health inequalities and health achievement. Journal of Health Economics

  5. Objective Question How much importance should be attributed to the goal of maximizing health relative to that of benefiting the worse off? Project Develop and test method to answer this question, so as to best provide input for the parameterization of the Achievement Index

  6. Methods

  7. Methods

  8. Results: Patterns

  9. Results: Weights

  10. Results: Weights

  11. Results: Weights

  12. Results: Achievement Index Wagstaff 2002. Inequality aversion, health inequalities and health achievement. Journal of Health Economics Chotikapanich and Griffiths 2001. On calculation of the extended Gini coefficient. Review of Income and wealth

  13. Results: Achievement Index STATA 9.2 v = 1,30 for median data v = 1,19 – 1,45 R-squared: 0,970 Root MSE: 0,318 Mean data: v = 1,24, R-squared 0,997, root MSE 0,094

  14. Results: Method • 19-26 %

  15. Lessons • Maximiziation of health not all that matters • Ranking tasks can expose inconstencies • Deliberation / guidance might be required • Context important: • Absolute level • Absolute differences • Relative differences

  16. Thank you

  17. Results: Other differences Atkinson 1970. On the measurement of inequality

  18. Results: Other differences Olsen 1994. Persons vs years: Two ways of eliciting implicit weights. Health Economics Rodriguez-Miguez and Pinto-Prades 2002. Measuring the social importance of concentration or dispersion of individual health benefits. Health Economics

  19. Results: Patterns

  20. Subcharacteristics Subcharacteristics related to QALE level: • Rank • Relative difference (ratio) • Absolute difference

  21. Welfare functions wi = v(1-Ri)v-1 wi = (href/hi)ε wi = eα(href-hi) Wagstaff 2002. Inequality aversion, health inequalities and health achievement. Journal of Health Economics Atkinson 1970. On the measurement of inequality Olsen 1994. Persons vs years: Two ways of eliciting implicit weights

  22. Results II: Drives

  23. Results III: Welfare functions Rank wi = v(1-Ri)v-1v = 1,46 R2 = Residual = 1,12 Relative difference wi = (href/hi)εε = 0,64 R2 = 0,9718 Residual = 1,97 Absolute difference wi = eα(href-hi)α = 0,022 R2 = 0,9562 Residual = 0,28

  24. Results I: General pattern

  25. The achievement index wi wi = v(1-Ri)v-1 Wagstaff 2002. Inequality aversion, health inequalities and health achievement. Journal of Health Economics

  26. Results: Weights

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