Concepts of Value in Health Care

Emotions and Decision Rules in Discrete Choice Experiments for Valuing Health Care Programmes for the Elderly

by Jorge E. Araña

Araña, J.E., León, C.J. and Hanemann, W.M. (2008). Journal of Health Economics, 27, 753–76.

The evaluation of health care programs is commonly approached with stated preference methods such as contingent... more The evaluation of health care programs is commonly approached with stated preference methods such as contingent valuation or discrete choice experiments. These methods provide useful information for policy decisions involving health regulations and infrastructures for health care. However, econometric modelling of these data usually relies on a number of maintained assumptions, such as the use of the compensatory or random utility maximization rule. On the other hand, health policy issues can raise emotional concerns among individuals, which might induce other types of choice behaviour. In this paper we consider potential deviations from the general compensatory rule, and how these deviations might be explained by the emotional state of the subject. We utilized a mixture econometric model which allows for various potential decisions rules within the sample, such as the complete ignorance, conjunctive rule and satisfactory rules. The results show that deviations from the full linear compensatory decision rule are predominant, but they are significantly less observed for those subjects with a medium emotional state about the issue of caring for the health state of the elderly. The implication is that the emotional impact of health policy issues should be taken into account when making assumptions of individual choice behaviour in health valuation methods.

Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research

by Christian Munthe

co-authored with Lars Sandman and Daniela Cutas. Published in Health Care Analysis, 2011, vol. 19, DOI: 10.1007/s10728-011-0183-y

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different... more This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.

Transgressive Technologies in Reproductive Medicine: Do They Call for a Revision of Notions of Health

by Kristin Zeiler

Zeiler, K In: Dimensions of Health and Health Promotion (red: L Nordenfelt och P-E Liss), Rodopi, Amsterdam, 2003.

Time and the consultation – an argument for a 'certain slowness'

by Joachim Sturmberg

JP Sturmberg and P Cilliers, published in Journal of Evaluation in Clinical Practice 2009

When natural time sequences were replaced by clocks, time became a measurable commodity and the 'speedy use of time' a... more When natural time sequences were replaced by clocks, time became a measurable commodity and the 'speedy use of time' a virtue. In medical practice shorter consultations allow more patients to be seen, whereas longer consultations result in a better understanding of the patient and her problems. Crossing the line of time-efficiency and time-effectiveness compromises the balance between short-term turnover and long-term outcomes. The consultation has all the hallmarks of a complex adaptive system whose characteristics are not determined by the characteristics of the components, but by the patterns of interaction among the components. Systems are dynamic and change over time; the dynamic nature is not incidental, but necessary as complex systems operate at conditions far from equilibrium. The central notion when we talk of time and complexity is that of 'memory'. Memory is carrying something from the past over into the future. Memory is filtered/interpreted, separating noise from information. Memory therefore is not an instantaneous thing, it takes time to develop; it is slow. The dynamics between the participating agents in the consultation will create shared memories that live on to shape future interactions. Shared memories are stronger and contain more relevant knowledge if they are based on frequent interactions and ongoing doctor–patient relationships, leading to a better understanding of the whole person – a process that takes time. Sufficient time, that is, 'a certain slowness', is an essential element of the healing relationship in the consultation. It creates a sufficiently stable, but adaptive, environment that can withstand changing demands. Hence a more complete understanding of the consultation and its time demands will not only lead to more effective treatment, it will also humanize a situation which has become to a large extent purely instrumental. This process of humanization is important not only for the patient, but also for the doctor.