Losing sight of the wood for the trees: some issues in describing and valuing health, and another possible approach.

ABSTRACT

BACKGROUND AND OBJECTIVE: The ability to value health in a way that allows the comparison of different conditions across a range of population groups is central to determining priorities in healthcare. This paper considers some of the concerns with the 'received wisdom' in valuing health--to describe it using a generic descriptive system and to value it using the hypothetical preferences of the general public. METHODS: The literature on the dimensions of health that matter most to people was reviewed and this paper discusses the use of global measures of subjective well-being (SWB) as a possible alternative. New analysis of the British Household Panel Survey was conducted to explore the relationship between life satisfaction and the preference-based quality-of-life measure the SF-6D. The impact on life satisfaction of each level for each dimension of the SF-6D is estimated through a linear model predicting life satisfaction with the SF-6D levels as determinants. RESULTS: Valuing changes in the health of the general population via changes in life satisfaction would lead to different weights being attached to the different dimensions of health, as compared to a well used utility score in which weights are taken from general population preferences. If preferences elicited via standard gamble exercises are based only on a prediction of what it would be like to live in a particular health state, then these results suggest that reductions in physical functioning matter less than people imagine and reductions in mental health impact upon our lives more than preferences would suggest. CONCLUSIONS: Using data from the British Household Panel Survey, it is shown that a focus on SWB would place greater emphasis on mental health conditions. The implications for health policy are considered.