Injury cost-analysis and ethics: At what costs?
Studies into the ‘cost of illnesses' or the 'burden of diseases' are expanding in number and certainly also in quality and utility for policy makers. There are clear reasons for this growth in cost analyses, since investments in public programs are constrained by fiscal and financial policies. Decision makers are committed to knowing whether an investment will produce the desired results at costs that are less than the gains and less than those of alternative measures. This paper focuses on the principal issues with respect to the utilization of cost analyses and seeks to provide guidance for more balanced decision making, taking into account public values as well. The focus on social costs and benefits originates from traditional utilitarianism. This principle assumes that all the benefits and costs can be measured on a common numerical scale and then added and subtracted from each other. However, the utilitarian principle has clear limitations. Different people attribute different values to risks and to the chances of getting harmed. Besides that, the most important utilities, i.e. the intangibles such as quality of life, are hard to condense into a numerical scale. Another problem is that one cannot reliably predict the outcome of interventions and therefore not adequately measure the benefits. Although these shortcomings may be overcome by more sophisticated techniques and methodologies, the major deficiency of the utilitarian approach is that it overlooks the importance of the basic public values. These relate to the citizen's right to health and safety, which should always serve as the main mission and vision of decision makers. Of course, the limited resources and the multiplicity of priorities must also be taken into account, which once more forces us to ensure transparent decision making procedures. The current priorities in prevention can be significantly improved by being firmly rooted in both thoughtful value judgements and sound analysis of the cost implications.
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Document Type: Research Article
Publication date: 1999-03-01