Improving Health in the United States: The Role of Health Impact Assessment by Committee on Health Impact Assessment

Author:Committee on Health Impact Assessment
Language: eng
Format: epub
Tags: ebook, book
Publisher: The National Academies Press
Published: 2014-08-02T00:00:00+00:00

ASSIGNING MONETARY VALUES TO HEALTH CONSEQUENCES

The health consequences of a decision can be characterized according to their economic or monetary valuation. Although monetary effects clearly are not health effects themselves, many decision-makers and stakeholders may give substantial consideration to the economic value of effects, and economic valuation of health effects can facilitate comparison with the costs and benefits of competing alternatives (Brodin and Hodge 2008).

Economic valuation has several constraints and is not appropriate in all circumstances. First, the wide array of end points may not be amenable to monetary valuation. Second, monetary valuation of health outcomes has implicit and explicit weighting of outcomes and populations that may or may not reflect the values and priorities of decision-makers. For example, willingness to pay will tend to be greater among populations that have greater wealth and will tend to be lower among those who are facing competing risks (Hammitt 2002). Third, some populations may bear a disproportionate share of the health costs of a decision, and others a disproportionate share of the health gain. Those distributional effects can be hidden in cost-benefit analysis conducted at a societal level but would be potentially valuable information for those who incur the costs and for those who receive the benefits. Fourth, monetary valuation of health outcomes can pose a substantial communication challenge for affected parties and other stakeholders and may distract from the findings of an HIA. In spite of those caveats, monetary valuation of health outcomes may be a useful approach in some decision contexts, such as those in which alternative decision choices might require implementing economically costly mitigations.

If economic analysis is conducted as part of HIA, it is important to maintain the distinction between HIA, which provides judgments of health effects, and cost-benefit analysis, which provides a more comprehensive analysis of all economic benefits and costs of a decision. Economic valuation of health effects is common in existing cost-benefit analyses of federal regulations; however, HIA should not be characterized as or confused with cost-benefit analysis.

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