Disentangling the welfarism/extra-welfarism distinction: Towards a more fine-grained categorization.

Ruben Andreas Sakowsky

doi:10.1002/hec.4382

Abstract

In health economics, the distinction between welfarism and extra-welfarism has been employed to discuss various epistemological and normative differences between health evaluation approaches. However, a clear consensus on the definition of either welfarism, extra-welfarism, or the differences between the two sets of approaches has not emerged. I propose an alternative set of distinctions that allows for a more fine-grained categorization of health evaluation approaches. This categorization focuses on five dimensions: (1) the maximand of an evaluation approach, (2) its sensitivity toward normative concerns that defy compensation, (3) its position on which groups of individuals or collective entities act as sources of values, (4) its sensitivity to changes of mind, and (5) the inclusion of process-external values.

Highlights

In health economics, the distinction between welfarism and extra-welfarism categorizes economic health evaluation approaches at the population level into two different camps (Coast et al, 2017)
Several accounts exist—each defining welfarism, extra-welfarism, and their differences in a different and sometimes conflicting manner. This lack of a clear definition of the welfarism/extra-welfarism (W/EW) distinction means that the concepts are less useful than they could be for categorizing differences between health evaluation approaches
I provide a brief overview over various W/EW distinctions, review their usefulness for cartographing the landscape of health evaluation, and present a more fine-grained set of categorizations that serves to address the differences between health economic evaluation approaches head-on

Summary

Introduction

The distinction between welfarism and extra-welfarism categorizes economic health evaluation approaches at the population level into two different camps (Coast et al, 2017). Welfarism refers to evaluation approaches focused on maximizing individual utility whereas extra-welfarism is described as an alternative transcending this focus. This lack of a clear definition of the welfarism/extra-welfarism (W/EW) distinction means that the concepts are less useful than they could be for categorizing differences between health evaluation approaches.

Results

Conclusion