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对健康的风险偏好:实证估计及其对医疗决策的含义

Risk preferences over health: Empirical estimates and implications for medical decision-making
Journal of Health Economics · 2024 · Mulligan, Karen、Baid, Drishti、Doctor, Jason N.、Phelps, Charles E.、Lakdawalla, Darius N.

中文摘要

主流健康经济学理论意味着,无论基线健康状况如何,健康相关生命质量(HRQoL)的预期改善为消费者带来的价值都是相同的。近来的若干研究对这一推论提出质疑。广义风险调整成本效果分析(Generalized Risk-Adjusted Cost-Effectiveness, GRACE)从理论上证明,只要消费者对健康并非风险中性,基线健康状况就会影响价值。已有的实证文献对健康领域风险中性的期望效用最大化提出质疑。我们在具有全国代表性的美国人口中估计HRQoL的效用,并利用这些估计来度量对健康的风险偏好。我们发现,个体在健康水平较低时呈风险偏好,当健康等于0.485(以0–1量表衡量)时转为风险规避,并在完全健康时风险规避程度最高(相对风险规避系数=4.51)。我们阐述了由此得出的对医疗决策、成本效果分析以及不确定性下健康相关决策的恰当理论的含义。

Abstract

Mainstream health economic theory implies that an expected gain in health-related quality of life (HRQoL) produces the same value for consumers, regardless of baseline health. Several strands of recent research call this implication into question. Generalized Risk-Adjusted Cost-Effectiveness (GRACE) demonstrates theoretically that baseline health status influences value, so long as consumers are not risk-neutral over health. Prior empirical literature casts doubt on risk-neutral expected utility-maximization in the health domain. We estimate utility over HRQoL in a nationally representative U.S. population and use our estimates to measure risk preferences over health. We find that individuals are risk-seeking at low levels of health, become risk-averse at health equal to 0.485 (measured on a 0–1 scale), and are most risk-averse at perfect health (coefficient of relative risk aversion = 4.51). We develop the resulting implications for medical decision making, cost-effectiveness analyses, and the proper theory of health-related decision making under uncertainty.
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