BMJ  2005;330:311 (5 February), doi:10.1136/bmj.330.7486.311

Letter

Economic evaluation and society's health values

Price and value are different

The first 150 words of the full text of this article appear below.

EDITOR—I admire Coast's bravery in writing a penetrating review of health economics.¹ I wonder if the problems go even deeper than she has acknowledged.

Firstly, I do not think that society is in tune with what its health values are.^{2 3} Even if society is in touch with these values any individual within it changes his or her values immediately he or she becomes a patient.⁴ It is not clear what the decision making axes should be in medicine, but there are at least four interested parties—namely, doctors, patients, society, and paymasters (government and management).

Medical practice is fundamentally deontological, with each doctor committed to do the best for each individual patient. The values of this interaction are mostly oblivious to the wider utilitarian need to use system resources efficiently.

Management is necessarily utilitarian as it has finite resources and has to try to show that it is using . . . [Full text of this article]

Shelf Surgery, Halifax, West Yorkshire HX3 7PQ npgdavies@blueyonder.co.uk

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