Evaluation of health policies: for a fair consideration of the interests of the populations.

Summary Two methods are generally considered for the evaluation of health policies. The cost-benefit approach is based on the sum of individual willingness to pay: it respects individual preferences but gives priority to the preferences of the richest people because their willingness to pay is generally higher. The cost-effectiveness approach selects policies that provide the highest overall health gain for a given total cost. It does not benefit high-income individuals, but it may have other undesirable effects, such as favoring treatment of a minor condition that will benefit the most people over a major condition that affects few. A variant of cost-benefit analysis avoids these pitfalls. It consists of weighting the willingness to pay by coefficients that vary in the opposite direction to an indicator of individual well-being combining income and health status. The indicator chosen is health equivalent income: this is the individual's actual income minus the amount he or she would be willing to forego in order to be in perfect health. For a given income, it therefore decreases when health deteriorates. Unlike subjective utility indices, it has the advantage of being based solely on the ordinal preferences of individuals. This approach is implemented through a survey conducted on a representative sample of the French population. Given their financial constraints, low-income individuals attach less relative importance to their health status. However, the coefficients obtained nevertheless allow us to overweight the least privileged individuals who have a combination of low income, poor health and a strong preference for improving their health. These coefficients can then be used to evaluate any policy for which individual willingness to pay is known.