19 de febrer 2013

An active life ruled by reason

The humble economist

The works by Tony Culyer are so familiar for every health economist that we couldn't live without them. Those that have arrived a little bit late, now have the opportunity to read all his contributions in one book. My impression is that any university professor could create a syllabus following only this reader: Social Scientists and Social Science, Extra-Welfarism, Ethics, Need and Equity,Health Policy,Health Technology Assessment.
The introduction highlights his academic life, 250 articles, more than two dozens of books and a strong public impact of his works.
I still remember the first time I was reading about the extra-welfarist approach. In those days, the individual utility paradigm was the basis for any article you could read. I was feeling uncomfortable on the assumptions, Culyer gave the opportunity to open the windows for fresh air. Unfortunately his message has not always been understood and applied. Let me reproduce some paragraphs from the introduction:
Culyer’s concept of “extra-welfarism” helps to liberate health economists from the confines of the traditional “Paretian” or “welfarist” approach to evaluating alternative policies and institutions that dominated economic thinking in the nineteenth and twentieth centuries. Traditional “welfarist” economic analysis assumes that subjective individual preferences or “utilities” (understood either as the desires that motivate individual decisions or the feelings of happiness that may or may not follow those decisions) are the be all and end all of the social good when it comes to doing “economic” analysis properly. Culyer’s “extrawelfarist” approach allows economists to use additional sources of information about individual wellbeing or lourishing – i.e. additional to subjective desires and feelings – for evaluating alternative policies and institutions. In keeping with his professional humility, of course, he does not endorse any specific view of what constitutes a flourishing life: “Flourishing may mean different things to different people; all I require is that it be a high goal whose accomplishment gives a deep satisfaction to the one living it, and perhaps others too, as when it is said of someone who has died ‘that was a life well-lived’.
The concept of “extra-welfarism” builds upon the work of Amartya Sen, who first coined the term “welfarism” and wrote of the need to use “non-welfare” or “non-utility” information when assessing individual wellbeing. Culyer developed and refined this idea in the specific context of health care, showing in particular how non-welfare information about people’s health – and not merely people’s health-related preferences or desires – could be fruitfully used in the health care field. The three essays in turn set out the basic idea; develop and refine the distinction between “welfarist” and “extra-welfarist” approaches to health economics, in a multiauthor essay originally lead authored by the eminent Dutch health economist, Werner Brouwer; and then explore a range of different practical applications of both “welfarist” and “extra-welfarist” approaches in the health sector, showing how both can be fruitful in different contexts.

In this post I made some reviews of his recent work and here you'll find an interesting article that it is pending to be read and commented in this blog. 
Right now I only would like to share with all of you the opportunity to read the whole book again, some articles are not easy to find. Definitely, it is a reference book for any person interested in Health, Health Care and Social Decision Making, as it says the subtitle.

PS. Check the extra-welfarist approach in p.59 of this excellent book of Vicente Ortún.