1. Building the cube Marc Fleurbaey

2. Deconstructing the cube Marc Fleurbaey

3. GOOD NEWS AND BAD NEWS Bad news: there is no simple micro criterion to decide the shape of the cube; it all depends on wider impacts on the population Good news: we know how to evaluate the situation of a population (or at least there are some ways)

4. WE NEED A SWF (ADLER) Health affects well-being directly, but also indirectly via capacities: focusing on health effects exclusively misses many benefits Rate of coverage affects poor-rich access Population covered affects health and consumption Services covered too Mode of funding should be part of the project The health budget affects consumption of other goods

5. SOLIDARITY MORE THAN INSURANCE (ADLER, VOORHOEVE) In general, the distribution of individual health and consumption is known ex ante, no macro-social risk (except for longevity and pandemics) The health system affects the distribution of health and consumption  evaluate with a SWF Peace of mind due to insurance does improve people’s situation, even from the ex post standpoint A perfect insurance model might not provide a good guideline (Dworkin): People don’t want to insure when harm reduces their marginal utility (frequent with health?)

6. INDIVIDUAL WELL-BEING 3 dimensions of individual well-being: longevity, health, consumption There is no way to trade-off these dimensions without relying on population values and preferences QALYs and similar measures are too restrictive (additive form) How to elicit preferences? 1) Behavior; 2) Stated preferences; 3) Life satisfaction

7. PREFERENCES Hard questions about:  Low longevity (is it better to die as an infant than as a child?)  Severe pain: incommensurably worse?  Unusual trade-offs: not too complex, but too simple  Would you prefer to live longer but poorer (by how much)?  Would you prefer a lower health but more income? What about preference heterogeneity?  Equivalence approach (Health Economics 2013 –joint with S. Luchini, C. Muller, E. Schokkaert)

8. SWF Some priority to the worse-off  Degree of priority hard to specify  Sometimes the Rawlsian absolute priority is ok (taxation)  For health policy this is dubious Change in population? Probably a good start to study a cohort  Ignores new lives created (not clear what the impact on total human population is)

9. RELATION TO CEA CEA: Unidimensional measure of longevity-health gains Can be weighted (O. Norheim: longevity-health weights) Fixed cut-off or fixed budget SWF (CBA): More democratic measure of benefits More end-state measure of benefits Weighted by social priority (poor) Includes non-health benefits (may be essential to convince) Trade-off between longevity-health benefits and other “consumptions”

10. 1.Eliciting preferences on longevity-health-consumption 2.Predicting the impact of expanded health care on population longevity-health-consumption (with feedback effects on growth) Conclusion: What are the difficulties?

11.  A. Wagstaff:  Provide the health care people need  At a cost they can afford  Focus on most urgent priorities (build-up process)  CEA can help but why not go beyond? Can one do without the SWF?