Health Decision Analysis: Evolution, Trends, and Emerging Topics

Health remains one of the most challenging realms for decision makers and policy making while critical for the well-being of humans, the stability of societies, and the development of economies. Decision making in this field ranges from medical doctors identifying the best treatments for patients, healthcare companies selecting the most promising drugs for development, healthcare providers deciding for adequate levels of resourcing, health regulators deciding whether to approve a new medicine or health technology, to regional and national health departments identifying how to increase the health security of regions and countries. In this positioning paper, and introduction to this Special Issue, we present the history, evolution, and trends of health decision analysis and suggest that these developments and news trends can be conceptualized as an emerging field of applied research for our discipline: Health Decision Analysis.

Microfoundations of Discounting

An important question in economics is how people choose between different payments in the future. The classical normative model predicts that a decision maker discounts a later payment relative to an earlier one by an exponential function of the time between them. Descriptive models use nonexponential functions to fit observed behavioral phenomena, such as preference reversal. Here we propose a model of discounting, consistent with standard axioms of choice, in which decision makers maximize the growth rate of their wealth. Four specifications of the model produce four forms of discounting—no discounting, exponential discounting, hyperbolic discounting, and a hybrid of exponential and hyperbolic discounting—two of which predict preference reversal. Our model requires no assumption of behavioral bias or payment risk.

The improving sequence effect on monetary sequences

Experimental studies reveal a preference for improving income sequences, challenging the axioms of the discounted utility model, such as the present value maximization principle. Through an experiment, we test the existence of this anomaly on short and long-term income sequences, by confirming previous experimental evidence. Although the participants are aware of the present value maximization, they select improving sequences of income mainly to cover their future spending needs, to feel motivation at work, and to receive a signal of success and status. In order to include this sequence effect in a mathematical valuation model, we propose an alternative model to value sequences which outperforms the traditional discounting model by fitting the present value with the preferences of the participants.