Abstract (German version follows): -/- This paper develops a new proposal for a coherentist business ethic in which ethically justified and empirically supported proposed solutions to economic problems are developed through a coherentist process of adjustments between the three levels of (1) conception of problem and its solution, (2) positive economic theory, and (3) ethical theories. Using an example, it illustrates how in this framework, Homann's business ethics gains in validity and relevance but loses its claim to universality. // -/- (...) Diese Arbeit entwickelt eine kohärentistische Wirtschaftsethik, in der ethisch begründete und empirisch gestützte Lösungsvorschläge für ökonomische Probleme durch einen kohärentistischen Anpassungsprozess zwischen den drei Ebenen (1) Auffassung von Problem und Lösungsansatz, (2) positive ökonomische Theorie, sowie (3) ethischen Theorien erarbeitet werden. Anhand eines Beispiels wird illustriert, wie Homanns Wirtschaftsethik in diesem Rahmen an Validität und Relevanz gewinnt, jedoch ihren Universalitätsanspruch verliert. (shrink)

There is a gap between health economic evaluation methods and the value judgments of coverage decision makers, at least in Germany. Measuring preference satisfaction has been claimed to be inappropriate for allocating health care resources, e.g. because it disregards medical need. The existing methods oriented at medical need have been claimed to disregard non-consequentialist fairness concerns. The aim of this article is to propose a new, contractarian argument for justifying needs-based economic evaluation. It is based on consent rather than maximization (...) of some impersonal unit of value to accommodate the fairness concerns. This conceptual paper draws upon contractarian ethics and constitution economics to show how economic evaluation can be viewed as an institution to overcome societal conflicts in the allocation of scarce health care resources. For this, the problem of allocating scarce health care resources in a society is reconstructed as a social dilemma. Both disadvantaged patients and affluent healthy individuals can be argued to share interests in a societal contract to provide technologies which ameliorate medical need, based on progressive funding. The use of needs-based economic evaluation methods for coverage determination can be interpreted as institutions for conflict resolution as far as they use consented criteria to ensure the social contract’s sustainability and avoid implicit rationing or unaffordable contribution rates. This justifies the use of needs-based evaluation methods by Pareto-superiority and consent. The view of economic evaluation presented here may help account for fairness concerns in the further development of evaluation methods. This is because it directs the attention away from determining some unit of value to be maximized towards determining those persons who are most likely not to consent and meeting their concerns. Following this direction in methods development is likely to increase the acceptability of health economic evaluation by decision makers. (shrink)

Schools of economic ethics inspired by Buchanan propose viewing ethical conflicts as prisoners’ dilemmas to facilitate solutions based on Pareto-improving institutional changes. Given that healthcare is determined by complex institutional arrangements, it has been claimed that this approach is also suitable for business ethics in healthcare. To scrutinize this claim, this research systematically searched for studies reporting PD structures in healthcare. PubMed, EconLit, and EconBiz were searched to find articles in German and English. Study type, characteristics of the game, and (...) the proposed means to overcome the dilemma were extracted and analyzed for aspects supporting or challenging the claim. Across 53 studies, 68 descriptions of various dilemmas in healthcare and public health were identified. Many authors successfully developed proposals for institutional change to overcome these dilemmas. However, many of these analyses exhibited limitations such as oversimplifications or inconsistencies. Also, the quality of evidence on both the characteristics of dilemmas and the effectiveness of proposed solutions was very poor. The subsamples of studies that explicitly cited the ethical approach were disjunct from those that applied empirical methods to analyze the dilemmas. The large number of identified PDs indicates that economic ethics is relevant to healthcare. However, there is a need for further evidence to substantiate both the descriptive and prescriptive claims of this ethical theory. It should thus be seen as a complement that needs justification, rather than a substitute superior to other ethical frameworks. (shrink)

Für ökonomische Evaluationen medizinischer Leistungen steht ein etabliertes Methodenspektrum zur Verfügung. Ziel der Arbeit ist, anhand ausgewählter Aspekte herauszuarbeiten, inwieweit diese Methoden für den derzeit viel diskutierten Bereich der Personalisierten Medizin anwendbar sind bzw. welche Besonderheiten dabei auftreten und wie diese adressiert werden können. Für die vorliegende Arbeit wurde eine explorative Literaturrecherche durchgeführt. In Abgrenzung zur herkömmlichen Medizin kann je nach Blickwinkel die Personalisierte Medizin entweder hinsichtlich der physiologischen Unterschiede oder hinsichtlich der individuellen Präferenzen der Beteiligten betrachtet werden. Je nach (...) Betrachtungsweise ergeben sich unterschiedliche methodische Herausforderungen an gesundheitsökonomische Evaluationen. Verbesserte Ausrichtung der Versorgung an physiologischen Unterschieden stellt die Evaluation beispielsweise vor das Problem, dass aufgrund des oftmals kleinen Stichprobenumfangs häufig Evidenz zur Parametrisierung von Entscheidungsmodellen fehlt. Informationswertanalysen können Hinweise über den potenziellen Nutzen weiterer Forschung geben. Das Konzept des „Expected Value of Individualized Care“ bietet einen den Informationswertanalysen sehr ähnlichen Ansatz, um den potenziellen Wert eines Einbezugs individueller Präferenzen in die Versorgung zu quantifizieren. Welfarismus und Extra-Welfarismus bieten unterschiedliche Lösungsansätze, wie Nutzen Biomarker-basierter Information im Sinne von „Empowerment“ in Evaluationen einbezogen werden können. Generell sind die Methoden der gesundheitsökonomischen Evaluation auch auf den Bereich der Personalisierten Medizin anwendbar. Es stellen sich jedoch eine Reihe spezifischer Herausforderungen, zu deren Lösung weiterer Forschungsbedarf besteht. (shrink)