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A concern that people ought to be given what they deserve, in both positive and negative senses, lies deep within the human psyche. Views on the level of reward or punishment that a person deserves for their actions will differ across persons, places, and time, but, I argue in this article, depend substantively upon some combination of intentions and outcomes. Using these characteristics, I propose a taxonomy of actions, ordered from most to least blameworthy, with, for example, it being suggested that for any particular level of harm an intentional yet unrealized harm is more blameworthy than an unintentional yet realized harm (a similar taxonomy can be developed for the positive domain of praiseworthy actions). The taxonomy is focused upon people's actions toward others, but I finish the article with a discussion of desert in relation to people's intentions toward themselves. Ultimately, I contend that the strength and sustainability of public sector services and welfare systems, not to mention our private relationships, rely upon the recognition that desert underpins our notion of justice.

In a previously published article, I reported some tests of prospect theory's reflection effect over outcomes defined by money and life years gained from treatment. Those results suggested qualified support for the reflection effect over money outcomes and strong support over longevity outcomes. This article reruns those tests while accounting for the intensity of individual risk attitudes, and, overall, show consistency with the reflection effect. However, I argue that these results do not necessarily offer support for the explanatory power of prospect theory. Rather, the results may be driven by evolved responses to circumstances that provoke perceptions of scarcity and abundance. Therefore, from an ecological perspective, behavioral patterns such as those that are consistent with the reflection effect, which, by extension, tend to be considered as erroneous or biased by most behavioral economists because they conflict with the postulates of rational choice theory, may not be unreasonable. Recognizing as such is important when considering how behavioral insights ought to inform public policy design and implementation.

This article is a speculative perspective on the behavioural factors that may influence price negotiations between pharmaceutical ‘buyers’ and ‘sellers’. It is contended that several behavioural economic-related phenomena may affect price negotiations, including anchoring, loss aversion, a tendency (or otherwise) to reciprocate and a concern for one's reputation. The most important influence, however, is likely to be anchoring, which will particularly benefit the seller of a product if they are allowed to set the initial anchor in a price negotiation. Consequently, it is argued that the most effective way in which to counter the seller's anchor is likely to be to regulate so that the buyer makes the first offer.

Over recent years, academics and policy makers in several countries have been advocating for measures of utility and happiness to replace gross domestic product as indicators of development. Yet the notion of utility has a somewhat confused history, meaning different things to different people at different times. Hume, for instance, aligned utility with public usefulness, Bentham with hedonic feelings of pleasure and pain, and Mill and modern welfare economists with pretty much anything, and this confusion has not been absent from contemporary calls for utilitarianism to inform public policy design and intervention. A possible reason why there are many different meanings attached to the concept of utility is because many people, much of the time, are not driven to maximise utility at all, irrespective of how it is defined. That is, the pursuit of utility does not drive all desires, but rather desires are antecedent; in those circumstances, at most, some conception of utility is a possible consequence of achieving one’s desires. Desires are multifarious and vary across people. The policy maker’s role over the private realm of individual decision-making should not therefore be to strive to maximise utility, but rather to put in place conditions that facilitate people in the pursuit of their own conception of a desired life.

In this article, I contend that the behavioural affects that tend to be labelled as errors by most behavioural economists, and as such have served as the justification for a paternalistic direction in behavioural public policy (i.e., policy intervention that aims to protect people from imposing harms on themselves), are in an ecological sense not errors at all. While acknowledging that modern societies are very different from the types of societies in which these affects evolved, I argue that we still cannot conclude that attempts to modify people’s choices in accordance with these so-called errors will improve the lives of those targeted for behaviour change, particularly given the varied and multifarious private objectives and desires that people pursue. Where people are imposing no substantive harms on others, I maintain that policy makers should restrict themselves to protecting and fostering the fundamental motivational force of reciprocity, which serves to benefit the group (which could be the whole society) and, by extension, most of the people who comprise the group, irrespective of their own personal desires in life. However, when one party to any particular exchange actively uses the behavioural affects to benefit themselves and imposes harms on the other party to the exchange, the concept of a free and fair reciprocal exchange has been violated. In these circumstances, there is an intellectual justification to introduce behavioural-informed regulations—a form of negative reciprocity—against activities that impose unacceptable harms on others. My arguments thus call for behavioural public policy to preserve individual autonomy within an overarching policy framework that nurtures reciprocity whilst at the same time regulates against behavioural-informed practices that impose substantive harms on others, rather than focusing on reducing the harms that people supposedly impose on themselves. This would be a major switch in emphasis for one of the most important developments in public policy in modern times. JEL Codes: D91, Z18

Over recent years, a number of behavioural economic-informed policy frameworks have been developed, ranging from soft and hard forms of paternalism, to regulation against negative externalities, the so-called nudge, shove and budge approaches. This article considers these different frameworks as applied to some of the challenges posed by the social care needs of contemporary societies. It is argued that all of the frameworks are worthy of serious consideration in this policy domain, in that they offer food for thought on how financial contributions to pay for social care might be increased, and how the quality of social care provision may be improved given available resources.

This study examines the potential of open-ended student drawing serving as a springboard for creative performance and innovative ways of knowing in undergraduate biology. Our methodology takes into consideration visual stimuli (images on the instructor's PowerPoint slides), students' responses to an open-ended drawing task, and the sociocultural context in which these drawings were produced. Our visual design analysis revealed that nearly 40% of students (n = 20/52) opted for creatively reinventing science examples in a manner that was highly original and novel. It is argued that open-ended drawing can help open the doors of science instruction to student creativity and creative performance.

There is an extensive literature across the humanities and social sciences on reciprocity as a fundamental driver of human behavior, and yet attempts to bring the main arguments from the diverse literatures together in a single interdisciplinary space remain scarce. This article aims to collate many of the main arguments from these literatures with the intention of speculating how reciprocity might be used to inform institutional structures, management practices, and public policy. This is significant, because the recent literature on public sector policy design tends to attach import to entirely self-regarding and/or altruistic motivations as fundamental drivers of human action, but, with some notable exceptions, says little directly on the role that reciprocity might have to play in motivating performance improvements. The lack of attention paid to reciprocity in the literature on human motivation and public policy design is problematic if one concludes that reciprocating behaviors are a major determinant of group cooperation and success.

Health inequalities and user financial incentives to encourage health-related behavior change are two topical issues in the health policy discourse, and this article attempts to combine the two; namely, we try to address whether the latter can be used to reduce the former in the contexts of the United Kingdom and the United States. Payments for some aspects of medical adherence may offer a promising way to address, to some extent, inequalities in health and health care in both countries. However, payments for more sustained behavior change, such as that associated with smoking cessation and weight loss, have thus far shown little long-term effect, although more research that tests the effectiveness of different incentive mechanism designs, informed by the findings of behavioral economics, ought to be undertaken. Many practical, political, ethical, and ideological objections can be waged against user financial incentives in health, and this article reviews a number of them, but the justifiability of and limits to these incentives require more academic and public discourse so as to gain a better understanding of the circumstances in which they can legitimately be used.

Pituitary adenomas rarely occur in young children, typically present with systemic symptoms, and rarely undergo malignant transformation. We report a 4-year-old girl who presented with visual disturbances initially diagnosed and treated as amblyopia. She subsequently developed headaches and a gait disturbance and was discovered to have a large, suprasellar, nonsecreting pituitary adenoma. The tumor was resected, but 22 months later she developed recurrence with malignant transformation.

Introduction . In contrast to the basic tenets of economic theory, there is substantial evidence that people's remembered and predicted utility of events systematically differs from the utility that they experience. These systematic differences are caused by ``gestalt characteristics.'' The objective of this study was to test whether people maximize quality-adjusted life years (QALYs), or whether QALY maximization is compromised by their being influenced by factors that resemble the gestalt characteristics when choosing between lifetime health profiles. Methods . Time trade-off values were elicited from 50 respondents, who were also presented with a series of hypothetical questions that each depicted 2 lifetime health profiles. The respondents were asked to choose which of the 2 profiles in each question they would prefer to experience. By inputting the values that the respondents placed on the health states into the lifetime health profiles, it was possible to observe whether their answers were consistent with QALY maximization or with various hypothesized gestalt-type effects. Results . Across decisions that involve a simple trade-off between the length of life and the quality of the health state, choices consistent with QALY maximizing were relatively common, although even here approximately half of the respondents violated this rule. Consistency with QALY maximization was lower in most of the other tests and indicated that many people might, for example, prefer to trade off some lifetime health to experience a good end to life, or to avoid highly unstable lifetime health profiles. Conclusion . The respondents' answers were often consistent with the hypothesized gestalt-type effects, but it is probable that for some of the questions the characteristics themselves were not driving the respondents' answers and that factors such as complex rates of discounting might have played a role. However, whatever the driving motivation behind the respondents' answers, the important point to note from this study is that QALY maximization is often substantially and systematically violated when people are offered a choice over the lifetime health profiles that they would prefer to experience.

The Veterans Health Administration (VHA) provides health care for U.S. military veterans. By the early 1990s, the VHA had a reputation for delivering limited, poor-quality care, which led to health care reforms. By 2000, the VHA had substantially improved in terms of numerous indicators of process quality, and some evidence shows that its overall performance now exceeds that of the rest of U.S. health care. Recently, however, the VHA has started to become a victim of its own success, with increased demands on the system raising concerns from some that access is becoming overly restricted and from others that its annual budget appropriations are becoming excessive. Nonetheless, the apparent turnaround in the VHA's performance offers encouragement that health care that is both financed and provided by the public sector can be an effective organizational form.

This study aims to illustrate whether or not students of a second-year introductory Zoology course who were taught their course terminology using an etymological approach would show improved learning on a number of metrics of student performance. Undergraduate students of any academic discipline are challenged by the learning of its specialized language, especially in the terminology rich fields of scientific study. A common approach among students towards learning the terminology is via rote memorization, often with little success. Studies in language learning have shown that learning scaffolds that involve a morphological breakdown of new words into their morpheme units allows for improved lexical access, as well as greater knowledge retention and transfer abilities to other words in the same morpheme families. The scientific lexicon is mostly made up of root morphemes and is auto-descriptive, therefore, by using an etymological approach while learning new scientific terminology, there are two advantages over rote techniques: firstly to have a learning scaffold that may allow students to integrate unfamiliar terminology into their personal lexical repertoires and secondly, to have the ability to infer meaning of the terms’ properties with respect to their scientific contexts. These contributions may constitute a more meaningful student learning experience than factual intake and regurgitation and also they are allowing for metacognitive processing and conceptual linkage to the structure and/or function properties of terminology in their specialized scientific disciplines. This study adds to the growing body of teacher-led instructional learning resources for specialized vocabulary components of effective specialized scientific language learning at the University undergraduate level

This article aims to assess the development of the English National Health Service (NHS) over the period 1979--2005, against the original, and often repeated, core objectives of the system: that it be universal in offering coverage to all members of the population in times of health care need; that it be comprehensive in its provision of health care services; and that it be (largely) free at the point of use. Comprehensiveness is open to interpretation, and may depend upon the wealth of the nation. Universality and (largely) free care at the point of use, which lend themselves to the principle of equal access for equal need, are more concrete, and it is not difficult to ascertain if they have been substantially and/or systematically violated. The article details briefly the developments in resource allocation, provider payment mechanisms, incentives and accountability, and notes that much of the emphasis on health sector change since the mid 1980s has been placed upon improving supply side efficiency and reducing waiting lists/times. Improving NHS efficiency, and indeed related aspirations associated with choice and health outcomes, can be perceived as 'secondary' objectives, in that they should not serve to undermine the core objectives of the system, assuming that the security offered by having an accessible, universal health care system is considered worthy of protection. The overall conclusion is that the NHS has performed quite well against its core objectives to date, although it is possible that the current preoccupation with choice and health outcomes will lead us down a different policy path in the future.

Health inequalities research has a long history in the United Kingdom, and the development of government policies that are intended to explicitly address the existing health inequalities has been gathering pace since the Labour Party returned to power in 1997. In this paper, using the influential Acheson Report as a reference point, one of us (D.N.) describes how health inequalities policies have been developed, and the other (A.O.) assesses how, ideally, such policies ought to be developed. Although progress in the development of health inequalities policies has been made, the policies, and the evidence that has informed them, have been less than ideal.

Summary Two of the fundamental purposes for establishing the National Health Service (NHS) were to increase social welfare and improve social justice. Decisions to increase NHS investment should ideally be taken with these fundamental objectives in mind. Given that society faces resource constraints, increased financial investment in the NHS will always involve forgone investment elsewhere, and it may never be possible to determine with any degree of certainty whether further real investment in the NHS will increase overall social welfare. If the Government decides to increase NHS investment for political reasons, it should therefore at least try to ensure that the methods by which it raises extra revenue improve social justice. The introduction of an NHS premium payment for high earners would be a progressive measure consistent with this objective.

In Japan, since August 1992, materials derived from pharmacoeconomic evaluations have been accepted at the time of new drug price negotiation. Pharmaceutical companies generally consider the materials they submit to be private information. Moreover, it is unclear how the government uses these materials in its policy decisions. In this paper, for the purpose of understanding the present status of pharmacoeconomic evaluation in Japanese pharmaceutical companies, the results from an investigative interview of selected employees at 22 pharmaceutical firms are outlined. An analysis of how the submitted economic data are reflected in drug prices is provided. This analysis clarifies that in recent years pharmacoeconomic evaluations have been submitted for most new pharmaceutical products. A clear connection between the submitted economic materials and the issuing of premiums to innovative or useful products, however, was not found. It is concluded that there is an urgent need to construct a system in which the r...

The conventional, or standard, time trade-off (TTO) procedure, which is used to elicit the values that people place on health states that are in turn required to calculate quality adjusted life-years (QALYs), asks respondents to trade off fewer life years for better health. It is possible to reverse the procedure to ask respondents to trade off less health for more life years. Theoretically, these two procedures should generate the same TTO values for any given health state. This article reports that for health states defined by differing frequencies of migraine attack, the standard TTO gives health state values that are significantly higher than those given by the reverse TTO. The observed systematic procedural invariance, which substantiates some previous findings reported in the literature and is consistent with a loss aversion effect, challenges the validity of the TTO for generating reliable valuations of health states.

s are written to summarise documents and to whet the reader’s interest. Alas, many readers just use them as a substitute for reading the whole paper, which given the brevity of abstracts can give a somewhat distorted impression. I hope that having read this abstract, you will read on. If you do, you will find that I offer a little personal history and a little impersonal history on the development of interest in the issue of health inequalities in England. I then summarise the policy response of recent Labour administrations, briefly detail the effects of this response, and finally offer my own three-pronged policy attack on our thus far really quite stubborn inequalities in health.

The standard gamble has a firm basis in the theory of risk and, for this reason, is the preferred method of health state value elicitation for many researchers. However, it is widely recognised that the use of immediate death as the failure outcome in the standard gamble renders the method insufficiently sensitive for the direct valuation of minor and temporary health states. Consequently, the indirect valuation of minor and temporary health states through a process of ‘chaining’ has been recommended. Unfortunately, a number of researchers have observed internal inconsistency in the standard gamble. That is, for health states that are not thought to be subject to the above mentioned insufficient sensitivity, the values elicited from indirect chained questions quite often significantly and systematically exceed those elicited from the direct procedure. A potential explanation for this is the possible influence of loss aversion when people are asked to weigh certainty against risk. The lottery equivalents method, an alternative value elicitation instrument that also has a firm grounding in the theory of risk, modifies the standard gamble approach of certainty versus risk to one of risk versus risk. The absence of certainty offers reason to suspect that the influence of loss aversion will be diminished (or even removed), and that the lottery equivalents method will thus prove to be internally consistent. The study reported in this article tests the internal consistency of the lottery equivalents method. In a manner similar to that observed with the standard gamble, the results indicate that the internal consistency of the lottery equivalents method is also to some extent compromised. Copyright © 2004 John Wiley & Sons, Ltd.

The Ministers of Health from Chile, Germany, Greece, New Zealand, Slovenia, Sweden, and the United Kingdom recently established The International Forum on Common Access to Health Care Services, based on a common belief that their citizens should enjoy universal and equitable access to good quality health care. The ministers intend to form a network to share thinking and evidence on health care improvements, with the specific aim of sustaining and promoting equitable access to health care. Despite a vast literature on the notion of equity of access, little agreement has been reached in the literature on exactly what this notion ought to mean. This article provides a brief description of the relevance of the access principle of equity, and summarises the research programme that is necessary for turning the principle into a useful, operational policy objective.

Summary Over recent decades, a great deal of effort has been devoted towards developing instruments that can be used to elicit health state values. All of these instruments are conceptually very different from one another and all suffer from serious inherent biases. In this paper I outline the conceptual foundations and empirical limitations of the three principal health state value elicitation instruments. Given that the conceptual parameters internalized within an instrument influence the elicited health state values, I argue that it is necessary to attain a broad agreement on what the appropriate parameters ought to be. When the appropriate conceptual parameters have been identified we will be in a position to develop the methodology of a single standardized instrument.

In recent years, more and more Japanese pharmaceutical companies have been submitting pharmacoeconomic data to the government, following the official request that such data may help in setting pharmaceutical prices. The companies have cooperated because, by doing so, they could influence pricing decisions for new products. However, the quality of these data at present is considered to be poor and heavily biased. The introduction of pharmacoeconomic guidelines that outline a set of standardised factors to be included in evaluations are necessary, so that an appropriate comparison of the cost effectiveness of the many new drugs that are introduced into the Japanese market each year can be made. In addition to supporting the development of standardised guidelines, the Ministry of Health and Welfare should clarify how pharmacoeconomic data are to be used to aid policy decisions and also mandate the publication of pharmacoeconomic data.

With moves to measure wellbeing afoot, this book considers the economics of happiness. However, reviewing it didn’t make Adam Oliver any happier

Evidence shows that they might, if targeted appropriately Recently, much interest has been shown in how financial incentives can increase health enhancing behaviours.1 2 3 Two centres are studying the subject—the Centre for the Study of Incentives in Health (a joint initiative between King’s College, Queen Mary, and the London School of Economics; www.kcl.ac.uk/schools/biohealth/research/csincentiveshealth/) and the Center for Health Incentives at the University of Pennsylvania (www.med.upenn.edu/ldichi/). By encouraging healthier behaviours, it is hoped that incentives will help to contain healthcare costs and improve health. If the incentives motivate people in higher socioeconomic groups more than those in lower socioeconomic groups, however, they could exacerbate health inequalities. In the linked analysis article (doi:10.1136/bmj.b3504), Schmidt and colleagues highlight this as a potential problem in Germany, where a sickness fund rewards people for engaging in preventive activities and for minimising use …

The notion of choice and its individualistic underpinnings is fundamentally inconsistent with the collectivist NHS ethos In both the policy1 and academic2 literatures, the issue of extending patient choice in the UK National Health Service (NHS) is currently a much discussed issue. From December 2005—for example, general practitioners (GPs) will be required to offer patients needing elective surgery the choice of five providers at the point of referral.1 Choice is often thought of as an intrinsically good thing; that is, that people value choice in and of itself.3 A probable underlying reason for this belief is that choice is tied in with the notion of individual autonomy, or freedom, a concept that looms large in ethical theories of the good. Beauchamp and Childress—for example, classified respect for …