Prevention, policy, and paradox: what is the value of future health?

Cost-effectiveness is an integral part of health care policy, influencing both medical and administrative decisions. However, current research methodology for evaluating cost-effectiveness produces several paradoxes, perhaps because it incorrectly represents the general populations's view of future health states. Recent work introduces clinical and demographic factors to the traditional cost-benefit model for discounting health outcomes. It suggests a revised model that provides a more accurate basis for health policy decision-making. This revised model will likely improve the apparent cost-effectiveness of prevention programs, which are at a distinct disadvantage in present models. This article presents examples of current paradoxes resulting from the standard discounting methodology, findings on the variability of health outcomes discount rates in patients, and preliminary thoughts on developing a revised model for discounting future health outcomes. This revised model should present the value of health promotion programs more accurately.