Expanding economic costing in health care: Values, gender and diversity

In this paper we offer a normative analysis of economic evaluations by critically examining Canadian social values in relation to health, and contrasting these with the inherent values, methodological assumptions and pragmatic policy consequences of conventional cost of illness (COI) models. Through this analysis we reveal the value biases and resulting limitations of existing COI approaches, and propose an expanded framework for estimating costs that takes into account gender and diversity. This proposed framework builds upon fundamental shifts in values discourse emerging in the fields of economics, ethics, social policy, and feminist theory. Specifically, we demonstrate the implications of these cross-disciplinary convergences for COI studies. The analysis and framework provide arguments for why and how traditional costing methodologies need to be transformed to realize their full potential for informing health policy decisions. The paper reflects the work of a multidisciplinary group of researchers from the fields of economics, political science, sociology, and nursing.