Normative discounted utility theory specifies that the values of all future outcomes (for example, those related to health and money) should be discounted at a constant rate. Two experiments demonstrated that, contrary to this prescription, decision makers use different discount rates for health-related decisions and money-related decisions. Temporal discount ings for health and money were similar in that both demonstrated two biases previously found in monetary decisions: discount rates were inversely related to magnitude of outcome and length of delay. The relatively large discount rates used by the subjects suggest why it is often difficult to implement preventive health measures that improve future health. Key words: discounting; intertemporal choice; health decisions. (Med Decis Making 1995;15:373- 386)

Government actions to reduce risks to health have varied greatly in their cost per death prevented, frequently by 10-fold or even 100-fold. This research asks whether disparities of this magnitude are justified by citizens' preferences abut the relative value of reducing deaths from different hazards. Four samples were asked to rank the relative priority of preventing deaths through 8 realistic programs, each addressed to a different hazard, and then to rate how large the differences in spending should be. Subjects were not asked to give absolute values on preventing deaths and were asked only for their relative valuation of the benefits of preventing a death, not to weigh the benefits and costs or to determine an optimal spending level. We found that in all samples the median respondent valued his top-rated program 5 to 6 times more than his bottom-rated program. However, because individuals disagreed upon the relative priority for different programs, the aggregated rankings barely showed more than a 2-fold difference in the amounts that should be spent. Thus, for the important programs considered by these samples, a large variation in spending does not appear to be justified on the basis of differentials in the values placed on preventing different types of deaths. A more deliberative methodology like the one used here appears fruitful for providing insights to policymakers about preferences in this sensitive area.