This paper is based upon an extensive review of 71 willingness-to-pay (WTP)
surveys of health and health care published in English during the period 1
985-1998. The aim of the paper is to outline the arguments advanced for the
superiority of WTP over quality-adjusted-life-years (QALYs) as a measure o
f benefit of health care programmes, and to review how empirical WTP studie
s adhere to their implications. An important argument is that WTP enables a
more comprehensive valuation of benefits than QALYs. Our main focus is the
refore to provide a careful review of the scenario descriptions used in the
surveys, according to which types of benefits are being valued, and how co
mprehensively the descriptions are presented. Furthermore, the 'cost-benefi
t argument', that WTP can assist in improving social efficiency, is discuss
ed before we inquire into the extent to which the studies actually compare
WTP with social costs. Copyright (C) 2001 John Wiley & Sons, Ltd.