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Contributions to the History of Health Economics

Introduction to the Special Issue: Contributions to the History of Health Economics

Philip Clarke et Guido Erreygers
p. 275-277

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1Nowadays, health economics is a thriving sub-discipline of economics. The field has its own specialised journals, conferences, research centres and academic programmes. Both policy makers and the medical sector make use of the results of applied health economics research. Insights from health economics are helpful to analyse the market for health care, to find cost-effective ways to eradicate diseases, to predict the effects of lowering the price of medication, etc.

2The origins of health economics are usually traced to two seminal contributions. Kenneth Arrow’s 1963 paper “Uncertainty and the Welfare Economics of Medical Care” (American Economic Review) has shaped the way health economists think about the market for health care. Michael Grossman’s 1972 paper “On the Concept of Health Capital and the Demand for Health” (Journal of Political Economy), on the other hand, laid the foundations of the influential health capital model. But the history of health economics goes further than that. Economists, social researchers, epidemiologists and many others have analysed topics at the intersection of medicine and economics. How to organise health insurance, for instance, or how to calculate the value of life in the context of cost-benefit analysis. Many of these issues have not received much attention by historians of economic thought.

3After the launch of the call for papers and the completion of the usual reviewing process, we accepted four papers for this special issue. The first two papers deal with the relationship between economics and healthcare policy. In “Health Economics: Scientific Expertise and Policymaking” Matthew Panhans explores the influence of (health) economics on the healthcare system of the US. He provides compelling evidence for the claim that a shift occurred in the dominant mode of influence of economics. Throughout the 1960s the main channel of operation consisted of influential economists appointed to committees or advisory positions. By the 1990s, however, this had radically changed: it was the cognitive infrastructure provided by the field of health economics which set in place an “economic way of thinking” about healthcare policy. Taking a broader perspective, Matthew Panhans argues that the case of healthcare policy in the US can be seen as a good illustration of how scientific expert advice becomes operationalized in society.

4In “Medical Doctor, Economist and Statistician: A Strategic Alliance for Healthcare and Development in the Italian Directorate General for Statistics (1861-1898)” Claudia Rotondi focuses on Italy in the second half of the 19th century. She studies the way in which statisticians and physicians drew the attention of politicians to pressing healthcare problems, and so doing tried to encourage national development. A particularly important role was played by the “statistics factory” of the Directorate General for Statistics at the Ministry for Agriculture, Industry and Commerce (MAIC), which existed from the Italian Unification (1861) until the end of the 19th century. Claudia Rotondi pays special attention to the period in which Luigi Bodio, a scholar with an extensive network of relations with other scientists, was the supervisor of MAIC. The case she studies helps understand how healthcare issues became a substantial element of the Italian nation-building process.

5The remaining two papers concentrate on debates within health economics. In “Identity and the Value of Health”, Florence Gallois and Cyril Hédoin focus on issues of health valuation. They argue that the identity of the economic agent is of crucial importance when dealing with the valuation of health states. According to the social choice model of standard welfare economics, the valuation of health states proceeds by evaluating how these bear on the well-being of individuals. Inspired by a fast growing literature on identity, the authors propose an alternative framework in which the well-being of individuals is dependent on their identity. They formulate two necessary and (together) sufficient conditions of agency that must be satisfied by any account of identity: a boundary condition and a narrative condition. Knowing that identity is relevant for the determination of the value of health, they then discuss the philosophical and economic consequences of the alternative view, and provide examples of how it would affect the assessment of diseases and pathologies directly affecting the identities of individuals.

6In the final paper, “Moral Hazard in Health Insurance” Michel Grignon, Jeremiah Hurley, David Feeny, Emmanuel Guindon and Christina Hackett revisit the debate around one of the concepts launched by Kenneth Arrow in his seminal 1963 paper. Their paper is a detailed history of the notion of moral hazard in the health economics literature and of the controversies associated with it among health economists. Borrowing the expression from the insurance literature, where it denoted deviation from “correct” behaviour, or “failure to uphold the accepted moral qualities”, Arrow used it to refer to situations where the insured tend to use more health care services to treat a given illness than the uninsured. A few years later, however, Mark Pauly argued that the application of the concept of moral hazard to health insurance was a misnomer. According to Pauly, there is nothing unethical or immoral in the responses of insured individuals, who simply react as rational individuals. Starting from these contributions, the paper traces in detail how the discussion about moral hazard unfolded in health economics.

7All in all, the papers of this special issue show that studying the history of health economics leads to deeper insights not only into the formation and development of the discipline itself, but also into the influence of health economists on health policies.

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Bibliographie

Arrow, Kenneth J. 1963. Uncertainty and the Welfare Economics of Medical Care. American Economic Review, 53(5): 941-973.

Grossman, Michael. 1972. On the Concept of Health Capital and the Demand for Health. Journal of Political Economy, 80(2): 223-255.

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Philip Clarke et Guido Erreygers, « Introduction to the Special Issue: Contributions to the History of Health Economics », Œconomia, 8-3 | 2018, 275-277.

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Philip Clarke et Guido Erreygers, « Introduction to the Special Issue: Contributions to the History of Health Economics », Œconomia [En ligne], 8-3 | 2018, mis en ligne le 01 septembre 2018, consulté le 22 janvier 2019. URL : http://journals.openedition.org/oeconomia/4068

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Auteurs

Philip Clarke

Oxford University

Guido Erreygers

University of Antwerp

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Les contenus d’Œconomia sont mis à disposition selon les termes de la Licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.

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