HEALTH ECONOMICS: A REVIEW ARTICLE
| DOI | http://doi.org/10.1111/j.1467-9485.1980.tb00935.x |
| Published date | 01 November 1980 |
| Author | ALASTAIR GRAY |
| Date | 01 November 1980 |
Scotfish
Journal
of
Political
Economy,
Vol.
27,
No.
3,
November
1980
0
1980
Scottish
Economic
Society
0036-9292jSOjOO240297
102.00
Review
Section
HEALTH ECONOMICS: A REVIEW ARTICLE
ALASTAIR
GRAY
Uniuersity
of
Aberdeen
(1)
A.
J.
CULYER
and
K.
G.
WRIGHT
(eds.),
Economic Aspects
of
Health Services,
Oxford, Martin Robertson, 1978, pp.
190
+ix. L9.85.
(2)
K.
LEE (ed.),
Econpmics
and
Health Plan-
ning,
London, Croom Helm, 1979, pp. 195.
€9.95.
(3)
J.
G.
CULLIS
and
P.
A.
WEST,
The Econ-
omics
of
Health
:
An Introduction,
Oxford,
Martin Robertson, 1979, pp. 309+ix.
€5.95
(paperback).
(4)
Report
of
the Royal Commission on the
Nutionul
Heulth Seroice,
London, HMSO,
Cmnd. 7615, 1979, pp. 491 +xi.
E8.00.
These
four
books-two collections
of
essays,
an introductory textbook, and a Royal Com-
mission Report-although sharing a common
concern about health and the provision of
health care, have a collective content of great
breadth, varying depth, and
some
duplication.
Taken as a group they provide the opportunity
to examine the current concerns of health
economists, and to consider developments in
the economic analysis of the health care sector
(particularly in the
U.K.).
As
a prologue,
therefore, a brief historical context is presented
and used to develop some themes within
which these books can be discussed.
For
much of the 1960s health economists-
at least in Britain-xhibited two main pre-
occupations. These were, first, to argue the
case that health and health care was, in theory
and practice, a valid area for economic
analysis; and secondly, to debate the relative
merits and failings of different systems of
health care finance and delivery (different
systems being, in effect, the retention of the
National Health Service, or the extension of
insurance-based private medicine).
The resolution of these issues
has
had an
important influence on the subsequent
interests of British health economists. To take
the second issue first: although it was clear to
some
as
early as 1963 that “in any relevant
discussion of the efficiency of British health
care, the continued existence of the NHS must
be accepted, if for no other reason than that it
is a political certainty” (Feldstein, 1963 p. 24),
a succession of articles appeared throughout
the decade, often comparing the actual limita-
tions of one system with an idealised version
of an alternative, and often making selective
use
of the apparatus of welfare economics to
derive support for policy recommendations.
Not until 1972 did much of the steam go
out
of this debate when Culyer conducted a
rigorous review which convincingly demon-
strated that such policy recommendations
were largely untenable on their own grounds
(Culyer, 1972). From the current situation in
the
U.S.,
we may deduce that when “political
certainty” on this
issue
diminishes, the interest
of economists revives, but by and large British
health economists have come
to
accept the
view that the continued existence of the NHS
in something approximating to its present
form
is
given, and that research might more
fruitfully concentrate on the operation of this
system. This attitude (quite clearly paralleled
in
both the remit and the recommendations of
the Royal Commission on the National Health
Service) goes a long way to explaining the
strong empirical bent of the subject, and the
particular emphasis placed on evaluative
techniques such as cost-benefit and cost-
effectiveness analysis.
Second, it can be seen in retrospect that
one of the most valuable outcomes of this
debate was the focusing of attention on
specific characteristics of health and health
care as commodities. The explicit object
of
this attention was to show whether or not
health care was sufficiently different from
291
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