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The Individual in Mainstream Health Economics: A Case of Persona Non-grata

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Abstract

This paper is motivated by Davis’ [14] theory of the individual in economics. Davis’ analysis is applied to health economics, where the individual is conceived as a utility maximiser, although capable of regarding others’ welfare through interdependent utility functions. Nonetheless, this provides a restrictive and flawed account, engendering a narrow and abstract conception of care grounded in Paretian value and Cartesian analytical frames. Instead, a richer account of the socially embedded individual is advocated, which employs collective intentionality analysis. This provides a sound foundation for research into an approach to health policy that promotes health as a basic human right.

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Notes

  1. For some health economists this is an empirical conundrum as educational attainment is usually presumed to be correlated with income or earnings, thus those with higher earnings/income may be presumed to be better educated. Other interpretations turn on a posited relationship between education levels and information concerning health-promoting activities. In other words, better informed agents are able to fully exercise consumer sovereignty.

  2. Fine [20] terms this the information-theoretic approach. Certainly it has galvanised the emergence of new fields such as, new institutional economics and public choice economics, and is a central constituent of game theory in economics.

  3. McGuire argues that clinicians may face a steep trade-off since their decisions can have a profound and irreversible effect on their “customers”.

  4. Kennedy [36] in his influential and highly controversial book, The Unmasking of Medicine, argues that the medical profession has extensive power through its ability to diagnose illness and set standards of care. He queries whether this power should rightfully reside within the medical profession, which he contests gains legitimacy by recourse to special expertise. However, this scientific expertise is based on the Cartesian notion of the body as a machine (Kennedy, Ch. 1): humans are reduced to machines. This he considers to be a “fundamental” misconception in the philosophy of medicine: it dehumanises and diminishes the very people medicine seeks to help.

  5. Culyer et al. [10], proposes the notion of “process utility,” i.e., the patient may gain utility from how care is provided, the process of care. In advocating this Culyer presumes that processes are the consequences of decisions. This appears to advance a dubious conflation between process and outcome; the former subsumed into the latter.

  6. Williams denotes ethics as a reflection on morality, which he views as a narrower conception of the former, where ethics discusses what constitutes the “good life.” Morality refers to particular views on how the individual should live.

  7. Mainstream economics is analytically confined to the domain of freedom through its concentration on markets and exchange.

  8. Other contributors have argued that market oriented reform has the potential to undermine, and even corrode, trust within health care institutions (see for example [27, 43]).

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Acknowledgements

The comments and criticisms of the editors and referees of this journal, participants at a session of the European Association for Evolutionary Political Economy 2004 conference, and the 2005 Association of Heterodox Economics conference are gratefully acknowledged. We are also pleased to acknowledge the financial support of the Carnegie Trust for the Universities of Scotland and the British Academy without implicating these bodies in any way. All errors and views expressed are the authors’ alone.

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Authors and Affiliations

  1. University of Amsterdam and Marquette University, Milwaukee, Wisconsin, USA

    John B. Davis

  2. University of Glasgow, Glasgow, Scotland, UK

    Robert McMaster

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  1. John B. Davis
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Correspondence to John B. Davis.

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Davis, J.B., McMaster, R. The Individual in Mainstream Health Economics: A Case of Persona Non-grata . Health Care Anal 15, 195–210 (2007). https://doi.org/10.1007/s10728-007-0044-x

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