ABSTRACT
A Social Economics of Health Care begins with recognition of the central role that a diverse array of social values play in determining the delivery and distribution of health care resources in contempory economies. Current health care economics, in contrast, generally restricts its attention to the values of efficiency and individual preference satisfaction, and moreover assumes that the market and an exchange-based organization of health care will resolve complex social issues regarding who shall have what health care. Since Amartya Sen’s critique of the dominant approach in economics as ‘welfarist,’ however, economists have begun to question the narrowness of their normative framework. These doubts are particularly unsettling for health economics, since the subject of health concerns individuals’ well-being in an especially personal and fundamental manner. Thus, unlike many other subjects economists investigate, the subject of delivery and distribution of health care immediately raises questions regarding equity, fairness, need, rights, trust, caring, and dignity alongside economists’ usual concerns with welfare and good consequences. To complicate matters further, these additional social values concerns are not easily explained within the framework of the market as an impersonal exchange between atomistic individuals. Indeed, relationships between health care providers and patients can be highly personalized, and the institutions that modern societies have created to provide health care often depend upon people sharing a very real sense of community with one another.
