Paradigms and research programmes: is it time to move from health care economics to health economics?

As an applied subdiscipline of economics, health economics has flourished, defining itself as the study of how scarce health care resources may be used to meet our needs. This evolutionary pathway has led to health economists adopting a very 'medical' model of health, in which the predominant production function for health is health care. This paper sets out policy challenges to health economics which have arisen in light of growing recognition by governments of the socioeconomic determinants of health and their stated commitment to tackle inequalities in health. It reviews Thomas Kuhn's theory of paradigm shift and Imre Lakatos' theory of scientific research programmes in the natural sciences, favouring the latter as an explanation of the evolution of the subdiscipline of health economics. The paper brings together four recently published visions of the future of health economics-visions that are almost exclusively focused on the production, organization and distribution of health care. In contrast to these visions, in Lakatosian terms, this paper challenges the subdiscipline's core 'positive heuristic', i.e. the set of imperatives which determines how the research programme should unfold, how it may be defended, its scope and boundaries. This paper argues that health economics will need to evolve to embrace a more socioeconomic model of health and, to this end, offers for debate an expansion of Williams' diagrammatic representation of the subdiscipline. It concludes by asking whether the magnitude and the magnetism of health care policy issues will continue to prove too strong to allow health economists, should they wish, to steer their research and educational programmes more directly towards 'health' rather than 'health care' as the relevant social want. Copyright 2001 John Wiley & Sons, Ltd.