Economic History and Health Care in Industrialized Nations

The focus is on three points: Medical care delivery is only a subset of health protection systems. Indeed, from a historical standpoint, nutritional improvement, establishment of sanitary control and the spread of educational achievement in industrialized nations have been clearly more significant for improving the health of nations (particularly in the reduction or postponement of mortality) than medical delivery has been. Second, our imperfect mortality data (which are about all we presently have) must be supplemented by a sophisticated collection of morbidity data so that we can compare output to the variety of inputs we are so frantically collecting. The design for such data collection must basically be the responsibility of epidemiologists and biostatisticians; only after they have completed their tasks can the analytical contributions of economists ring true. Finally, the two methods upon which economists have relied, investment in human capital (essentially an aspect of benefit-cost studies) and production function analysis (leading to an examination of substitutabilities), have inherent logical inadequacies. None the less, the product has served to improve our understanding of the problems and probably thereby to improve the quality of the health institutions serving our various communities. It is reasonable to expect that these techniques, coupled with better data and refined perceptions of the priority of problems, will serve us even better in the future.