How Scientific Breakthroughs and Social Innovations Shape the Evolution of the Healthcare Sector

The chapter argues that the conventional scientific determinism does not explain the long term evolution of health care systems. First the illness and the medical knowledge and techniques are socially constructed and historically determined. Second the methods for financing and organizing care shape the intensity and direction of medical breakthroughs. Third scientific advances generally do not reduce the medical costs because the new therapies diffuse and more complex diseases challenge medical expertise. It is thus important to replace a static equilibrium-based approach with an evolutionary and institutionalized vision that takes into account the two sided causalities between social innovations and the invention and diffusion of new therapies. The performance of the health care sector cannot be measured by usual productivity indexes since so many factors determine the life expectancy in good health of the population. A large diffusion of education exerts positive spill overs upon the prevention of diseases and the preservation of health. This calls for a society wide approach to health as a component of a genuine to, “anthropogenic” mode of development. Clear social innovations are required for this mode to prosper and not only purely medical breakthroughs.