In this book we have analysed, from an economic perspective, the major challenges involved in providing medical care, such as identifying demand for health and healthcare, comparing healthcare systems with regard to access, quality and financing, the relationship between macroeconomics and health, the economic evaluation of medical technologies, prioritizing services, paying providers appropriately, improving equity in financing healthcare, reducing catastrophic spending, reducing “unnecessary” care and looking at the profession of medicine from a business perspective.

Underlying most health economic analyses is the seemingly compelling narrative of scarcity and, hence, improving efficiency while preserving choice. Neoclassical thinking is the established economic theory that has invaded almost every human relationship from standard market exchanges to education, justice and, ultimately, dying. This can be enlightening and certainly provides a stimulating additional perspective. Economics, however, lacks any intrinsic values and norms; in fact, most economists would argue that this lack is a key advantage of their profession.

Human interaction requires norms. Norms are derived from a set of values. Economics, as a value-free and mathematics-based science, can make policy recommendations but requires a value framework to supplement it and make it normative. Economics alone is not sufficient to determine public policy. At best, “pure” economic reasoning assists in the development of focused reasoning and an understanding of the consequences of action; at worst, it creates a false scientific truth based on an unrealistic reduction of the complexity of human interaction and promotes solutions that are useless, misguided or downright harmful. As Evans et al. (1994: 359) wrote: “Competition and markets should be means to an end, but not ends in themselves. … If they are treated as ends, the objectives of efficiency, equity and cost containment will NOT be achieved” (emphasis in original).

The repeated call for “more competition” (although much more nuanced in recent years and acknowledging the specifics of the healthcare sector) is in most cases not matched by solid evidence that competition really does lead to greater efficiency. “More competition”, in fact, does not necessarily result from applying neoclassical thinking.