Philippe Batifoulier & Nicolas Da Silva (2024)

In David Primrose, Rodney D. Loeppky, Robin Chang (eds), The Routledge Handbook of the Political Economy of Health and Healthcare. London: Routledge.

Abstract. This chapter examines the institutionalist tradition of the economics of conventions (EoC) in the field of health and healthcare. It examines the EoC from its origins to its more recent development in order to demonstrate how it conceptualizes healthcare and health policy as strongly normative issues. Specifically, for the EoC, health is a domain in which a plurality of social values, habits, deontological and professional rules, and ethics are omnipresent and, when codified as conventions, function to determine the social trajectory of health processes. Accordingly, unlike neoclassical economics, the political economy of health and healthcare acknowledges such values as inherent to economic analysis and seeks to analyze their plural forms and performative implications in practice. In turn, based on a discussion on the concepts of marketization and industrialization, the chapter also presents a critical account of neoliberal policy concerning healthcare and health. It concludes by arguing that the EoC provides a powerful means for comprehending the conventions legitimizing capitalism, while pointing to the need to transcend the political-economic confines of this system in order to secure broader health and healthcare objectives.

Extract: “Because patients and doctors are a priori conceived as Homo Economicus, neoclassical economics holds that they must be made responsible in the only effective way: via financial incentives that will activate their self-interest. However, with regard to health, patients are a long way removed from this abstract figure, who has no problems of birth and survival or of passions associated with fear of illness and death, because s/he is immortal. Simultaneously, while doctors are, of course, sometimes able to act in an opportunistic manner, medical ethics is more than a means to satisfy their self-interest. Morality, social values and professional ethics are central to the health sector. Unlike neoclassical economics, the political economy of health and healthcare acknowledges such values as inherent to economic analysis and seeks to analyze their plural forms and performative implications in practice. […]  we have examined how the French school of the EoC accords importance to the plurality of these values in order to consider different normative conceptions of health and healthcare. Accordingly, a value-free analysis of health policy is unfeasible. In practice, the EoC examination of a plurality of values is not only a means to criticize neoliberalism. It is also a way to understand its expansion in health and healthcare processes, because neoliberal policy also requires moral justifications. Debating about the political economy of health is, thus, not analogous to deliberating on any other economic practice. Of course, health is an important part of financialized capitalism. Yet, health can also generate new ways of life that attempt to secure the well-being of citizens.
The conventionalist approach illuminates this reflection in two ways. First, contemporary forms of health capitalism involve competing conceptions of the common good that can be analyzed with the pluralist framework of the EoC to comprehend its several orders of justification (market order, industrial order, domestic order, and so forth). Second, health constitutes a new spirit of capitalism, supported by a novel moral reasoning. Emphasizing concern for the self and the healthy body, the affirmation of health as ‘good in itself’ shows that capitalism cannot evolve without integrating the claim for good health. Yet, the system can only do so in limited and contradictory ways that, in turn, remain oriented around advancing the interests of a wealthy and powerful minority. The EoC, thereby, provides a powerful means for comprehending the conventions legitimizing capitalism, while pointing to the need to transcend its political-economic confines in order to secure broader health and healthcare objectives.” (p. 44)

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