A J. Culyer – författare

The Handbook of Health Economics provide an up-to-date survey of the burgeoning literature in health economics. As a relatively recent subdiscipline of economics, health economics has been remarkably successful. It has made or stimulated numerous contributions to various areas of the main discipline: the theory of human capital; the economics of insurance; principal-agent theory; asymmetric information; econometrics; the theory of incomplete markets; and the foundations of welfare economics, among others. Perhaps it has had an even greater effect outside the field of economics, introducing terms such as opportunity cost, elasticity, the margin, and the production function into medical parlance. Indeed, health economists are likely to be as heavily cited in the clinical as in the economics literature. Partly because of the large share of public resources that health care commands in almost every developed country, health policy is often a contentious and visible issue; elections have sometimes turned on issues of health policy. Showing the versatility of economic theory, health economics and health economists have usually been part of policy debates, despite the vast differences in medical care institutions across countries. The publication of the first Handbook of Health Economics marks another step in the evolution of health economics.

The Handbook of Health Economics provide an up-to-date survey of the burgeoning literature in health economics. As a relatively recent subdiscipline of economics, health economics has been remarkably successful. It has made or stimulated numerous contributions to various areas of the main discipline: the theory of human capital; the economics of insurance; principal-agent theory; asymmetric information; econometrics; the theory of incomplete markets; and the foundations of welfare economics, among others. Perhaps it has had an even greater effect outside the field of economics, introducing terms such as opportunity cost, elasticity, the margin, and the production function into medical parlance. Indeed, health economists are likely to be as heavily cited in the clinical as in the economics literature. Partly because of the large share of public resources that health care commands in almost every developed country, health policy is often a contentious and visible issue; elections have sometimes turned on issues of health policy. Showing the versatility of economic theory, health economics and health economists have usually been part of policy debates, despite the vast differences in medical care institutions across countries. The publication of the first Handbook of Health Economics marks another step in the evolution of health economics.

All too frequently, the largest effective barrier to interdisciplinary communication is jargon. The symposium whose proceedings appear in the following pages sought, of course, to eliminate unnecessary and obscurantist jargon; but it sought also to do something far more ambitious - to confront the intellectual issues that are attached to the use of the word "evaluation" in medicine and health services. To this end a carefully selected group of experts in medicine, epidemiology, and health econom­ ics was invited to present papers. They were selected for their reputations either as conceptualizers or as empirical evaluators, or - the rarest breed of expert - as both. The context was to be empirical. Three procedures were selected that had been subject to evaluation but that posed rather different types of problem. The first was the treatment of renal failure by dialysis of various kinds. This has a relatively long history of evaluation, with a large literature, and particularly raises broad policy is­ sues within the health services of Western societies as to - the size of programmes to be provided; the type, location, and mix of treatments; the selection of patients to receive treatment; and the measurement of the success of various strategies. The second was the treatment of duodenal ulcer by a new species of drug - the hista­ mine Hrreceptor antagonists (specifically, cimetidine).