Diverse economic methodologies and health system research UK funders’ workshop on health policy and systems research in low and middle income countries DFID/ ESRC/ Wellcome Trust 13.12.11 Maureen Mackintosh Open University, UK Professor Maureen Mackintosh, 14 Dec 2011

Professor Maureen Mackintosh, 14 Dec 2011 Two issues/ questions We know many health systems are highly marketised and/or private sector dominated – what methodologies are needed to diagnose its extent and nature? Health systems are major economic sectors producing goods and services – what methodologies are needed to understand their direction of change (dynamics)? Professor Maureen Mackintosh, 14 Dec 2011

Diverse economic methodologies relevant to marketised health systems 1. Exploratory methodologies drawn from development economics, investigating economic systems through fieldwork. 2. Business and financial economics applied to industrial and service sectors, e.g. contracting, business strategy. 3. Evolutionary methodologies used in industrial economics to identify the drivers of changing market structure in industrial and service sectors. Professor Maureen Mackintosh, 14 Dec 2011

Evolutionary methodology   Evolutionary Traditional Dynamics Open, nonlinear, far from equilibrium Closed static linear systems in equilibrium Agents Heterogeneous, rules of thumb for decisions with incomplete information, learn and adapt Homogenous, use complex deductive calculations to make decisions, do not learn or adapt Networks Models interactions between agents; networks change over time Assumes agents only interact indirectly through market mechanisms Evolution Co-evolutionary learning and differentiation: perpetual novelty in firms, strategies, technologies, markets. No mechanism for endogenously creating novelty. Growth through increases in productivity. Professor Maureen Mackintosh, 14 Dec 2011