By Gavin Mooney . Published by Oxford University Press , Oxford UK , 2009 ISBN: 9780199235971 , Hardback , 288 pages . RRP $$123.95

Reviewed by Ya-Seng (Arthur) Hsueh

School of Population Health, The University of Melbourne, Victoria.

Given that Thomas Rice's breakthrough book, ‘The Economics of Health Reconsidered’ was published in 1998, why is there a need for a second book to challenge the orthodox economic paradigm used in the field of health economics? Perhaps Rice would be the most relevant and credible person to answer this question. On the back cover of ‘Challenging Health Economics’ there is indeed a statement by Rice: “While others before him have poked holes in market-based theory as applied to health, Gavin Mooney is the first to provide a convincing alternative paradigm”. This statement clearly indicates that this is a much needed book with an alternative paradigm which can deal with and resolve crucial issues associated with the existing paradigm. The current consequentialism paradigm, based on market-based micro-economics, for many occasions can be critiqued as “one size fits all doesn't fit at all”. Mooney's alternative paradigm presented in this book has identified core issues at different levels (that is beyond the individual/‘consumer’ level) in relation to any complex health care system like ours.

Mooney grew up in the United Kingdom and had spent six years in Denmark, before settling in Australia. As an leading health economist internationally, he has noticed the differences in the health care systems in these three societies and people's attitudes toward each of these health systems. Furthermore, he has recognised the impacts of societal structures on access and the impacts of cultural values on people's beliefs of illness and medical seeking behaviours. However, the existing paradigm with the focus of analysis at the level of individual ‘consuming’ outcome has excluded the possibilities of incorporating the multi-level impacts of systems, communities, wider social structure and cultural beliefs/values, or with an assumption that the differences between health systems and societies to be negligible in analysis of individuals. Written in an accessible and compassionate way, Mooney's book argues convincingly that there is a strong need to critically review where health economics stands and where it might be going, factoring in collective values and specific beliefs in diverse groups, communities and cultures as well as processes of establishing health policies and implementing health interventions.

The book starts with a concise and clear presentation of the key problems of the orthodox economic paradigm and the needs for an alternative paradigm in health economics. This is one of the best analyses I have read about what's wrong with the orthodox economic paradigm in applying to health and health care. He then presents the new paradigm with a notion of communitarianism, and describes how this paradigm has been developed from his own previous works as well as other influential health economists and philosophers. Mooney coherently outlines the philosophy of communitarianism. He also presents nicely how reflective and group preferences can be used to provide a base for communitarian claims. Grounded in real experiences in Australia, the last part of the book uses excellent examples to illustrate how community values are defined, chosen, and elicited. More importantly, under the proposed new paradigm, readers in the health sector will have an understanding with insights regarding the equity issues (due to diversity in structure and culture) and their associated issues in priority setting, economic evaluation, and health policy making.

This book doesn't include any mathematical equations and its overall presentation is reader-friendly. I found this book not only tries to develop a genuine ‘Economic of Health’, but is also a good try in making economics human and humane. Any health economist and health policy maker wishing to make a difference in health and health care will likely benefit from reading this book. It is also a must-read for those who are committed to forming a humane health system. It is an essential text for courses in health economics, priority setting and reform of health system, as well as health policy and management. Highly recommended.