A holistic approach to the economic evaluation of health programs using institutionalist methodology.

The paper examines possibilities for employing more holistic approaches to the evaluation of health care programs. It is argued that the reductionism of conventional forms of economic evaluation, where value (or benefit) is seen in terms of either health consequences or individuals' utility, can cause a number of aspects of such programs to be overlooked. As such, this imposes fairly strict limits on the capacity of economic evaluation to inform public policy. In contrast, institutionalist economic theory in common with the community development approach to health promotion is an area of research which acknowledges that change to the broader socio-political environment can be a source of value. It is suggested that this idea has, for instance, significance for the evaluation of indigenous health programs where notions of "cultural appropriateness" have strong influence over the effectiveness and acceptability of such programs. It is concluded that no one evaluative approach is appropriate in all situations and that a greater receptiveness to broader sources of social value can help to improve the way evaluations are conducted.