Evaluating Paradigm Changes in Health Care Management

Abstract

Paradigm changes have become a recurring theme in studies of health care management (HCM). Yet, paradigms in HCM challenge three fundamental premises underlying the notion of paradigm: incommensurability, superiority, and scientificity. In this paper, we take up that challenge by asking how HCM scholars can evaluate paradigm changes in their discipline. For that purpose, we go back to Kuhn’s theory of scientific revolution and we propose a framework for analyzing paradigms in HCM. We then apply that framework to a case of paradigm change in the French health care system. Evaluating the two-year impact of that change through quasi-experimental methods and panel analysis, we find that the assumptions that policy makers had made about HCM paradigms did not hold during that period. Our contribution to the literature on paradigms in HCM is threefold. On the theoretical level, our analytical framework accounts for the commensurability of HCM paradigms. Regarding methodological aspects, we illustrate how evidence-based approaches drawing on that framework may help test assumptions of superiority between those paradigms. On the practical side, we propose new research avenues that leave room for a greater participation of HCM scholars in the paradigmatic changes that are taking place in their field.