Product Description
America's healthcare system is at a crossroads, faced with rising costs, quality concerns, and a lack of patient control. Some blame market forces. Yet many troubles can be traced directly to pervasive government influence: entitlements, tax laws, and costly regulations. Consumer choice and competition deliver higher quality and lower prices in other areas of the economy. The authors conclude that removing restrictions can do the same for health care. ... Read more

Customer Reviews (7)

Persuasive (but "wonkish")
This book is logic, well-reasoned, and has lots of footnotes pointing to research studies and reliable sources of data.Even if you disagree with their prescription for how to fix the problem, you will get a lot from this book by following along with their diagnosis of the problems facing our health care system.

The book's greatest strengths may also be it's greatest weakness.This book is "wonkish" -- filled with hard data and logic. If you're looking for entertaining anecdotes or emotional arguments, this is not the book for you.

Only problem is he uses the word 'free'
...but only in the title. A well written book both describing (in surprisingly concise writing) the problem, as well as laying out a path towards fixing it. I can't say I fully agree with his proposals, but I am much better informed, and my views have been altered as a result of this book. In my mind, that is a terrific outcome for any book of substance.

Extremely important book for an extremely important topic: health care
"Healthy Competition" by Michael F. Cannon and Michael D. Tanner of the Cato Institute is a critically important book for both those interested in health care policy as well as for every American as we all eventually consume health care services.

Cannon and Tanner's book starts with a foreword by the Hon. George P. Shultz: "We begin with a riddle.What country's health care system offers the best health services in the world, is consistently criticized for not being accessible enough, and yet is so accessible that overutilization is leading to runaway costs?"The answer is, of course, America.

The following 147 pages offers a detailed analysis of what's wrong with American health care (government and insurance industry policies that lead to overuse of medical services) and what's right (the strong remnants of a free market system that encourages innovation, high quality, at an often lower cost).Both detailed and heavily footnoted, but also very readable at the same time, "Healthy Competition" strikes the right balance between a dense academic paper and a clarion call for action.

In concluding the book, Cannon and Tanner write:

"Despite its marvels, America's health care sector continues to present troubling symptoms: excessive costs, uneven quality, a lack of useful information for patients and providers, extraordinary waste, and enormous burdens for future taxpayers.An accurate diagnosis points to too much government influence and too little choice and competition.Proposals to increase the role of government would aggravate these symptoms.More subsidies or controls would drain from the medical marketplace even more of the dynamics that drive other sectors of the economy toward lower prices and higher quality.The only sure remedy is to restore those dynamics to the health care sector.

"Although there are dark clouds on the horizon, we are heartened by the creation and steady growth of health savings accounts.HSAs have already begun to change private-sector health care from within, and will enable a reexamination of the role of government in health care."

The last citation in "Healthy Competition" comes from a June 1, 2004 Harvard Business Review article by Michael Porter and Elizabeth Teisberg.It deals with the oft-heard argument that we somehow should not apply free market principles to the health care sector:

"It is often argued that health care is different because it is complex; because consumers have limited information; and because services are highly customized.Health care undoubtedly has these characteristics, but so do other industries where competition works well.For example, the business of providing customized software and technical services to corporations is highly complex, yet, when adjusted for quality, the cost of enterprise computing has fallen dramatically over the past decade."

Cannon and Tanner accept this argument while also embracing the argument of many of the proponents of government control of health care because it is special and distinct from other parts of the economy - they just come to the opposite conclusion, concluding in their last paragraph, "...Unlike software, wireless communications, or banking, health care involves very emotional decisions, which often entail matters of human dignity, life, and death.However, we do not see the gravity of these matters as a reason to divert power away from individuals and toward government.Rather, we see the special nature of health care as all the more reason to increase each consumer's sphere of autonomy.The special nature of health care makes it all the more important that we use the competitive process to make health care available to more consumers - and makes it all the more important to get started now."

Two side notes of a personal nature: on February 1, 2007, I introduced AB 245, a bill that would allow the tax deductibility of contributions to HSAs (California is one of only four states that do not treat HSAs as tax deductible); and author Michael Cannon is someone I have grown to respect from our first meeting in 2004 as Lincoln Fellows of the Claremont Institute.I suspect we will be hearing quite a bit from Mr. Cannon over the next few decades - and, if policymakers are smart, they will listen carefully to what he has to say.

Reviewer: Chuck DeVore is a candidate for U.S. Senate in 2010, a California State Assemblyman, he served as a Special Assistant for Foreign Affairs in the Department of Defense from 1986 to 1988, retired from the Army National Guard as a lieutenant colonel, and is the co-author of "China Attacks."

Free Markets are Healthy
Intellect with humility is hard to come by.Cannon and Tanner define a clear path for all Americans to have health insurance and they have the humility to believe in Americans as wise consumers.Different than politicians who 'know what's best for you,' they trust you to make prudent decisions for yourself.Free markets are healthy and they provide an excellent outline for cost savings and a healthier 'you' by putting you in charge of your own well being.I want to thank Cannon and Tanner for being Americans and loving freedom, especially in the face of fear mongering socialists.God Bless America!

CJF
I enjoyed the book and found it presented a well organized argument for why it is so critical to allow the markets and consumers to experiment with new methods of controlling health care costs and improving access.I also appreciated the author's acknowledgement that health care is a special service that is critically important in our lives.That is what makes reforming the system so challenging.

The book makes clear that market based proposals to reform health care are designed to lower the cost of care and increase coverage.These are proposals that are critical to all Americans. ... Read more

Product Description
A world-renowned physician traces the rise of the medical-industrial complex that has made a disaster of our healthcare system--and tells us incisively what we need to do to change it.

The U.S. healthcare system is failing. It is run like a business, increasingly focused on generating income for insurers and providers rather than providing care for patients. It is supported by investors and private markets seeking to grow revenue and resist regulation, thus contributing to higher costs and lessened public accountability.Meanwhile, forty-six million Americans are without insurance. Health care expenditures are rising at a rate of 7 percent a year, three times the rate of inflation.

Dr. Arnold Relman is one of the most respected physicians and healthcare advocates in our country. This book, based on sixty years' experience in medicine, is a clarion call not just to politicans and patients but to the medical profession to evolve a new structure for healthcare, based on voluntary private contracts between individualsand not-for-profit, multi-specialty groups of physicians. Physicians would be paid mainly by salaries and would submit no bills for their services. All health care facilities would be not-for-profit. The savings from reduced administrative overhead and the elimination ofbilling fraud would be enormous. Healthcare may be our greatest national problem, but the provocative, sensible arguments in this book will provide a catalyst for change. ... Read more

Customer Reviews (12)

A physician perspective on the goals of health care reform
"A Second Opinion" takes another complementary viewpoint from the eyes of a physician. Dr. Arnold S. Relman is widely known as former editor of the New England Journal of Medicine and for his prescient 1980 article on the commercialization of medicine, and his phrase "the new medical-industrial complex". As many of his predictions have come true, he argues for a radical change in both ends of the current system to reduce waste and administrative overhead, improve quality, and provide coverage for all.

Dr. Relman details the post World War II development of medical practice in the US, and the transition of role of the physician responsible for "care of the sick" to the varied roles they have today in the commercialized "health care industry". He describes the effects of commercialization as fragmenting the delivery of care at the expense of quality, encouraging overutilization of new technologies, and increasing inequity of care.

In "A Second Opinion" he argues for a single payer system to eliminate administrative costs in the insurance industry and waste in the overutilization of treatment. In addition, he recommends a restructuring of the delivery of care to physician multi-specialty group practices (PGPs) that resemble the integrated health systems such as Kaiser, with reimbursements based on a fixed annual dollars per patient and doctors paid on a salaried rather than fee for service basis. In this way, physicians would return to their roots as a profession of primary caregivers, without regard to the level of compensation or financial incentives to practice medicine a certain way. In addition, like the PGPs, health care delivery facilities such as hospitals would be not-for-profit entities owned by the local community.

By telling the history of how the practice for medicine has been commercialized and the effect of the growth of Medicare and the indemnity insurance industry, Dr. Relman is able to convey the ethic that has been lost in his profession that a systemic change could restore. In addition, he makes a detailed comparison with the Canadian system, recounting its history in parallel with ours. The result is that Canadians have 100% coverage and spend $3500 per person annually, or one-half the amount in the US (only 10% of GDP). He concludes with a open letter to his colleagues in the profession about the need for change and his vision of the practice of medicine in salaried not-for-profit multi-specialty group practices.

Because of his perspective as a physician and manager of health care institutions, he doesn't approach the subject with any faith in market forces or technology to correct the current situation. In fact, he believes that the movement of consumer driven health care (CDHC) will fade with time just as HMO's did. The combination of catastrophic indemnity insurance and health savings accounts (HSAs) promoted as a solution to restore consumer decision making in the market will not change the fee for service orientation of the major expenditures such as hospitalization. Thus, it will fail to contain costs and at the same time will cause hardship in paying for physician office visits for low income individuals that may forego care to save the money in their HSAs.

One issue with Dr. Relman's approach overall is that it freezes the current state of delivery of healthcare in place and makes adoption of innovation difficult, because there is no profit motive to compensate for risk taking and investment in service delivery. The rate of innovation in medical technology is increasing, not decreasing, and medical practice will need to keep up with the emergence of personalized medicine and telemedicine. But this structure would not preclude the medical device and pharmaceutical industries from remaining as for-profit suppliers to these non-profit delivery entities.

Proposed solution to fixing a sick system.
At the beginning of my medical career, physicians feared inroads from socialized medicine. Three decades later we were pawns of capitalized medicine as insurers dictated what drugs to use, tests to order, and how long to keep a patient in the hospital. HMOs tout preventive care, and there are actually billing codes for this, but they are largely not reimbursed. During this time Dr. Relman held many prestigious positions that puts him near the top of the list of the most important physicians of our era. In this small book he succinctly outlines the history of patient care and the doctor-patient relationship over five decades. He reproves the entrepreneurial spirit that overtook physicians in the 1950s and how it created conflicts of interest. He describes how Medicare and Medicaid may have helped many patients, but almost destroyed the concept of a physician or surgeon giving free care to the poor. As insured health plans became more common in the 1970s and 80s, he castigates the unconscionable profit motive that effectively restricts health care to those who need it most. He outlines the socialized systems in Great Britain and Canada, good aspects and bad. Finally, he proposes a single payer plan for the United States.

It's hard to disagree with Relman when the current system is in such a mess. Nevertheless I maintain that any new or revised system should not eliminate entrepreneurship. Socialism has already demonstrated that if you fail to reward excellence and ambition, you only reap mediocrity.

very well researched and very accurate insight
The author has done his research and has accuratley articulated the major issues. This book should be read by all interested in the current health care and cost dilemma.

Health-care reform
Dr. Relman was editor of New England Journal of Medicine for 14 years, a practicing physician, and on a variety of health care boards.His health care reform ideas offers the best or equal to the best plan for affordable, universal health care(at a basic level of care).He recommends single payer system, that physicians work in non-profit multi-speciality clinics for better comprehensive care of patients, that physicians receive bonus for going above a standard level of patient load.

A Second Opinion, Arnold Relman MD
Superb "tough love" analysis of the way commercialization of healthcare has driven behavior predictably towards financial rewards while perpetuating disparities in access and quality of care and severely eroding the primary care workforce necessary for rational care for our next generation.Dr. Relman candidly acknowledges that correction of these patterns will cause some financial hurt to entrepreneurial physicians and physicians in highly remunerative procedural niches, as well as the familiar bogeymen of the for-profit commercial insurance companies and profit-driven hospitals.If physicians fail to take active, participatory leadership in the necessary corrections, a blunt and clumsy governmental change process will likely be necessary. ... Read more

Product Description
Few domestic issues dominate today's headlines as much as the high cost of health care. Despite this media attention and a litany of election-year debates over health care funding, some 45 million Americans remain without adequate health insurance. Philip Funigiello chronicles the contentious political history behind this state of affairs, from the New Deal to the present.

Funigiello unlocks the puzzle of why the United States has never guaranteed its citizens health security comparable to that enjoyed by people of other first-world nations-and he tells what needs to happen for policy reform to take place. Examining specific episodes in the history of health care financing, he highlights the importance of key individuals in the legislative process, the political haggling involved in shaping a bill, the clash of personalities and agendas that determine its fate, and the extent to which American ideas about fairness are reflected in the result.

Beginning with the National Health Survey of the 1930s, Funigiello traces the long struggle to enact Medicare and explains how medical inflation adversely affected both public and private employment-based insurance systems. He then recounts how Medicare became a target in the Republicans' war on spending, assesses the ill-fated Clinton health plan, and brings everything up to date with the Bush administration's expansion of Medicare to include prescription drug coverage.

Throughout this history, Funigiello shows that both liberals and conservatives, Democrats and Republicans, share the blame for not providing every American with health security as a right of citizenship. He argues that ideological values such as rugged individualism and laissez-faire capitalism have continually overshadowed the spirit of pragmatism, cooperation, and community ethos that health security requires.

As the swelling ranks of the uninsured threaten to destabilize the entire health care system for those who can still afford it, this country is faced with growing health insecurity unless we learn to rise above political differences. Chronic Politics is an incisive look at how history has affected current policy and is required reading for all concerned with the politics of financing health care in America. ... Read more

Product Description
This volume explores the nature of health and health-care experiences in Russia by comparing societies and communities with different socio-cultural conditions. Key questions addressed by the authors include: How do Russians understand health and what are the factors that influence this understanding? How does this influence Russian self-treatment and prevention behaviour? What are the effects of poverty and standards of living on health? And, how do Russians seek and get access to medical care?These themes were explored through the collection of original data from households in three Russian cities: Moscow, Voronezh and Kazan - the same households interviewed for the authors' earlier work on work and welfare, and poverty and social exclusion. Such a longitudinal follow-up of the same households over 10 years is a unique achievement. In addition questions were identified for inclusion in the 2005 Russian Longitudinal Monitoring Survey, conducted by University of North Carolina, Chapel Hill.This book is especially valuable for its collection of original data following a period of rapidly worsening health status amongst the Russian population and a grave decline in male life expectancy.The findings are set within the context of experience from Finland and the UK, allowing the authors to explore the challenge of the Russian health-care crisis to Western European models of health status and health care. ... Read more

Product Description
A growing reliance on market disciplines and incentives characterised health care reform strategies in many countries in the 1990s, yet the country which relies most heavily on private health care - the U.S.A. - is the most expensive in the world and still fails to deliver affordable health care to millions of its citizens. This apparent paradox is the starting point for Markets and Health Care: A Comparative Analysis. ... Read more

Product Description
As communism fell in Europe, a period of transformations began in several areas. This work examines the changes in health care in the former German Democratic Republic, the Czech and Slovak Republics, Hungary and Poland. The book consists of two parts - the first containing a general description and analysis of the health care systems of the countries studied. The appraisal of what has been achieved is made possible by comparison with the state of the health care structure before the collapse of communist rule. In the second part, a more detailed description of developments is given. ... Read more

Customer Reviews (1)

Back to Bismarck:
The aim of this book is to describe the current state of health system change in a number of countries of Eastern and Central Europe: the former German Democratic Republic, the Czech and Slovak Republics, Poland and Hungary. Of necessity this description is a cross-section of an ongoing process. We will put the desription in a broader framework by looking back at the history of the systems and by looking forward at current policy plans. To give an updated picture of the latter, we have also used policy documents in the national languages. The country descriptions are up-to-date till June 1996.

The book consists of two parts. The first part contains the general description and analysis of the transformation of the health care systems of the countries studied. This is based on the more detailed description of the developments in the individual countries in the second part of the book. To appraise what has been achieved until now in these countries, it is not enough to describe just the current structure of the health care sector. It is also necessary to desribe the structure as it was right before the cessation of the communist system. And to be able to understand the direction developments are taking, it is also important to have some basic understanding of the past system, before the introduction of communist rule, that these countries can fall back on. Together, these elements form the building blocks of the country descriptions of the health care system; they consist of:

1 a brief statistical portrait of the country,

2 a description of the pre-communist health care system,

4 the stuation shortly before the transformation of the communist systems in 1989.

4 the changes in the structure of the health care systems after 1989.
--- excerpt from book's Preface ... Read more

Product Description
Some people say that a picture is worth a thousand words. The field of management often uses a 'rich picture' systems methodology, 'an innovative tool that encapsulates knowledge relevant to strategic reform'. It is often described in the management literature as a 'soft systems methodology' for linking hard and soft facts in a cartoon-like representation to illustrate a complex problem simply and clearly. The following research is presented using the rich picture methodology to capture the current long-term care and long-term services and supports (LTSS) crisis. The picture and narrative rely on expert research from the past and present, as well as on one-on-one open-ended interviews with key stakeholders in the fields of disability, long-term care, and health care. The setting for the rich picture is the ocean, with the current LTSS ship heading toward an iceberg that represents the barriers and challenges to systems reform.The 'cast' for this rich picture will provide the substantive descriptions and body of research and analysis about the barriers and challenges of navigating through the current system of LTSS.The presentation of the research is purposeful, so that the reader and the researcher can begin the voyage together with a snapshot of the problem. The purpose of this research is to produce new knowledge and understanding of current experience with and future need for affordable LTSS for people with disabilities. This research on the State of LTSS Financing and Systems Reform is the first part in a five-part series that will tell the story of the current LTSS system to set the stage for the exploration of future market demands and current gaps in supply; to explore promising state practices and challenges; and, to picture what the 21st century's comprehensive, consumer-responsive system might look like and make policy recommendations.The research is based on five assumptions. First, people with disabilities, whether young or old, desire and deserve choices when seeking assistance with daily living that maintains their self-determination and maximum dignity and independence. Second, the current financing mechanisms (public and private) will become unsustainable in the near future without significant reform.The system must be affordable to all Americans regardless of income levels and must consider opportunities to leverage public and private support in new ways without impoverishing beneficiaries.Third, there is an opportunity with the changing demographic picture of the United States to explore the possibilities of a universal approach to the design and financing of services and supports that is responsive to individuals under the age of 65, as well as seniors with disabilities, without sacrificing individual choice and flexibility. Fourth, formal and informal caregiving must be sustained, examining family needs and workforce recruitment and retention challenges. Fifth, the approach to quality must examine consumer direction and control of resources in addition to traditional external quality assurance mechanisms. ... Read more

Product Description
Provides information on the ways priorities are currently set for health care around the world. It describes the methods now used in the six countries leading the process, and contrasts the differences between them. It shows how, except in the UK, frameworks have now been developed to set priorities. The text sets forth the key issues that need to be tackled in the years ahead. Descriptions of the leading trends are accompanied by suggestions to resolve outstanding difficulties. Topics include: the need for national research and development funding for new treatments; ways to shift resources permanently towards prevention and chronic care; and how DALYs may replace QALYs. ... Read more

Product Description

Customer Reviews (4)

Is this just a fantasy, or not?
David Gratzer (and I) would like for you to imagine a world where "health-care reform" is a non-issue.It is a non-issue because the government and the insurance companies play almost no part in health care (AKA "going to see the doctor.")In this world, you go to see the doctor in exactly the same way as you go to see an automobile mechanic: he fixes the problem, and you pay him cash.

Well, welcome to Disneyland, you may be muttering.But it's not Disneyland.It's the country I grew up in, the United States of America in the 1950's --- and it's also the country I live in right now.Both of these "Fantasyland" countries had no tolerance at all for frivolous malpractice lawsuits, and jury awards which amounted to "another way of winning the lottery."You could NOT sue your doctor for $150 million without getting laughed out of court.

Well, the malpractice plague struck America, and soon doctors were paying anywhere from $30,000 to $250,000 a year for malpractice insurance.That is to say, it became clear that somebody had to pay those absurd $150 million claims.And perhaps worse, the whole industry succumbed to the "insurance model."

The only way I can think of --- to convince you of the inherent problems in the insurance model --- would be the true story of my Dad and a female acquaintance.This woman was chattering on about what her doctor had said a week ago, versus what her doctor had said two weeks ago, and made it clear that she did not let a month go by without dropping in to see her doctor.In an idle moment, she asked my Dad how often he went to the doctor, and he honestly replied that he hadn't seen a doctor in twenty years. (Dad was a veterinarian, so he knew quite a bit about practicing medicine.)

To put it briefly, people with good health insurance are shopping with a giant credit card they never have to pay off.Do YOU want to pay the "doctor bills" of some middle-class housewife who simply MUST see a doctor every month?

Put the "insurance model" together with the "malpractice crisis," and you get enormously expanded health costs.First, a lot of people are consuming way too much of something that is "free," and, second, doctors are terrified into providing "defensive medicine," and worse --- they are obligated to spend huge amounts of time practicing "defense documentation."(If that malpractice suit ever appears, by gum, they'll need all the documentation they can get.)

David Gratzer's extremely illuminating broadside brings all these ideas into the public debate, and I urge you to read it.

Short but not sweet on Obama reform
Gratzer manages to fill this short booklet with presumably all necessary info on major chapters in Obama's 'reform package'. Though some will find Gratzer too scant he will appeal to those who need an overview in the debate on the issue, a majority will appreciate his book BECAUSE the book takes only twenty minutes to read..

The Indict this Socialism Deserves
Watch Video Here: http://www.amazon.com/review/R3I1YCTGKWBW6I More government isn't reform, it's devolution. Gratzer's suggestions are what I call reform and the stuff of change and hope. An excellent book indeed.

Summary of What's Wrong with Public Health Care
Excellent short book on all that's wrong with ObamaCare. Dr. Gratzer is a former Canadian psychiatrist who has had exposure to both Canadian and US health care systems. He provides evidence that many health outcomes are significantly better in the US on average. The major tenets of Obama's health care reform are provided and critiqued. The book also provides a much needed reminder of how we got into our current situation. In the 1940s, as a result of wage and price controls, employers started offering health insurance when they couldn't offer higher salaries. Then the IRS made insurance premiums paid by employers non-taxable. Gradually, most services became covered by employment based health plans, thus separating the cost of the service from the consumer. This could only lead to rising costs, leaving those without employer based coverage unable to afford care. It has been government intervention, not the free market, which has lead to many of our current problems. The book offers a useful quick summary to anyone concerned about the current health care reform. ... Read more

Product Description
The last several years have seen a sharpening of debate in the United States regarding the problem of steadily increasing medical expenditures, as well as inflation in health care costs, a scarcity of health care resources, and a lack of access for a growing number of people in the national health care system. Some observers suggest that we in fact face two crises: the crisis of scarce resources and the crisis of inadequate language in the discourse of ethics for framing a response.

Laurie Zoloth offers a bold claim: to renew our chances of achieving social justice, she argues, we must turn to the Jewish tradition. That tradition envisions an ethics of conversational encounter that is deeply social and profoundly public, as well as offering resources for recovering a language of community that addresses the issues raised by the health care allocation debate.

Constructing her argument around a careful analysis of selected classic and postmodern Jewish texts and a thoughtful examination of the Oregon health care reform plan, Zoloth encourages a radical rethinking of what has become familiar ground in debates on social justice. ... Read more

Customer Reviews (2)

Informative and well written
A wonderful book for helping us understand the ongoing health care debate.Full of needed information and written in an engaging and understandable way.

a bit disorganized but I'm glad I read it
Less of a coherent book than a collection of essays only slightly related to each other: first an essay on Oregon's attempt to find a logical way of rationing Medicaid spending, then an essay on various theories of justice generally (e.g. Rawls, Nozak), then a discussion of various attempts by Jewish sages (of the talmudic and midrashic eras) to create Jewish law governing allocation of scarce resources in situations where lives were at stake, and then finally an attempt to relate the book of Ruth to modern politics.(The author's general bias is in favor of national health insurance of some sort).I thought the "Jewish essays" were more interesting than the rest of the book -- perhaps because I'm more interested in Jewish topics, perhaps because the issues raised in sacred texts are more likely to be relevant in 2003 than the details of Oregon's Medicaid policy. ... Read more

Product Description
This work is a critical ethnography of decision making with respect to the assessment of health care need in the UK health systems. Theories of need, justice, and rights are reviewed in relation to the structural changes that have occurred to the Health Service in recent years. To illustrate the arguments, a case study of planning services for kidney failure patients is used. The decisions of a group of professionals involved in an independent review of government services evaluates critically using particular theories of need and communicative action. The relationship between needs, as understood and defined by medical and managerial groups, and markets form the focus for a more general critique of the reformed UK health system. ... Read more

Product Description
Wasting Away is a provocative text that examines and assesses the Canadian health care system. This seven-chapter book explores the development of the Canadian health care system and breaks the analysis down into accessible units: who provides (the institutions and the people); who pays (funding sources); and who decides (public, private, and patients). The concluding chapter sums up the winners and losers in this system. A new Introduction by the authors thoroughly updates the subject. ... Read more

Product Description
This Reader lays solid foundations for continuing professional development in the rapidly changing world of health and social care.

A series of ley articles explores current challenges facing practitioners across a broad spectrum of the caring professions, including:

- the need for accountability to service users, funders of services and local communities

- the required skills for teamwork and collaboration, anti-discriminatory practice and patient and client participation

- ethical dilemmas of working in conditions of resource constraint and engaging in questions of quality and performance review.

A thorough and critical analysis ofthese increasingly important themes, this book covers organizational issues, the social and economic context of policy, and the need for reflective practice. The chapters illustrate the similarities and differences between the NHS and social services.

Selected to appeal to a wide audience of students and practitioners, these readings provide an in-depth understanding of the context of professional practice in health and social care.

It will be an essential resource for students and practitioners in health studies, nursing, social work and allied professions.

Changing Practice in Health and Social Care is a set book for the Open University course K302 Critical Practice in Health and Social Care.

Product Description
Produced in close consultation with state health care officials from all around the country, this important volume addresses the central implementation, management, and federalism dimensions of health reform. Chapters by some of the country's leading health policy and public management experts explore the administrative challenges of reform as they relate to health alliances, cost containment, quality of care, medical education and training, and other key issues. They discuss various working principles for developing an administratively sound health reform policy. The contributors are Lawrence D. Brown, Columbia University; Gerald J. Garvey, Princeton University; Donald F. Kettl, University of Wisconsin-Madison; Michael Sparer, Columbia University; James R. Tallon, United Hospital Fund; James R. Fossett and Frank J. Thompson, State University of New York, Albany. ... Read more

Product Description
Is there a crisis in Canadian health care? While the establishment of the Canadian health care system is widely considered a triumph of citizenship, after four decades the national program is in a fragile state marked by declining public confidence. In First Do No Harm, Sullivan and Baranek provide a concise introduction to the fundamentals of health care in Canada and examine various ideas for reforming the system sensibly. Arguing that administrators and policymakers should follow Hippocrates’ dictum "first do no harm" when evaluating and reforming the Canadian health care system, the authors discuss health care financing, popular Canadian health care myths, waiting lists and emergency room overcrowding, and home- and community-based health care. This book is an invaluable invitation to Canadians to think carefully and creatively about the present and future of our health care system. ... Read more

Product Description
In Mexico City or Nairobi or Manila, a young girl in one part of the city is near death with measles, while, not far away, an elderly man awaits transplantation of a new kidney. How is one denied a cheap, simple, and effective remedy while another can command the most advanced technology medicine can offer? Can countries like Mexico, Kenya, or the Philippines, with limited funds and medical resources, find an affordable, effective, and fair way to balance competing health needs and demands?

Such dilemmas are the focus of this insightful book in which leading international researchers bring together the latest thinking on how developing countries can reform health care. The choices these poorer countries make today will determine the pace of health improvement for vast numbers of people now and in the future. Exploring new ideas and concepts, as well as the practical experiences of nations in all parts of the world, this volume provides valuable insights and information to both generalists and specialists interested in how health care will look in the world of the twenty-first century. ... Read more

Product Description
The prevalence of child undernutrition in India is among the highest in the world, nearly double that of Sub-Saharan Africa, with dire consequences for morbidity, mortality, productivity and economic growth. Drawing on qualitative studies and quantitative evidence from large household surveys, this book explores the dimensions of child undernutrition in India and examines the effectiveness of the Integrated Child Development Services (ICDS)program, India's main early child development intervention, in addressing it.

Although levels of undernutrition in India declined modestly during the 1990s, the reductions lagged behind those achieved by other countries with similar economic growth. Nutritional inequalities across different states and socioeconomic and demographic groups remain large.

Although the ICDS program appears to be well-designed and well-placed to address the multi-dimensional causes of malnutrition in India, several problems exist that prevent it from reaching its potential. The book concludes with a discussion of a number of concrete actions that can be taken to bridge the gap between the policy intentions of ICDS and its actual implementation. ... Read more