John Wiley & Sons Limited, 2003, 18 chapters, 259 pages+index
ISBN 0 7879 6888 9
This well-written book describes, starting from an economic point of view (unaffordable future costs), in great depth the many problems that health care in the United States encounter. The authors state very rightly that no single villain is responsible for the troubles and that no single silver bullet (easy solutions) is there to cure the system. They extensively analyze and describe the different aspects of why healthcare costs more than it needs to (lack of organized delivery systems working systematically to improve quality and value; lack of incentives for economical choices all around; lack of national health policy to guide the system). They emphasize the need for re-engineering a health care that makes a full and consistent use of science based, outcome focused, computer supported, patient centered, medical best practice. In this way the book primes US-health care cost drivers and creates an informed debate to achieve a more accountable, efficient, valuable and affordable health care.
In Chapter 11 (“where do we go from here?—a call for a National health strategy”) the authors describe 7 key elements, 7 major initiatives for an overall national strategy. These are: (1) improve quality of care and patient safety; (2) address consumers choices, behaviors and incentives, creating an improved market model for both buying and selling health care; (3) improve population health; (4) prevent monopolistic and other anticompetitive behaviors; (5) create a workable framework for dealing with the uninsured; (6) “make sure miracles keep happening”—support and fund training, medical education, medical research, a re-supply of the health care workforce and a re-engineering of actual health care delivery, particularly in hospital setting; (7) create an underpinning for the entire cost, value and quality agenda—i.e. the creation of an automated medical record that will give the doctor and patient in the exam room all the information needed to provide the best care efficiently and consistently. The use of this system is embedded in each of the other objectives.
The following chapters describe how the 7 initiatives actually will work. It starts with the most important one, safety and quality, and describes a series of actions (improving accountability, performance reporting, systematic review of care outcomes, targeted internet communications to physicians, guidelines, not rules, automated decision support tools, patient access to guidelines, need for rewarding use of protocols, focus on best practices, etc), all needed to reach the goals.
Most developed countries encounter more or less the same problems. In this way, “epidemic of care” is not only a “strong medicine” for the American situation. The book gives a handsome and readable, “evidence based” overview on all themes where reform is needed in our changing and graying societies in order to maintain quality, affordability, access to care and innovative power. Hopefully this book will influence the political debate in the US and help, as the writers point out, in creating a blame-free atmosphere of urgency and combined action in the upcoming November-elections on the theme of health-care reform.