New York: Palgrave Macmillan, 2007, pp 284,
ISBN 987 0230 00140 4
The second and updated edition of this introductory textbook provides a broad ranging introduction to health policies on provision, funding and governance, in a wide range of health systems, using Australia, Germany, Japan, New Zealand, the Netherlands, Singapore, Sweden, the UK and the USA as detailed examples throughout.
The introductory chapter explains what comparative health policy is, how health policies are understood and the approach—and its limitations—taken for comparing them. It introduces briefly the frameworks or typologies that can be used for comparing between countries.
The second chapter describes the policy and cultural contexts, including health determinants, in which health policies are developed in the different countries.
Chapter 3 compares funding and provision of health care and chapter 4 is about priority setting and allocating resources: how policies are set to equilibrate demand and supply against the background of increasing market-orientation of policy. The approach to rationing, and the criteria used for that, is extensively dealt with.
Chapters 5 and 6 are on the medical profession, as doctors are a dominant force in health policies, and on home care and the different approaches to (funding of) informal and formal care.
Chapter 7 deals with Public Health and widens the scope of the previous chapters from health care policy to health policy. Policies on obesity, alcohol and tobacco are briefly discussed.
The final chapter summarizes what comparing health policies means; it reiterates the limitations and discusses what one can learn.
Each chapter ends with an attempt to draw conclusions on trends or developments. Interestingly, the question of trends and convergence of health policies (the authors deny that convergence actually has been shown to occur) is a recurrent theme in the book. However, when discussing the drivers of policy convergence, more attention to the effects of EU regulation and policy on member states' health policies might have been helpful. Somewhat surprisingly, the book ends with a discussion on whether the medical paradigm, which underpins the whole book, is still relevant for comparing health policies.
This book is very rich in information and analysis. However, in a book of 230 pages one can only include so much when comparing health policies; it requires the art of omitting. Choosing what to include and what to omit needs a clear framework for describing health policies, and the frameworks presented and discussed in the first chapter are helpful but insufficient. The framework dominantly used in this book is the one that describes types of health care systems by provision and funding, on a scale from free market systems to government monopoly. Only in chapter 3 are the principles underpinning types of health systems and policies are introduced: equity, solidarity and individual responsibility, leading to a certain level of patient choice.
Indeed, Primary Care and hospitals are presented as settings where doctors can choose to practice or as entrance points to the health system for which patients can choose. But the discussion of policies on delivery systems as such, is scant, whereas this is a major policy concern in all countries. This is a pity and even more so because further throughout the book references are made to primary care especially, without much mention of historical or current policy orientations.
The book does not discuss policies on integration of health services and the relation between health and social services and hardly says anything on quality of care, whereas these are major policy concerns. The same goes for the role of other professions in health care and the role of patients or the public at large and their organisations as policy drivers. The role of evidence in health policy making and the use of international data (comparisons) are also not discussed.
There is an occasional error; the European Court of Justice is mistakenly described as European Court of Human Rights, and the categories of health care are misrepresented in Table 1.3. However, overall, the book is clearly structured and accessible, with convenient use of boxes, Tables and Figures.
The authors have chosen not to include country-chapters, but to focus on inter-country comparisons. As a result, this book cannot be recommended for looking up information on health policy in one of the countries selected.
In spite of what the book does not offer, its close reading can be recommended to health policy makers and researchers for what it does claim to offer and indeed offers: a map of health policy determinants and health policies. They certainly will find a wealth of background information on developments in health policies with many considerations on their comparability. They will not find comfort, however, since health policy comparison is so complex. The authors end on a pessimistic note, when they observe on one of the last pages: “Lesson learning is politically motivated and selective and is used to substantiate already made policy choices”.