International Journal of Integrated Care, 21 April 2004 - ISSN 1568-4156
Book review
What makes a good healthcare system?: comparisons, values, drivers
Alan Gillies
Radcliffe Medical Press, 2003, viii, pp 213,
ISBN 1 85775 921 4
Natasa V. Daniilidou, MSc, Health Economist

Health is a political issue. Those in charge of the health system, politicians, assume that they know what is a good system and how to make one better. But is it so?

In this book the writer analyses and compares three healthcare systems, namely the British, the Canadian and the Australian, in order to identify what are the assumptions behind the different views of what is a good healthcare system.

Actually, by the end of the book it is self-evident that no simple answer to this question can be provided. However, reading the twelve chapters of the book proves to be a valuable experience in a number of ways:

Firstly, the advantages and disadvantages of each healthcare system are clearly stated or concluded from the text, so the reader is able to reach his/her own conclusions.

Secondly, the writer uses many ways to find what he is looking for: case studies, interviews with key stakeholders, including clinicians, managers, academics but also patients, and key policy documents to report on the three systems.

Thirdly, the writer manages to provide a lot of information on the three systems without making things complex; on the contrary, the book is interesting, eloquent and easy to read. In that, helps the fact that all evidence and references concerning the arguments presented are published on a website, and it depends on the enthusiasm and personal interest of each reader to access them or not!

More specifically, in the first two chapters, after being introduced to the cast of the case studies and identifying what their health needs are, we watch their interaction with the health system. Each individual has preferences and expectations from this interaction. Thus, it is probably utopic to believe that we can create a model of a good healthcare system against which performance of any other system can be measured. As Alan Gillies puts it: “The quality of the service provided as perceived by the patient, is whether their expectation is met, rather than whether some absolute standard is met”.

Health policy is the result of the interaction of values and drivers, both of which vary from county to country and culture to culture. Six chapters are devoted to the analysis of values such as universality, accessibility, efficiency etc., and drivers such as finance, scandals and ideology, upon which health policy of each country is based.

The next three chapters initiate the reader to the reality of the British, the Australian and the Canadian healthcare systems, which provide a solid base for comparison between them.

Finally, the writer's closing remarks on what is a good healthcare system derives from his research while he was writing the book. It comes as little surprise that his initial opinion about the three systems was considerably different from what he concluded upon at the end, after having studied the three systems' characteristics.

The writer does not overtly express his opinion on integrated care, which is referred to only when it is relevant in a healthcare system. So, for example, lack of integrated care is considered as one of the weaknesses in the UK NHS, although the 1997 New NHS White Paper replaces the internal market with integrated care. However, as the writer argues, this has not happened yet. In Australia, integrated care is clearly stated in some key policy documents, but no further mention is being made throughout the book. In Canada, integrated social and home care remains somewhat problematic, as homecare and some other services are excluded from Medicare.

In conclusion, the book provides a thorough presentation and analysis of how the three systems work, the reasons they work in that way and what is each system trying to achieve. It makes clear that no model healthcare system can exist since basic needs and meeting patient expectations are two separate things. I could not agree more with Dr Glyn Hayes's and the writer's argument that it all comes down to whether you are one of the “worried well” or actually ill when you evaluate the healthcare system you are going to interact with. It is always the perspective…