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Book Reviews
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Daniel Callahan and Angela A. Wasunna, Medicine and the Market: Equity v. Choice (Baltimore, Johns Hopkins University Press, 2006). 0-8018-8339-3, Hardcover.
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This is an important and interesting book that takes on an enormous topic: the role of 'the market' in health care systems. The scope is broad, and the book's coverage of the topic is global. For the most part, the authors do an extremely good job of weaving together the strands of research covered. Medicine and the Market seeks to explore whether there is a role for the market in health care systems and, if so, what this might be. The book shows that, despite a long history of rhetoric, especially from within the United States where the health system is premised on ideals of free markets and individual choice, there is scant evidence to support assertions in favour of market-based health systems. For this reason, the book ought to be compulsory reading for policy makers and, especially, students of academic disciplines that feed into health policy (economics and policy analysis, for instance).
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A real strength of the book is its breadth of coverage, with case studies of both developed and developing world countries. Many developing countries, of course, were required by institutions such as the World Bank in the 1980s–90s to implement market-oriented health policies. The failures of such policies are well documented in the book. There is good material on how the Canadian and United States health systems differ, and, as with the rest of the book, this is against a backdrop of historical, political, and philosophical ideas. There is also comprehensive coverage of developed world health systems, especially those of Western Europe. Many of these systems are crafted to support universal health service access and have high levels of government funding and control, or compulsory social insurance. The book shows how these systems out-perform the United States, the authors' home country, on virtually every measure. |
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Another strength of Medicine and the Market is in its analysis. This is both historical (a lengthy chapter traces the history of market thought as applied to health care from the time of Adam Smith), as well as structural. The wide range of countries covered are grouped not just into developed and developing world categories, but are also clustered as 'market rejectors' (for example, Canada and Denmark), 'market accommodators' (Australia and Belgium), or countries that had at one time flirted with the market and then had 'second thoughts' about its capacity to deliver on preconceived goals (New Zealand and the Czech Republic).
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If the authors set out to prove that market advocates have little evidence to back their stance, they have succeeded with flying colours; so too if they were seeking to show the fl awed underpinnings and design of the United States health system and to highlight alternatives (they are particularly keen on European designs). Like any great book, this one is not perfect. The very brief discussion of New Zealand contains a minor inaccuracy (suggesting that the State-Owned Enterprise Act 1986 saw the government becoming more not less directly involved in state trading functions). Health policy is a fast moving field and the research in the book was dating even by time of publication (a common problem for health policy scholars). As such, moves to further embrace the market in countries such as Britain and Denmark are not covered. While eminently readable as a whole, toward the end of the book there is a slight feeling of repetition as, once again, key assertions are reemphasised. Such issues, however, should not detract from what is likely to become, for those concerned about big issues to do with health policy and system design, one of the great books of the decade.
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| ROBIN GAULD |
| UNIVERSITY OF OTAGO |
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