Book Description

This groundbreaking book, which brings together information in a singular way, provides an authoritative overview of the social and economic factors which are seen as the most powerful determinants of population health in modern societies. Written to link closely with the WHO Centre for Urban Health initiative on social determinants of health, it will provide the scientific justification for isolating different aspects of social and economic life as the primary determinants of health. Providing the background to ten 'key messages' which form the basis of the WHO campaign, the book will have a broad audience amongst public health professionals, health promotion specialists and health policy makers. ... Read more

Reviews (1)

A ground-breaking, authoritative work
Marmot and Wilkinson do a thorough, comprehensive job of exploring the emerging field of how social inequalities affect the health of populations. This is a great resource both for public health professionals and for those who are looking for an accessible way to be introduced to the topic. The second chapter alone - a detailed description of the physiological mechanisms by which psychosocial stress is translated to worse health outcomes - is worth the price. Marmot and Wilkinson's work has significance far beyond the realm of public health, and should be read by policy-makers of all ideological stripes. ... Read more

Book Description

In the first edition of the acclaimed Governing Health,Carol S. Weissert and William G. Weissert examined health care policy making from a long-term political perspective, describing how Congress, the president, special interest groups, bureaucracy, and state governments helped define health policy problems and find politically feasible solutions. Now, in this second edition, the authors have expanded their coverage and analysis to demonstrate their themes in four key time periods: 1965, when Medicaid and Medicare were passed; 1981, when OBRA came into being; 1994, when health care reform was at the forefront of President Clinton's agenda; and 2000, when health care reform formed a part of the presidential campaign platforms. ... Read more

Reviews (2)

Best book in print on the health policy process
I have used this book for a number of years now in a class I teach on the Politics of Health Policy (along with Kingdon's classic). It provides an excellent overview of how health policy is made and the politics around it, drawing on both the academic literature as well as recent policies. The first edition focussed more on "medical" care than broader health issues. I look forward to the second edition!

A Look at Health Policy from a Political Science Perspective
This book takes a comprehensive look at health policy in the U.S. from a political science perspective. It addresses all the institutional influences of health policy, such as Congress, the President, interest groups, regulatory agencies, and federalism. It also addresss prominent political science theories and relates them to health policy.

This book is a must-read for any health professional or student who would like to explore the how health policy is REALLY developed. I also highly recommend this book to social scientists and students who are interested in applying governmental relationships to health policy. ... Read more

Book Description

With a focus on the five P's of competitive advantage—power, position, pace, potential, performance—this text selectively applies and adapts the concepts and methods of strategy analysis to the unique constraints and realities of the healthcare industry. This comprehensive text gives your students the basics of strategy, provides them with the know-how to adapt to their future organization's unique strategic plan.

Text is truly geared towards the unique healthcare market, addressing subjects as payment structures, autonomous groups of health professionals, and merging systems.

Benefits:

An accompanying web-based study system, Strategy Resources, will give readers access to StratCenter, an extensive database of U.S. healthcare organizations and markets. StratCenter allows you to compare competitors and complete in-depth market analyses.

A glossary is also available. ... Read more

Book Description

Emerging out of the era of the robber barons and Theodore Roosevelt’s desire to “civilize capitalism,” the Food and Drug Administration was created to stop the trade in adulterated meats and quack drugs. In the almost one hundred years since, it has evolved from a squad of eleven inspectors dogging dishonest tradesmen into America’s most important regulatory agency, keeping tabs on the products of about 95,000 businesses and more than$1 trillion worth of goods annually.

This book shows how the agency combats self-serving political and industrial interests and protects Americans from hazardous medicines, medical devices, and foodstuffs while enforcing rigorous scientific standards. Hilts takes us back to the FDA’s beginnings, when it confronted businesses that acknowledged no limitations on what could be brought to market or on the claims they could make for a product. With the coming of the FDA, our government, for the first time, was able to force the removal of toxic elixirs from the shelves and to insist on accurate labeling.

We see the subsequent fights the FDA waged, and won, for mandatory testing, and against such conservatives as—in our own time—Ronald Reagan and Newt Gingrich, who tried to curtail regulation. We see how the FDA protected the American consumer from thalidomide and other lethal pharmaceuticals, how it took on the tobacco industry, and how it stumbled in confronting the deadly mysteries of AIDS. And we are given, as well, a litany of extraordinary corporate excesses that the FDA has exposed and successfully battled.

Protecting America’s Health shows society adapting to both the burgeoning of science and technology and the ascendancy of the capitalist market. It makes startlingly clear the essential role the FDA has played in maintaining and protecting the quality of life—and health—to which the American public has long been accustomed. ... Read more

Reviews (3)

Only The friendly side of the FDA
As with many institutions, the FDA servers a perceived needed purpose. This book is a history of why the agency was needed and its design. It is filled with horror stories and how the FDA came to the rescue. Some of these stories even scared me as I recognized the products and or brands. The chapter "Capitalism in Crisis" reads more like a political statement against capitalism than a "FDA is out to help" statement.
What they do not say is that the FDA is the Government to the point that they can carry guns and badges. Now with the fast pace of drugs and device invention the FDA is needed more than ever. The other side of the coin is that thy have become an unwatched agency that can and does set its own rules to how a business can do their job down to describing the data field that are to be stored in their computer. Their regulations read like a phone book of conflicting statements (with no recourse). And you can be shut down on a whim if you do not follow the regulations as interpreted by their agent as they are the law.
The book contains an excellent set of notes. They are divided in to chapters. And there is a fair index. For people that like pictures there are eight pages of monochrome photographs.
The author has written several articles on medicine for various periodicals.

Fascinating look inside the FDA
Hilts has written a masterful account of the history of the FDA. It is an amazing tale of the health protections we now take for granted. The FDA as we know it is a relatively modern creation. Just 50 years ago the basic safety of our drugs was in question since no efficacy and safety testing was in place. There was no such thing as clinicial trials. Hilts takes us through the evolution of the FDA from a shoestring operation to its massive size today.

What is evident is that the FDA, flaws and all, still is the only barrier between the public and sometimes ethically challenged businesses. Often criticized as slow and anti-business it is clear that the FDA has tried to do what is right most of the time. At times the book reads like a novel when describing instances of deadly foods or drugs being sold to the public. For those who criticize the FDA, it is well worth reading to establish the historical context. It is clear Mr. Hilts is no friend of industry and this must be noted in reviewing his book. Sometimes only the worst of American business is noted, with little credit to the life saving miracle drugs produced by industry. That said Mr. Hilts book should be read by all those who deal with the FDA.

Excellent History of FDA
This is an excellent, well researched history of the U.S. Food and Drug Administration and the modern pharmaceutical industry. Hilts does a good job of explaining the complex and technical new drug approval process for the general public. The author builds a solid case for well controlled clinical trials as a necessity for approving new drugs and biologics that are both safe and effective. He documents the history of pharmaceutical disasters from Elixer of Sulfanilimide and Thalidomide, to Rezulin.

Although the book focuses on the regulation of drugs, there is also a good overview of important developments in medical devices and food, including the battles over food labeling and silicone-filled breast implants. Hilts gives a fascinating account of political efforts to curb the agency including dirty tricks during the Nixon administration and more current deregulation efforts by conservatives in Congress. The author is a journalist who has worked for the Washington Post and New York Times. It is well written and easy to read. The book is a must for understanding the FDA. ... Read more

Book Description

The pharmaceutical industry is praised as a leader in high technology innovation and the creator of products that increase both longevity and quality of life for people throughout the world, Yet the industry is also reviled for its marketing and pricing practices and even its research and development priorities. Its competitive nature is undergoing change today, with the entry of new firms and products increasing competition at the same time that mergers reduce it.

This book employs the tools of economic analysis to explore the conflicting priorities and aims of the pharmaceutical industry, from both a US and worldwide perspective. Schweitzer discusses the industry both as a manufacturer of products and as a major player in the making of health-care decisions. The author also analyzes the reasons and results of the shift in the locus of demand for pharmaceuticals. Presently the most important factor in formulating the future direction of pharmaceutical research are the demands of the large managed-care organizations rather than individual physicians. HMOs make decisions about product access on behalf of hundreds of thousands of patients. Recent changes in the regulatory environment--including patent law and FDA approval policies--have also influenced the pharmaceutical sector and are therefore investigated in detail.

Pharmaceutical Economics and Policy provides an insightful and expert analysis of this complex sector, and suggests appropriate regulatory approaches to assure that both private and public objectives continue to be served. It provides the first comprehensive look at the economics of the pharmaceutical industry in over 25 years. Readable and balanced, it will serve as an authoritative reference source for students and researchers in health services, health administration, health economics and policy, as well as for policy analysts and economists in industry, managed care organizations, and hospitals. ... Read more

Reviews (3)

Regrettably, out of date...
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...since its publication in 1997, for during the interval we've had (among other developments):

(1) The Food and Drug Administration Modernization Act (FDAMA '97),

(2) The promulgation of the Pharmaceutical Research and Manufacturers of America (PhRMA) Code on Interactions with Healthcare Professionals (2002), and

(3) The federal Department of Health and Human Services (DHHS) formally weighing in with their final "anti-kickback" guidance from the Office of their Inspector General (OIG), incidentally shutting the door between pharmaceuticals marketing and the drug manufacturers' "support" of continuing medical education (CME) on April 28, 2003.

Things have *changed,* folks. There's eight years' worth of changes that neither the author nor the rest of the industry took into consideration back when the galleys of this book were returned to the publisher. Time for a new edition.
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most comprehensive book on the Pharmaceutical market
I believe the book is useful for everyone in The Pharmaceutical Industry. It will be useful for reps, higher management, physicians, technicians, scientists, product and regulatory affairs managers and just about anyone who wants to "think outside the box" of their specific role within the industry. Despite its broad range the book is succinct, never vague, and contains a plethora of useful information. I came across this book without never having heard about the author and with the sole purpose of finding specific economic data. I found that and much more. What an astonishing surprise the book was. The book presents the most comprehensive and intelligently condensed information about the overall pharmaceutical market forces, that I saw recently. specific to the industry. For instance, the short Chapter (2) on marketing Pharmaceuticals offers more important data and contextual information than most books entirely dedicated to Pharmaceutical marketing. In a little more than 20 pages the author manages to provide useful information about sales forces management and economic analysis, including joint marketing, along with definitions about all types of promotional materials and relevant organizations for promotion of Pharmaceuticals, including Continuing Medical Education and the FDA's Division of Marketing. In the even shorter chapter on pricing, the author starts by cleverly laying out the fundamentals of supply and demand for Pharmaceuticals and goes on to quantitatively and contextually explain the worldwide differences. Overall the book has information just about any Pharmaceutical market topic; from all of the non-life sciences issues associated with pre-clinical development of drugs to the structure and future trends of the industry. All this information is easy to find because the book is simply organized in internal analysis (the industry) versus external analysis (consumer, market, public and private influential institutions). I'm truly impressed with the depth and range of knowledge displayed in this book, so much so that if I wasn't working for The Pharmaceutical Industry already I would approach Professor Schweitzer for a postdoctoral research.

Review of Pharmaceutical Economics and Policy
I commend the author's attempt to provide a comprehensive review of pharmaceutical economics and policy in less than three hundred pages. This book is an interesting read and is accessible to those of us who are not economists. However, I would not recommend this book to others due to the facts that (1) the author is inconsistent in referencing the literature and (2) he often fails to present alternative interpretations of the empirical evidence. For example, the author uses evidence of price discrimination to demonstrate the "importance of consumer demand" in the pricing of pharmaceuticals and, by extension, the presence of competition in the pharmaceutical market (pgs. 103-105). However, he fails to point out that price discrimination by pharmaceutical companies reduces consumer surplus, a direct benefit of competitive markets. In addition, the book contains many typos that may prove distracting to some readers. ... Read more

Book Description

What forces lead to changes in governance among medical schools and their associated teaching hospitals? To what extent do such changes affect how well those schools and hospitals do their work? In this book, John A. Kastor, M.D., focuses on the academic medical centers of the University of Pennsylvania and the Johns Hopkins University, two institutions that underwent dramatic change in governance during the late 1990s.

Drawing on extensive interviews with more than three hundred administrators, physicians, and other medical professionals at Penn, Hopkins, and elsewhere, Kastor identifies the factors that influenced changes in governance at these two institutions. Chief among these, he finds, are structure, personality conflicts, and current events. This book will be of interest to administrators of teaching hospitals as well as professionals in health policy and management. ... Read more

Book Description

"Deeply felt, deftly rendered, stunningly informative and often enraging" (Publishers Weekly), Hooked appears as we are finally waking up to the inadequacies of our current drug-rehab policies. With court-mandated rehab being debated across the country, Shavelson's in-depth look at the struggles of five addicts as they travel through the treatment maze makes a powerful case for reform.

Highly readable and shaped by Shavelson's experience as a journalist and physician, Hooked takes us through the anguishing "intake" and controversial House meetings, inside counselors' and judges' offices where many treatment decisions are made, and to prison cells where, under current policies, many addicts end up. It explores the links between drug addiction, mental illness, and trauma, including child abuse—links often ignored by current rehab efforts—and argues for an integrated approach that treats the roots of drug abuse, not just the behavior itself.

Hailed as "compelling" and "heartbreaking" (Time Out), Hooked offers a provocative, honest look at the seemingly intractable issue of drug addiction, and offers powerful alternatives to our current policies. ... Read more

Reviews (12)

Treatment for the treatment system!
Over 2 million Americans in prison, another million each year arrested on drug charges, economic development tied grimly to building prisons and jails. America made a wrong turn somewhere. It isn't like we don't know where and when. It was when we lost faith in the ability of therapists to treat addicts, became afraid and decided they must go to jail and for longer and longer periods of time. Those who understand addiction know that jail sentences do not cure it, regardless of the length. But, judges and prosecutors and victims and voters don't care. They want to feel safe. So the burden falls on those of us who believe drug treatment is a better alternative. And our confidence is shaken by pretty low success rates. Lonny Shavelson has discovered what most have missed. We cannot clean up the addicts until we clean up the treatment system. The system has built a career on convincing us that if someone does not do well in recovery it is not the fault of the therapy or therapist. "The addict just didn't want it badly enough," they say. Not true, Shavelson argues. His book is a must read for policymakers looking for what Shavelson calls, "the elusive secret to effective rehab." It is coerced treatment, make 'em go and make 'em stay long enough for it to work. But...and this is the key to Shavelson's book...the "secret lies...not only in coercing addicts into programs, but in coercing the programs to do rehab right." No legislator or governor should spend another nickel on treatment until they read this book and put it to work in the treatment system. Treatment folks should read it as a "self help" guide. Hold up the mirror to your face! For all of you, a curious thing will happen as you read this book. You will come to understand that no one just becomes an addict. Sure some make bad choices but for most the bad choices were made for them. Childhood traumas, sexual abuse, genetic predisposition. As you read about the lives of the 5 addicts Shavelson tells us about, you find yourself...caring. If we are going to meet this challenge, that is what we must do. Caring is the elusive answer. We must care enough to do what we need to do. For anyone who is involved in the substance abuse issues at any level, this book is required reading. Wonderful book.

Hooked on this Book!
This skillfully written account of the struggles of five addicts, each of whom the author followed for several years, is not only informative about the promises and perils of rehab, but incredibly moving in its portrayal of courageous attempts to put wrecked lives back together. Set in San Francisco's maze of competing bureaucracies, with forays into homeless encampments and drug lairs as well as welfare hotels and a suburban home, the book makes a powerful argument for a coordinated approach to treatment that meets an addict's long-term psychological and physical as well as short-term behavioral needs. A surprising finding is that people mandated to treatment by drug courts do better than people who "demand" it: the latter are not only stonewalled by hard-pressed administrators, but abandoned to their old environments after "graduating" from whatever program they managed to get into; whereas the drug courts place their clients, track them tenaciously, and give them chance after chance to succeed, often in the face of public opposition.

Lonny Shavelson is also tenacious in following his chosen addicts, several of whom lapse and relapse and are all but lost to the streets. Each of these five is lit from within, at least briefly. One falls through the cracks, but most appear to have been saved, if not through grace, through their own hard work and the faith of a few people in the system...along with the author. This is a riveting read, about people who demand our attention, respect, and empathy. Others in similar circumstances deserve better from the system.

our rehab process
drug rehab right between the eyes that pulls no pun ches and shows us where we need to go next

A must read for those interested in the subject
Hooked is a very good book. It starts of as one of those investigative journalist things with a description of real drug addicts. Often books of this type look at these people as if they were the inmates of a zoo, but rather than doing that the book uses their problems to illustrate the difficulties which plague organisations which provide assistance to drug addicts.

One woman suffers from a combination of mental illness and drug abuse. Her attempts to find help are continually frustrated by the fact that when she applies for assistance from mental health professionals she is told that she has a drug problem and she is referred onwards. When she speaks to drug agencies she is told that she has a mental health problem and told to see a psychologist. In the last chapter of the book she is able to find an agency which will help her, but this occurs only after the intervention of one of the doctors. The intake staff is concerned about accepting her as they prefer people who have fewer problems and who are easy to deal with.

A lot of the book is focused on one person Mike who attends a live in facility for close to a year. His story illustrates how current rehabilitation facilities fail to have access to services such as detoxification and also use ritual humiliation as a means of controlling the inmates. Mike breaks a rule by developing a relationship with another inmate. He has to sit in a chair for three days and to go through a re-education session similar to those that featured in the Chinese Cultural Revolution. The author makes the point that the people running the program are generally untrained and not able to work out when such treatment is appropriate or whether those who might be put through it could suffer from major mental illnesses. Those people who suffer from substance abuse problems generally will have a background of some difficulty. In this case Mike was a person who was raped repeatedly as a child. There was however no psychological treatment available in the program. More important however is the inability of the program to deal with relapse. Drug addiction is a problem that is often defined by the tendency to relapse. However the response of Mikes program was to kick him out. That is despite the fact that if allowed back into the program his prognosis would have been good.

The author is an admirer of the Drug Court system. The reason for his admiration is that the Drug Court is better able to make the diverse and not well functioning elements of the treatment system accountable. Thus they use relapses to build the drug addicts skills in dealing with their addiction so that they are more likely to stay clean. They can also ensure that rehab placements accept people, provide them with appropriate care and they can also direct addicts to detoxification.

The book is not only an interesting discussion of the issues the author is able to interest the reader in the story of the addicts he studies. One can see them as humans and follow their struggle to get on top of their problems and to live lives as valuable citizens. A book which should be a must read for anyone with an interest in the area.

How Addicts and Alcoholics Need To Be Treated
Mr. Shavelson showed compassion to these four addicts and one alcoholic he followed for a few years. They led lives that most people can't understand. As a recovering alcoholic of 15 years I believe Mr. Shavelson is right on the mark. We need an overhaul of the system. Quit shaming the addicts and alcoholics. We are filled with shame. Having PTSD I can tell you that humilating people will make them drink and drug, not ponder why they engage in their behavior. It's not coddling to show loving kindness. It's humane. They need people to show they care since they have had little love in their lives. It takes time before they will let people into their lives and trust people. Trust needs to be earned. Addicts and alcoholics just don't want to be hurt more. Also, mental health and rehab counselors need to work together instead of shuffling them back and forth with "You need to quit drinking and/or drugging before we can help you" from the mental health counselors and the rehab counselors telling them "You need to seek help for your mental illness before we can help you". What a Catch 22! Throwing people out for a slip (relaspe) is insane. If they could just stop drugging and drinking they wouldn't need help. Just saying no to drugs and alcohol just doesn't work. You have to work on your issues and it is a slow and painful progress. It taken me 2 and a half years before I quit drinking for good and it's still a 'one day at a time' program for me. This is a life or death disease. Throwing people on the street after 90 days treatment is a waste of time, effort and money. Anyone who knows an addict or alcoholic or is one should read this book. That is just about everyone. Thank you Lonny Shavelson for writing such a important book. I recommend this book even if you don't think you know such people. It's a better read than most fiction. As they say, truth is stranger than fiction. ... Read more

Book Description

Long a target of policymakers and reformers, the current American healthcare system is, in the words of Richard D. Lamm, "unsustainable, unaffordable, and inequitable, and needs to be substantially amended and revised." In this informed and erudite look at the current state of the American healthcare system, Lamm exposes the problems existing not only in policy and professional circles, but also in public attitudes and expectations. In so doing, Lamm provides a framework for reform, seeking to rebuild the "house of healthcare" that has fallen into disrepair. ... Read more

Reviews (8)

Ethics and Economics - an American Challenge
Lamm clearly shows that the US health care system puts priority higher on the ethics of personal medical practice than it does on the overall health of the US population. Our (US) system is provider driven, which results in defensive medicine and over treatments. "Long shot" medical practice costs us: 27 percent of costs are for the sickest 1 percent. US spends about 50 percent more per person than other developed countries spend. Why? Says Lamm: "We fund too much marginal medicine and fail to fund enough basic health care. We spend too much on high technology medicine and not enough on prevention." This amounts to spending the budget to save a few trees while the forest gets weak and sick.

The need exists to set limits on treatments, so that more people are more healthy and costs can be maintained, as European countries have done. This book does not claim to have all of the answers, but does challenge Americans to begin an honest debate of ethics vs costs.

We should listen to his challenge. Buy this book now, before your medical costs get too high for you to afford it.

Endorsement for: THE BRAVE NEW WORLD OF HEALTH CARE
What health care nightmare has your name on it? The United States is $7 trillion in debt. Consumer debt exceeds $2 trillion. The average American credit card carries an $8,000.00 balance. As baby boomers eat and age their way into a health care pile up in the next 10 years, our health care industry recoils against horrific odds in providing for millions of Americans. Not withstanding, millions of legal and illegal immigrants have not and did not pay into a system they use today. Millions of uninsured Americans suffer.

Governor Lamm, once again, identifies what is happening across the United States. He offers solutions that, if ignored, all Americans stand to suffer in the long term.

Darwinism in action
I give Governor Lamm two stars for trying to devise a solution to one of the most difficult public policy issues of our time. But his solution is horrific.

He advocates a health care rationing plan in which, in effect, those who are sickest will be jettisoned in favor of those who are somewhat sick or not sick at all. It's not just social Darwinism, which deems poverty to be proof that those who are poor are inherently defective, that is, unfit to survive and therefore beyond help. This is Darwnism at its purest: the unhealthy are by definition unworthy of society's limited resources. Call it the life-raft approach. "Let's throw off the raft those we deem less likely to survive in order to improve the chances of those we believe more likely to survive." As Scrooge might put it, those who are in danger of dying "had better do it, and decrease the surplus population."

It's not unlike the day when lepers were segregated into colonies. Merely a short step away is killing the unhealthy to prevent them from consuming any more of our limited health care dollars. Unthinkable? Germans didn't think that making Jews wear yellow stars would lead to their deliberate slaughter. Many people don't know that Hitler deemed the disabled as unfit for German society as Jews and slaughtered millions of disabled people as well.

As you might imagine, I fall among the disabled. Through no fault of mine, multiple sclerosis has ravaged my middle-aged body. And it chills me to think that, under Lamm's "divert resources toward the fit" rationing, a healthy young serial murderer would get a liver transplant before I would. Moreover, researchers would have no incentive to find ways to reverse existing damage; when resources are explicitly diverted toward preserving health and preventing illness, doctors would be idiots to work toward treatments that fall far down on the list of health care priorities.

Lamm correctly points out that we implicitly ration health care today. Those with insurance get more care than those without. But at least those without insurance can hope to get it someday. Nothing in the world will make a disabled person fit to compete against the young and healthy for health care.

Lamm has framed the problem well. We do need an explicit method of rationing health care. But we need a lot more debate on the ethics of such a plan before we deem one segment of society irredeemably beyond its pale.

Political science & public policy blend in serious discourse
Political science and public policy blend in a serious discourse by former Colorado Governor Richard Lamm, who takes a fresh look at the current state of the American health care system in Brave New World Of Health Care. Problems in policy, professional circle, and in public attitudes and expectations alike are deftly surveyed in an engagingly thoughtful discussion of how reforms and changes may be enacted.

Health Care Financing
Anybody that is concerned about the rising costs of health care in America should read this book. As a physician, I am disappointed at the lack of leadership in medicine as well as among the politicians.
We are sending the current bills for health care to our children. Gov Lamm's book provides great insight into the fiscal problems we are facing and provides some good suggestions on how we might go about addressing the problem. ... Read more

Book Description

This book takes the conversation between bioethics and health policy to a new level.Moving beyond principles and normative frameworks, bioethicists writing in the volume consider the actual policy problems faced by health care systems, while policy-makers reflect on the moral values inherent in both the process and content of health policy. The result is a vigorous dialogue with some of the nation's leading experts at the interface of ethics and health policy.the book provides a history of the values implicit in U.S. health policy, a discussion of the federal and state roles in policy making, an ethical examination of the social goals expressed through various policies, an analysis of the role of public opinion in the creation of health policy, and an exploration of the value of the private sector in health policy.In addition, the authors examine some of the major ethical controversies in health policy, such as the challenge of balancing ethical concerns with economic realities, the need to allocate scarce health resources, the call for heightened accountability, and the impact of various policies on vulnerable populations. The book concludes with an examination of the ethical issues in health services research, including the threats to privacy that arise in such research.To a greater extent than any previous volume, it establishes a strong connection between the disciplines of medical ethics and health policy. ... Read more

Book Description

Keeping in step with the ever expanding global economy, health care providers and pharmaceutical companies are establishing themselves in foreign health markets at an unprecedented rate. The question is, How can these organizations prepare themselves for the challenges and opportunities they will find in today's worldwide health care marketplace? Written by an international panel of highly acclaimed health care experts, Global Health Care Markets is a comprehensive guide to the current state of health care delivery systems worldwide. This much-needed resource profiles the world's most significant regions and markets, analyzes the important trends in international medicine and technology, and provides helpful projections of the opportunities for providers, vendors, agencies, and governments.

... Read more

Book Description

Why, alone among industrial democracies, does the United States not have national health insurance? While many books have addressed this question, Dead on Arrival is the first to do so based on original archival research for the full sweep of the twentieth century. Drawing on a wide range of political, reform, business, and labor records, Colin Gordon traces a complex and interwoven story of political failure and private response. He examines, in turn, the emergence of private, work-based benefits; the uniquely American pursuit of "social insurance"; the influence of race and gender on the health care debate; and the ongoing confrontation between reformers and powerful economic and health interests.

Dead on Arrival stands alone in accounting for the failure of national or universal health policy from the early twentieth century to the present. As importantly, it also suggests how various interests (doctors, hospitals, patients, workers, employers, labor unions, medical reformers, and political parties) confronted the question of health care--as a private responsibility, as a job-based benefit, as a political obligation, and as a fundamental right.

Using health care as a window onto the logic of American politics and American social provision, Gordon both deepens and informs the contemporary debate. Fluidly written and deftly argued, Dead on Arrival is thus not only a compelling history of the health care quandary but a fascinating exploration of the country's political economy and political culture through "the American century," of the role of private interests and private benefits in the shaping of social policy, and, ultimately, of the ways the American welfare state empowers but also imprisons its citizens.

... Read more

Reviews (1)

Your Money and Your Life
American politicians like to pride themselves on their pragmatism: Colin Gordon provides the valuable tale of how "pragmatism" got the United States Health Care system into an ungodly mess. By 1990 the United States spent 13% of its GNP on health care, while no other OECD country spent more than 9%. And yet at any given time at least 15% of Americans lack proper health insurance, while much of the insured's coverage is spotty and sacrificed to insurer profits. The generous system of remuneration practically breeds health care inflation. As one public relations consultant warned medical conservatives in 1961, the United States was the only major country not to have some form of national health insurance. He pointed out that if such a system was the high cost, low quality mess the AMA claimed it was, why hadn't conservatives in the 59 countries that had adapted successfully convinced people to change their minds and adapt the American system? A good question, but the AMA, the insurers, the hospitals and major employers have been alarmingly successful at keeping common sense at bay. Why is this the case?

Colin Gordon notes contrasting explanations such as American ideological opposition to government assistance, the institutional weaknesses of governmental welfare structures, and the power of anti-welfare capital. He points out the weakness of the first argument: national health insurance has always been popular in opinion polls. And the American government has improved its bureaucratic capacity over the years. The real problem is that, thanks to the nature of American politics and past mistakes, the forces supporting national health insurance have been weakened and fragmented and have never been able to match the influence of the powerful health care lobbies. Gordon's book is very well researched. It relies on 74 sets of private papers and oral histories, including in-depth use of the Johnson and Nixon presidential libraries. He starts with an overview of the various attempts to achieve health insurance during the Progressive Era and the New Deal, and the thwarted attempts to achieve something under Truman, Johnson, Nixon and Clinton. He then discusses the way labor unions tried to create a private welfare state, and then discusses how reformers got themselves into endless muddles by trying to use the metaphors of contractual insurance. He then discusses the ideological themes of national health care insurance's opponents, then the way racism has hampered the health care debate. Finally he looks at the way the opponents of health care insurance successfully mobilized, while the health care reformers were always checkmated. The result is a fascinating portrait of selfishness. We see the AMA and its Republican allies successfully redbait national health care insurance as Communist, Nazi or even tied to the Kaiser. (One propagandist went so far as to argue the Holocaust wouldn't have happened if Bismarck hadn't socialized medicine.) We see British doctors, Canadian bankers and The Economist bemused at the AMA's distortion of British and Canadian medicine. (The AMA responded by preventing local medical societies from investigating British medicine for themselves). We see Republicans complaining that if the government could provide free health care, why not free toupees? Racism, sexism, misogyny all play their parts in the private health care's arguments. We see how they argue that they shouldn't have to pay the cost of keeping African-Americans well. Their illness and poverty are, of course, their own fault, not that of the doctors who refuse to treat them or the society that seeks to degrade them. We learn how health care, like welfare, is divided into "deserving" and "undeserving" citizens and services. We also learn how Johnson's officials faced the challenge of segregated and grossly unequal hospitals and promptly ran away.

More important, we also learn about the failed logic of reform. While there is an understandable constituency of doctors to make as much money as possible privately, there are understandably fewer doctors willing to do what is best for their patients. In other countries political parties and trade unions would take up the slack, but not in the United States. As Gordon points out political parties are notoriously difficult to influence in the public interest. Both parties prefer limited political mobilization, low voter turnout and interest-based organization, rather than make the sustained mobilization national health insurance would require. For the Democrats, reform was hampered until the sixties by the strength of their authoritarian and reactionary Southern base. After the sixties the party moved to the right and relentlessly tried to flatter business to support them. Gordon is particularly good about the failure of the Clinton Health Plan. For once, doctors, hospitals, insurers and employers had different interests. But instead of choosing one group, Clinton and his colleagues tried to soothe them all. They threw away their best asset, popular support for national health insurance and appeals on grounds of universality and equity, for a technocratic solution that could mobilize no-one. But it was not possible to satisfy everyone since their interests conflicted, and the attempt to do so either annoyed some groups or weakened their lukewarm support. Gordon goes on to discuss how unions, group health advocates, and people concerned about black health care could have hypothetically pushed for national health insurance. But unions were too weak to influence a Democratic party hampered by Jim Crow. In supporting their own private welfare state, they undercut support for universal health care, made further reform more difficult and ultimately put their trust in a system that would be ravaged by deindustrialization and deunionization. The same problem occurred with group health, maternal health and black health advocates, as they supported short-term measures that made fundamental reform impossible. If the story of liberal reform is one of compromise, Gordon tells the tale of how reformers compromised themselves to death. ... Read more

Book Description

McGuire and Anderson bring the findings of the behavioral biology of group cooperation to bear on the vexatious problem of healthcare reform. One of the few certainties that we have is that the approach of the last 50 years--arguments between advocates of government or private insurance--has led to intractable gridlock. It is thus necessary to ask whether the initial assumptions buried within this controversy might have fatal flaws. In the authors' views, they do. Our modern society would never tolerate funding of any other necessity or convenience by such clumsy methods. In short, McGuire and Anderson contend we must pay for healthcare the way we pay for food, housing, clothing, and transportation. ... Read more

Reviews (4)

awsome book
This book rocks! Everyone should read especially stupid politicians who let our health system be the way it is.Besides Mr. anderson is very smart- smartest guy i know anyway! :)

Very informative and beneficial to everyone
Should be on the Best seller lis

An authoritative and fierce assessment of our medical mess.
The authors are eminent and accomplished physicians associated with several of the outstanding medical institutions in the world. They focus their attention with a a kind of brutal humane sympathy on the manner in which our medical system has become entwined in games of technology rather than styles of care, in the organization of cashflow rather than the movements of patients to health. They show how easily third-party payments become a form of "big-brother is watching you" except that the brother is a miserably small-minded accountant or share analyst. This is at once a heart-breaking book because of the awful reality it so fairly documents. But it is also reassuring that two skilled practitioners can so clearly and productively document what is happening in medicine, and also what can be done about it. It could well be required reading for medical students and hospital administrators - and patients with a sense of self-defence!

REALLY important new look at healthcare crisis
This book should be required reading for every member of congress - not to mention every Presidential candidate in both parties and the pundits who talk about their proposals. Most of us know that health insurance and managed care are a mess. Politicians inundate us with promises and pronouncements about funding medical care, but the current debate is based - as McGuire and Anderson clearly show -- on rhetoric and absurd assumptions. They wisely suggest we go back to the basics of human nature, and rethink the issue with an open mind. To begin with, they offer ten principles that are so obvious that everyone has forgotten them. For example, "A large proportion of healthcare costs occurs in the last year of life. That is how it should be. That is when we are sick." Self-evident when you think about it. But read McGuire and Anderson: it will change the way we think about the issue - and maybe get us out of the bind. A marvelous read, clearly written and thought provoking. I'll bet your doctor - if he's not the manager of an HMO - will like it. And that your insurance agent will be furious. What else would you expect from a book that quotes an honest HMO executive's comment that "profit is our goal and we will do what we need to do to generate it." ... Read more

Amazon.com

Any writer attempting to tackle the AIDS pandemic faces a demanding task. Now spanning decades and covering the globe, it has claimed a staggering number of lives (more than 40 million people are currently infected with HIV and 8,500 die of AIDS each day). That's more than most of us can grasp. The plague's heroes and villains aren't celebrated or demonized like those in a conventional war. For AIDS, there is no FDR or Hitler; there are just the victims of an inconceivable holocaust. Greg Behrman employs an almost cinematic perspective to address the catastrophe in his fast-moving history, cutting to new locations and characters to capture the epic nature of the global AIDS struggle. A vivid cast of characters populates these pages, ranging from U.S. presidents to activists, physicians, diplomats, and rock stars (U2's Bono emerges as one of the most pragmatic and effective combatants).What's heartbreaking is that, despite the best work of many (and, to a degree, because of the tepid or obstructive efforts of others), the disease remains a mighty foe. Both moral and moderate in tone, Behrman focuses on American anti-AIDS efforts, believing the United States' mighty wealth at the end of the 20th century and its own experiences with the epidemic gave it a unique capability and responsibility to lead the fight the fight in Africa and elswewhere. The American effort, he's forced to conclude, has been "inglorious." --Steven Stolder ... Read more

Reviews (1)

A fascinating, insightful read
Greg Behrman's Invisible People is a riveting, well-written account of how the AIDS epidemic has shaped the global landscape. Personally, I was astounded by the statistics in the preface --25 million dead, 40 million currently infected, 8,000 people dying of AIDS every day--and gripped by Behrman's description of the heroes and villians in our battle against one of the greatest killers the world has ever known. This is an important book. ... Read more

Book Description

An explanation of how thieves exploit the U.S. health system and steal more than $100 billion each year.Fraud and abuse bleeds more than 100 billion dollars each year out of the U.S. health system. This detailed examination shows the problem is worse than almost anyone knows, mostly invisible, and still far from controlled. Sparrow reveals that current control systems fail by presenting fraud perpetrators with a safe, easy-to-hit target: fully automated check-printing systems, which only require thieves to bill "correctly," regardless of whether or not any medical service is provided. This target attracts an extraordinary range of criminal entrepreneurs, from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, even major hospital chains. Sparrow's research examines the much-misunderstood effects of managed care on the problem, the government's recent attempts to grapple with fraud, and the campaign by various provider associations to undermine those efforts.TOC: PrefaceAcknowledgmentsIntroductionFictitious CompaniesThe State of the ArtControl FailuresTwo Distinct Sciences: Fraud Detection, and Utilization Review, How Goes the War?Counterattack, New Frontiers for ControlFalse ClaimsManaged CareThe Nature of the Fraud-Control ChallengeThe Pathology of Fraud ControlThe Importance of MeasurementAssessment of Existing Fraud-Control SystemsThe Antithesis of Modern Claims ProcessingPrescription for ProgressA Model Fraud-Control StrategyDetection SystemsConclusionAcronyms and AbbreviationsNotesIndexBIO: Malcolm K. Sparrow teaches Regulatory and Enforcement Strategy, and Analytic Methods, at Harvard's John F. Kennedy School of Government.Formerly a Detective Chief Inspector with the British police service, he now specializes in issues of enforcement strategy, regulatory compliance, and risk control--he is the acknowledged national expert on the subject of Health Care Fraud. He is author of The Risk Business: Defining the Regulatory Craft (2000), License to Steal: Why Fraud Plagues America's Health Care System (1996), Imposing Duties: Government's Changing Approach to Compliance (1994); and co-author of Beyond 911: A New Era for Policing (1990) and Ethics in Government: The Moral Challenge for Public Leadership (1990). ... Read more

Reviews (3)

No real point at all!
This book did not really need to be written. It is written by a fraud investigator and is about nothing but specific fraud in Medicare, but we already knew there was tremendous Fraud. If you didn't know that billions are stolen in every conceivable way you do now, and don't need to read the book.
Yes, the gov't sends out $250 billion each year for healthcare related goods and services while somewhere between 5-50% is pure fraud, but what do we do? If you want a Fraud investigators answer: simply improve the software to spot anomalous patterns like one patient with 20 primary care providers in one month. If you want to know one new thing that has not been suggested and tried a million times before you will not find it here.
Creative and brilliant ideas such as medical savings accounts where each American deposits his own tax dollars his own medical savings account and is thereby given the maximum incentive to spend wisely are not considered. What is considered exclusively is fine tuning the likes of which have been tried and tried for the last 45 years.

Finally, someone who "gets it"!!!
This is a remarkable book which opens the readers eyes to some of the "real" issues in the financial state of healthcare in the United States. It pulls together what the people in the trenches have struggled with for years ... and puts it into an easy to read text that you just CAN'T put down. This should be required text for anyone working in healthcare or anyone who receives care from the system.

Straight talk on fraud
Although he has a wealth of expertise and a scholar's background, Sparrow speaks in a narrative style about the sad state of health care fraud in America today. While some progress is being made, there remains a little depth and sophistication in the responses to the complex and clever fraud schemes out there. Regretably, the many policitcal and institutional barriers to mesuring and uncovering fraud continue to allow the system to be drained of precious dollars. While it takes a large investment to begin the fight on the level Sparrow advocates, the return is immeasurably greater. Not recommended for folks who don't need their blood pressure to rise. ... Read more

Book Description

Providing a comprehensive view of the health status and health care resources of the rural areas of the U.S., this well-organized and well-illustrated book updates Health Care in Rural America, published by the Office of Technology Assessment in 1990. ... Read more

Book Description

America may be one of the wealthiest countries in the world, but its citizens rank near the bottom in health status. Americans have lower life expectancy, more infant mortalities and higher adolescent death rates than most other advanced industrial nations--and even some developing countries. Though Americans are famous for tolerating great inequality in wealth, the gross inequities in the health system are less well recognized. In Healthy, Wealthy and Fair, a distinguished group of health policy experts chart the stark disparities in health and wealth in the United States. The authors explain how the inequities arise, why they persist, and what makes them worse. Growing income inequality, high poverty rates, and inadequate health care coverage: all three trends help account for the U.S.'s health troubles. The corrosive effects of market ideology and government stalemate, the contributors argue, have also proved a powerful obstacle to effective and more egalitarian solutions. A clarion call for a populist uprising to end the stalemate over health reform, Healthy, Wealthy, and Fair outlines concrete policy proposals for reform--tapping bold new ideas as well as incremental changes to existing programs. This important work will be indispensable to all those who care about our people's health, inequality, and American democracy. ... Read more

Book Description

Health Care Finance: Basic Tools for Nonfinancial Managers is a practical financial management text for those who need basic financial management knowledge and a better understanding of health care finance. Using actual examples from hospitals, long-term care facilities, and home health agencies, this text will enable you to read, analyze, understand, and use financial statements and budgets in today's health care environment. ... Read more

Book Description

Harm reduction programs accept the reality of drug use while attempting to reduce its harmful consequences to individuals and society. This term, coined about 15 years ago in the U.K., has become a policy paradigm increasingly explored throughout most of the industrialized world. An example of a harm reduction program is the widely accepted substitution of methadone for the more "harmful" heroin. Programs that divert drug-involved offenders into treatment are another example of the operationalization of harm reduction policies.

In these 10 original chapters, international contributors discuss the philosophical basis and history of harm reduction policies and examine their outcome. They also cover controversial topics related to harm reduction, especially conflicts between the public health system where most programs are located, and a worldwide criminal justice system that further marginalizes drug users. Included in this book are descriptions of programs in the United States, the United Kingdom, Canada, Brazil, the Netherlands, Switzerland, and Australia.

The editors provide the context with a substantive introductory chapter focusing on the nature of harm reduction. The first part contains five chapters presenting the American perspectives on harm reduction; Part II includes five chapters presenting international perspectives from countries with particularly innovative harm reduction programs and policies.