MICHAEL J. LONG. Health and Healthcare in the United States. Chicago IL: Health Administration Press. 1998. xi + 175 pp., 13 figs., 36 tbls., $38.00.
This book was written to introduce students in various programs, including nonprofessional programs, to the organization of health care and the components of health care services in the United States. The book consists of three sections: Chapters 1 and 2 differentiating health care and medical care, and describing public health; Chapters 3, 4, 5, and 6 describing the health care system related to acute care; and, Chapters 7, 8, 9,10, and 11 describing the continuing care system. The book ends with a discussion of an integrated care system.
In Chapter 1, the author differentiates between medical care and health care then discusses the impact of medical care on the health status of populations. The author also provides a diagram relating inputs to health and health status. A second diagram relates medical care and public health to an episode of care and the type of care provided. Although I found the description of the Inpatient Component confusing, the framework should help students differentiate between preventive, acute, and continuing care. Chapter 2 is a description of public health with good definitions of a public good, positive and negative externalities, the role of the Federal government in public health and the role of local health departments. I particularly liked these two chapters and would highly recommend them to both beginning students and practitioners.
The section on services related to acute care begins with a chapter describing how a person enters the medical care system and the corresponding treatment pathways which provides the foundation for subsequent chapters on ambulatory care, hospital care, and managed care. The chapter on managed care begins with a schema for differentiating managed care by unit of control and component of care then the major types of managed care are described. It is a good basic description of acute care and managed care understandable to entry-level health care professions students. However, acronyms are heavily used which may frustrate novice readers.
The section on continuing care begins with a short chapter describing the hierarchy of continuing care and its relationship to aging and the activities of daily living. Noninstitutionalized continuing care, institutionalized continuing care, hospice care, and continuing care retirement communities are described separately. Readers should gain a basic understanding of critical concepts in continuing care, including an understanding of the activities of daily living scale. I also liked the author's integration of social services into the discussion and the description of continuing care retirement communities.
The book ends with a discussion of an integrated health care system and whether such a system is possible in the United States. The author uses his experience in three health care systems, those of the United States, Canada, and the United Kingdom, and the relative emphasis on egalitarian versus libertarian values in each country as a basis for his discussion. He concludes that a singlepayor system is consistent with American libertarianism. The discussion is informative but I would have liked a comparison between the health care systems of Canada, the United States, and the United Kingdom. I find that most health care practitioners lack basic knowledge about differences in the systems.
Overall, I liked the book and I believe the author achieves his goal of writing an introductory text for a wide variety of students; it is easy to read and presents basic concepts. I will certainly use it, particularly the first two chapters, in my work with students.
[Author Affiliation]
Marion K Slack The University of Arizona
