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Richard B. Saltman and Josep Figueras. European Health Care Reform: Analysis of Current Strategies. WHO Regional Publications, European Series no. 72. Copenhagen: World Health Organization, 1997. 308 pp. $45.00 paper.
European Health Care Reform is an ambitious book. Combining "epidemiological, economic, organizational, and managerial perspectives" (x), it seeks to summarize the experience with recent health care reforms across the European continent and to provide a foundation for health policy development. Rich in data, approaches, and theoretical frameworks, it draws on 41 background papers (with 69 contributors and 487 footnotes), including a wide range of theoretical works, empirical studies, and policy documents. It ambitiously attempts to provide descriptions, analyses, and theoretical frameworks as the basis for policy recommendations.
The study canvasses a wide range of topics, such as the significance of the scarcity of resources, the funding of health care, the goal of attaining efficiency in the allocation of resources, the organization and management of health care, and the implementation of reform. The authors attempt to weave these disparate threads together by invoking four "Integrating Reform Themes": the changing role of the state and the market, decentralization, patient choice and empowerment, and the evolving role of public health. The first two concern the changing role of the state in welfare and efforts to decentralize administrative and financial responsibilities from central governments to lower levels of administration. The third, consumer empowerment, involves European nations' attempts to broaden individual consumer choice of health provider, increase consumer representation in the policy process, and protect patients' rights through legislation. The fourth theme, the role of public health, entails the question of the boundary between health care and other goods and services.
The book is strongest when it is descriptive. For example, the chapter "The Pressures for Reform" describes the context of health reform: changing ideologies and cultural values in society, macroeconomic factors, demographic pressures, and changing patterns of illness and disease. Fiscal pressures have created pressure on public (health care) spending, while rising expectations, new technologies, and aging populations have increased demand for services. The chapter illustrates how patterns of health and sickness vary between East and West, men and women, as well as among other population groups, and points to some of the now well-known determinants of health and...