Saving bodies and souls | |
European health care reform: analysis of current strategies. Richard B Saltman, Josep Figueras, editors. Copenhagen: WHO Regional Publication, European Series no 72, 1997 (xi + 308 pp.). ISBN: 92 890 1336 2. |
Health care, like
the finance and software sectors, is now a global endeavour. The internationalisation of new pharmaceutical products, clinical technology and surgical practices, to mention only three, is highlighted by rapid, sometimes virtually instantaneous, diffusion of information across countries. Some patients with the means to travel will be lured, by excellence or merely by reputation, to another country to access a specialist or centre of their choice. Telemedicine promises that diagnostic and other activities can be done remotely, including across national boundaries. But what about health policy and reform initiatives? Are these primarily domestic in nature, reflecting the history and idiosyncrasies of each particular country, or have these, too, become internationalised? If anyone had any lingering doubts, this book, commissioned by the World Health Organization (WHO) in Europe, will dispel them. It summarises the views of a range of leading scholars and practitioners in health policy, funding and management from Europe, Canada, the World Bank and WHO. The key message is convergence. Although there are many reform strategies available, and clear differences in the package of reform measures adopted within countries, there are common themes. There is a tendency towards market-oriented rather than centrally planned delivery, and a penchant for reorganisation, with a preference for decentralisation and privatisation. Empowerment of the patient, encouraging choice and informed consent, is emphasized, and finally, there is a predilection for a population approach, centred on the health sector's contribution to health gain. Many ideas about how to tackle resource scarcity and promote equity, efficiency and effectiveness are provided. The final chapters, on implementing reform, managing change and the way forward, are thoughtful. This book could be read by anyone wanting to broaden their appreciation of the international health policy scene, but perhaps most profitably by those with direct responsibility for policy development. Jeffrey Braithwaite
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