A Design for the Future of Health Care

K.V. Nagarajan is an associate professor in the School of Commerce and
Administration, Northern Health Human Resources Research Unit,
Laurentian University.

Health-care administrators around the world are looking for ways to cut
costs while maintaining quality. This timely book provides a blueprint
for accomplishing this goal.

The book comprises nine tightly written chapters. Following a critical
review of the health system in advanced countries, the author focuses on
various aspects of health care. Among the topics covered are primary
care, specialized care, integrated systems, physicians of the future,
measuring health outcomes, allowing for community participation in
decision making, and the role of information in health care.

A recurring theme is the need to shift the balance of power in favor of
consumers, the community, and the private sector. Citing Alberta’s
Regional Health Authority (RHA) model, the author would like to see a
regionalized model in which physicians are paid on a capitation basis
and health-care services are provided through contractual arrangements
with the private sector. Bryan’s proposed model does not take into
account a number of issues. For example, private-sector care does not
automatically translate into a low-cost/high-quality system.
Furthermore, regionalization is not suitable to small jurisdictions.

In the final analysis, Bryan believes that health is largely an
individual responsibility. In keeping with the age-old nostrum that an
ounce of prevention is worth a pound of cure, he urges everyone to
develop a personal health plan. While there is obvious value in such a
plan, it is inappropriate to attribute all health problems to individual
behavior. What about genetic diseases (cystic fibrosis), diseases caught
from tainted blood (HIV), iatrogenic diseases (Cushing’s syndrome),
illnesses and deaths due to unsafe working conditions (mining),
environmental pollution (Minamata), and chemical emissions from
factories (Bhopal)?

Its limitations notwithstanding, this book contains many valuable
insights that will prove useful to health-system managers and planners.