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Doody's Review ServiceReviewer: Eugene C. Rich, MD (Creighton University Medical Center)
Description: This work is a description of the defining forces and state of the U.S. healthcare system today and alternative directions for the coming decades. The author draws upon working with leaders in healthcare for twenty years as a futurist, strategist, and consultant.
Purpose: The author's stated purpose is to "provoke, enflame, excite, and insult the leaders in healthcare to stimulate them to try harder and build a better future."
Audience: The intended readers include health policy experts as well as administrators of hospitals, health plans, and group practices.
Features: The author first addresses the current values and the environmental factors that enhance the U.S. healthcare system. He then discusses the role of purchasers, the emerging importance of consumerism, the evolving role of health plans, and the special challenges facing providers. He concludes by reviewing four alternate futures for the U.S. healthcare system and offering a challenge to current healthcare leaders. Among the many positive features of the book are the author's cleverness and the readability. Many sprightly and incisive "sound bites" on U.S. healthcare are provided. Illustrative quotes and tables are scattered throughout the book. Despite the 2000 copyright date, a few facts are offered that are already outdated (e.g., discussion of the now defunct merger of UCSF and Stanford). These inaccuracies are minor and understandable, however, given the chaotic environment of the U.S. healthcare system at the close of the 20th century. Given the conversational and subtly anti-academic tone, it is not surprising that the work suffers somewhat from an absence of references and a limited index.
Assessment: The author succeeds in being simultaneously thoughtful, provocative, and entertaining while addressing the complex issues of the U.S. healthcare system. Although there are more authoritative and scholarly books on this topic, this one will be an enjoyable and worthwhile addition to the library of healthcare leaders and serious students of U.S. health policy.