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Doody's Review ServiceReviewer: Sylvia E. Furner, MPH, PhD (University of Illinois at Chicago)
Description: This is a critique/criticism of the British National Health System upon the occasion of the system's 60th anniversary. Much beyond simple criticism, however, the author provides compelling ideas for better health and healthcare delivery based on individual choice.
Purpose: The book is concerned with how best healthcare consumers in Britain can be in control of that care and how medical professionals can be enabled to deliver the best care possible. As the title suggests, the book focuses on who decides who decides and how consumer choice in healthcare decision making can be made real. Certainly, given growing evidence in many countries that substantial inequities exist in both health status and healthcare, the discussion in this book is of considerable importance. While the author states that the book is concerned with process, and hence there are no graphs or charts, some of the arguments would be better illustrated if data were provided. He makes a strong and important case for helping individuals make choices, based on the provision of information with which to make those choices. The author should have taken his own words at face value and supported more of his proposals with data.
Audience: In my view, this book is written, first and foremost, for policy makers. However, in the interest of one of the main points in the book, namely, consumer choice, healthcare consumers also would benefit greatly. The author has an extensive background in studying health policy and is a strong advocate for patient rights and an accessible healthcare system. This book demonstrates his vast knowledge of, and interest in, a healthcare system that optimizes consumer choice, enhances medical professionals' ability to deliver care, and insures fair and ethical treatment for all.
Features: In his extensive discussion of the benefits of moving Britain to a healthcare system based on consumer choice, the author provides for consideration policy recommendations, based on a thorough understanding of the shortcomings of the current National Health System (NHS). He also provides examples of where the NHS policies have led to less than optimal care. Most noteworthy is the chapter focused on cancer treatment and the policy that requires a person seeking to purchase care by private providers loses the benefits of NHS care. Further, there is an important discussion on the role that politicians and other policy makes have in both the current system and in the proposed consumer choice model. Although the author clearly articulates that the book is about process, and further explains that this is the rationale for the lack of data to support criticisms and proposals, some supporting data would have lent more credence to some of the points made.
Assessment: This book provides compelling information on the shortcomings of Britain's National Health System and will give those outside of Britain pause to consider whether this system is one that should be emulated. The arguments for a healthcare system based on consumer choice are solid, well articulated, and important. As Britain and many other developed countries face the growth of the older population, who will be high consumers of healthcare, the need to fix a "broken" system is critical. This book provides an important set of ideas and policies that have implications beyond the British healthcare system.