REVIEWED BY JOHN T. SHEA, STD
Thomas P. Weil
University of Michigan Press, Ann Arbor, 2001, 344 pp., $50.
This book contains a wealth of knowledge and great insight into
the past, present, and future of our health care delivery system. The question
concerning health networks posed by the author in his title — can they be the
solution? — is an especially interesting question in view of the fact that, as
early as 1929, a group called the Committee on the Cost of Medical Care was
formed to study the economic and social aspects of the delivery of health services
in the United States. This committee recommended that such services be organized
on a regional basis, with appropriate coordination of primary, secondary, and
tertiary services. Ever since then, we seem to have been trying to put old wine
in new skins, with only limited success to date.
Throughout the book, the author has a constant theme. If health
networks are organized and managed appropriately for the best interest of the
community, he argues, they will provide greater access, improve quality of care,
reduce cost, and enhance social equity. He cautions, however, that given the
size, scope of services, and market clout of some regional networks, they could
become fiscally and politically powerful oligopolies and could use that power
simply to enhance financial position.
This is where health care leaders and their trustees need to
be mindful of the purpose of their organizations and faithful to that purpose.
Weil addresses these issues in a chapter on leadership that would serve as a
good resource for leadership search committees.
Any book that discusses health networks must include the requisite
comparison of the U.S. health system with those of other nations. In making
these comparisons, Weil focuses on the Canadian and German health care systems.
He concludes that Americans' values and cultural heritage cause us to be wedded
to a multipayer, pluralistic system of organizing, managing, and funding health
care. Therefore, we will not see any meaningful attempt to create universal
health care in the foreseeable future. We can expect more of the same three-tiered
system: fee-for-service care for the wealthy, HMOs for the middle class, and
continued access problems for the poor.
The book has much to offer. I enjoyed the historical context
set by the author, as well as his knowledge of the various ways the economy,
coupled with cultural norms, is likely to enhance or impede the development
of health policy.
John T. Shea
Senior Vice President, Business Development
Bon Secours Health System
Marriotsville, MD