Comparative Health Policy - Book Review

　Comparative Health Policy - Robert H. Black and Viola Burau 　　ISBN 0-333-98599-0　　(Palgrave Macmillan) 　

　現在のコースにおける推薦図書のひとつ。 　
　世界の医療政策に関する比較を、政治的・歴史的・文化的背景に基づいて分析したり、予算配分や責任の所在、Human Resource、医療専門職への対応、公衆衛生に対する姿勢、などの多くの視点から分析をしています。　統計学的データは主にOECDから持ってきてありました。 　

　学生を対象に書かれており、内容もJournalに投稿されているような難しい書かれ方ではないので、比較的読みやすかったです。 　
　「医療政策とかって、政治家と役人が考えたらいいんでないの？」　と思っているような医療従事者に対して、まさに自分たちの現場で起きていることが政策に直結しているのだと思わせてくれるような内容になっています。 　
　
　あえて弱点を指摘するなら、OECDからのデータを時々Modifyしてるところ。 　「IT発展や医療にかけるコストと医療の質は反映しない」ということを述べている箇所で、MRI保有台数のリストを載せていますが、（あえて？）日本のデータは載せてありません。
　日本は、MRI保有台数、平均寿命とも現時点で世界1ですから、筆者の言わんとしていることに相反するんですね。　 　だからといって、この本の有用性は変わらないです。
　医療政策の全体像をわかりやすく解説してありますし、臨床現場にいる医療従事者が自国の医療政策に目を向けるいいきっかけを作ってくれるんじゃないかと思います。 　

　このBook Reviewは、コースでの最初のAssignment(1000 words)でしたー。 　
　ちょっとmodifyして載せますー。 　文法間違いなどなど、お許しを―

＊Book Review (Assignment)

To understand overall idea of health care system and related policy among many countries could be a challenge for clinical professionals and under graduates and postgraduate students. The book named Comparative Healthcare Policy written by Robert H. Blank and Viola Burau published by Palgrave MacMillan, New York in 2004 (ISBN 0-333-98599-0) introduces cross-country comparison in health care issues and concerns with statistical data and practical examples. This is one of the recommended books for the students of Masters of Healthcare Management at Manchester Business School in 2007.

One of the authors, Dr. Robert H. Blank, the chair of public policy at Brunel University in London, has published many books related healthcare issues and policies. Ms. Viola Burau is another author, the associate professor of political science at University of Aarhus in Denmark, and interested in comparative analysis of health policy. Both of them have published health policy related academic articles. This book is written primarily for students; however, highly evaluated contents would be suitable for stakeholders who responsible for making healthcare policy. Worldwide healthcare systems are examined from various views such as background context, financing and resourcing, and medical professionals’ standpoints. In this review, firstly the strength points will be indicated and these strength points will be examined. To follow the discussion about strength, the weakness of the discussion in this book will be described and an analysis of the weakness will be explained. Finally, conclusion will be given in the end of this book review.

　There would be two strength points in this book to understand the worldwide health care policy. One of the strength points could be wide range of aspects to analyse worldwide health care systems. The authors analyse the health policy in each countries from the government side to the position of medical professionals and home care which ‘is a complex policy field’ (P 167). While most of developed countries have been facing many health care issues such as increasing health care expenditure, the problem solving approaches are different. By comparing historical and statistical data of countries, the authors successfully show that there is no perfect solution to sustain health care systems efficiently in each country. Moreover, several potential schemes to make future health care policies are suggested by introducing background context and financing and resourcing structures in health care system to existing problems. In addition to the analysis from decision makers’ view, medical professionals’ roles in health care policy are emphasised. It is suggested that the implication with appreciating the role of professionals is crucial when health policy is established. This result of analysis would encourage medical professionals who are tackling daily issues in practical setting to recognise how essential their behaviour towards making health policy.

Using a lot of examples of real practice in different countries would be the other strength point of this book. To describe with a combination of academic theories and practical examples has an advantage to make readers understand the idea of health policy. Additionally, comparing and comparison of practical examples in different countries are helpful not only to understand the specific aspect of topic in each chapter, but also to grasp overall idea of health care policy. This approach would be beneficial especially for students.

　On the other hand, one possible weak point in the book would be that the amount of patients’ opinions towards health care system is relatively small compared with the rest of the facts based on statistical data and academic research papers. Although there are tables which show the types and settings of health care services and the expenditure on medical services (pp 74-75) and description about health care choices in many countries, the facts related to the patients’ satisfaction about healthcare in different services are limited. The patients’ opinions such as satisfaction rate and their behaviour among each health care system would be helpful to expand the understanding of efficient health policy in different countries and cultures. Furthermore, explaining of the strategies to control the power of media which affects patients’ opinion could be more beneficial to recognise patients’ health care demands in each country.

In addition, some statistical data from Organisation for Economic Co-operation and Development is not up-to-dated. For example, table 4.1 on page 91 shows MRI units per million population in 1995; however the data of Japan in where the highest number of MRI is available is not listed in this table. If there is the data of Japan such as 35 in 2003 (ECD 2006), the conclusion of the authors that the measuring healthcare quality with technological developments such as MRI units’ availability is questionable would be difficult. Because, Japanese life expectancy also the highest in the world base on the WHO data (WHO 2006).

In conclusion, this book could be one of the good resources especially for students who would like to expand their health policy. Although some weak points such as relatively small amount of patients’ voice and non up-to-date resources could be suggested, these points would not significantly decrease the quality of this book. Most of contents are well analysed with wide range of aspects supported by large amounts of practical examples and academic data of different countries. Moreover, the reader of this book would be realised that these advantages would make them not only understand about what health policy is, but also have the new idea to solve existing healthcare issues in their own countries.

Bibliography

OECD (2006) [Online] OECD Health Data ‘OECD Health Data 2006 How Does Japan Compare’ available at: http://www.oecd.org/dataoecd/30/19/36959131.pdf [Accessed 9th October 2007]

WHO (2006) [Online] ‘Core Health Indicators’ Available at: http://www.who.int/whosis/database/country/compare.cfm?strISO3_select=JPN&strIndicator_select=HALE0Male,HALE0Female&language=english&order_by=FirstValue%20DESC [Accessed 11^th October 2007]