Health Care Policy, Performance and Finance Strategic Issues in Health Care Management

Article excerpt

HEALTH CARE POLICY, PERFORMANCE AND FINANCE STRATEGIC ISSUES IN HEALTH CARE MANAGEMENT Huw T. O. Davies and Manouche Tavakoli (Eds.) Burlington, VT: Ashgate, 2004, 291 pp., $39.00 (hardcover).

What are the current trends and ideas in the organization and delivery of health care that stimulate technological advances, leading to a more effective use of resources? This area of inquiry attracts many participants, and there is merit in providing a forum to share information and ideas.

This book is a product of The Fifth International Conference of Strategic Issues in Health Care Management (2002, University of St. Andrews). Twenty countries were represented at the conference and the 18 articles selected for inclusion were chosen from more than 100 presentations. The participants were economists and individuals interested in research and structure in organization management. The text, annotated with graphs and charts, is organized into four sections: Health Care Policy and Technology Assessment; Policy and Performance; International Policy Innovation; and Organizing Innovation. The editors, members of the faculty at the sponsoring University of Aberdeen, have written a preface that places the articles in a framework citing the contributions of individual chapter authors.

An indication of the relative importance of each section may be discerned from the number of pages per section as well as the number of articles included. section I (Healthcare Policy and Technology Assessment) is 43 pages and has 3 articles (chapters). Section II (Policy and Performance) is 95 pages and has 5 articles. section III (International Policy Innovation) is 87 pages and has 6 articles. section IV (Organizing Innovation) is 143 pages and has 3 articles. In length, Organizing Innovation is first, but in number of articles, International Policy Innovation is superior.

Section I (Healthcare Policy and Technology Assessment) is really the conceptual basis for the sections that follow, yet it is the briefest in ratio of articles to pages. In "Health Technology Assessment: More Questions Than Answers?" the authors undertake a thorough analysis of 64 health technology assessments (HTAs). The study focuses specifically on those HTAs developed by the British National Health Service Program in relation to clinical practice. The authors believe that the designs are often flawed, and there is a lack of emphasis on cost and clinical effectiveness. The article concludes with a recommendation for "more effective alignment of resources and incentives to those who innovate and evaluate in health care, rather than depend on the systematic review of weak primary evidence." In other words, this approach has not proved useful for the purpose intended, namely, providing guidance to policy makers and clinicians about cost-effective choices or better clinical outcomes.

The second chapter presents a case of local implementation of a health care intervention. "NICE Works: A case Study of the Local Implementation of NICE Guidelines." NICE is the acronym for National Institute of Clinical Excellence. The authors conclude that there is a lack of information on how local authorities should implement these strategies. Managers rather than clinicians generally take the lead in implementation. Costs also vary from the national estimate. It appears that more work and understanding are required for practical application.

The final chapter in this section is titled "The Effect of United Kingdom Neonatal Staffing Study Results on the Prior Views of Neonatal Doctors: A Bayesian Analysis." The study focuses on how an individual's quantified belief is modified with the introduction of new data. The more strongly a belief is previously held, the more convincing is the need to change to an opposite position. The issue at hand was the "optimal configuration of service for providing neonatal intensive care services." In other words, the consideration is smaller units versus larger facilities. …