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This volume weighs the importance of Congress in the failure to enact health reform by examining more broadly how Congress shapes health policy. ... Read more

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Medicaid is the primary means for providing medical care to the nation's indigent and disabled populations. Daniels and his contributors examine the efforts of 16 states to reform their Medicaid programs through a system of "managed care"--programs that seek to control or manage the use by patients of physicians and other health care services. ... Read more

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In the decades since the Great Society, service sectors as diverse as public assistance, Medicaid, long-term care, and mental health have come to rely on case management to coordinate and rationalize service delivery. Created as a tool for integrating services on the level of the individual client, case management has evolved into a means of rationing resources and controlling costs. Thus a program that began as a service technique has helped to drive the most significant trends in American health care and social welfare, including the entrenchment of bureaucracy, the challenging of once dominant professions, and the rise of corporate control.

Managing to Care explains the historical development of case management strategies, assesses organizational and operational issues cross-cutting case management programs in different sectors, and critically examines the popularity of this technique as a dominant mode of service system reform. Dill identifies recurrent themes and tensions in the application of case management through case studies of long-term care, services for people with chronic mental illness, and the public welfare system. By analyzing case management in historical and critical perspectives, she opens to scrutiny aspects of its practice that have often been taken for granted, and identifies new possibilities for its application. ... Read more

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Bolivia has made significant progress in health status and equity in the last decade, due to the implementation of a series of health policies directed primarily at reducing maternal and infant mortality and controlling communicable diseases. These policies include the introduction of a focus on health outcomes in the context of decentralization, the implementation of a public health insurance, the strengthening of vertically-financed public health programs and to a lesser extent, an increase in the size of the sector’s workforce and greater participation of indigenous peoples.

Health Sector Reform in Bolivia analyzes these policies, draws lessons from their implementation, discusses remaining challenges and provides recommendations in the context of the country’s latest policy developments. Findings show that while coverage has increased in almost all municipalities, significant equity gaps remain between the rich and the poor, the urban and rural, and the indigenous and non-indigenous. The analysis suggests that three key issues need to be addressed: first, maintaining the focus on national priorities in the context of the new expanded maternal and child insurance; second, strengthening efforts to extend care to poor rural areas; and third, improving the effectiveness of the system in the context of the new management model. ... Read more

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In this book, Peter West examines the genesis of the reforms in the NHS, which introduced the internal market in health care, and the incentives created for the three major stakeholders, purchasing health authorities, NHS trusts and GP fundholders. Drawing on published research and the author's own experiences working for health authorities and trusts over the last five years, the book examines in detail the freedoms and powers created by Working for Patients and the types of behaviour likely to be stimulated by the introduction of market-style incentives. After an assessment of the position of each of the three stakeholders, the final chapter reviews the current working and future prospects for the internal market and the potential changes to it that will be introduced by developments in health care purchasing and provision. The book will be of interest to a wide range of students of health policy and health services management, as well as clinical and other staff in health service purchaser and provider roles.It is written for a non-specialist audience and while assuming some general familiarity with health services in the UK, it assumes no prior knowledge of health economics. ... Read more

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Health economist Roger Feldman argues that a radical shift in Medicare policy is not only possible but imperative. Under Feldman's medical indemnity proposal, Medicare would pay each patient a fixed amount of money, reserving larger subsidies for sicker people. Feldman argues that a radical shift in Medicare policy is not only possible but imperative. ... Read more

Customer Reviews (2)

A unique proposal calling for a revamp of the current medicare system
Does the answer to America's health care crisis lie in a budget for patients? "How to Fix Medicare: Let's Pay Patients, Not Physicians" is a unique proposal calling for a revamp of the current medicare system. The current system has physicians getting paid, no matter their charge - but Feldman proposes that giving each patient a fixed amount, more if they are in need of it, would encourage them to shop around and therefore encourage physicians to lower their own prices. Unusual but thought provoking food for thought, "How to Fix Medicare" is a good pick for any debating America's health care.

An interesting idea, but I remain unconvinced (maybe I just don't understand)
While I usually am quite enthusiastic about the books from AEI Press, I am not feeling very supportive of this book.Maybe I am misunderstanding the proposal.While I do agree with the author that the current Medicare system is awful for patients, doctors, and hospitals, I do not think the indemnities the author describes will provide the results Roger Feldman describes.

For example, lets say granny gets a check for $12,000 to take care of her hip operation (if that's the right price, I don't know).So, about this time her drug addicted grandson talks her out of the money or she decides to double her money at the casino before she pays the hospital.What if she decides to fix her hip with magic crystals?I suppose if only approved medical facilities can redeem these indemnities it might work.However, can you imagine the political football of allowing new kinds of "practitioners" in as a means of "lowering" health care costs?A significant chunk of our health insurance money goes to quack non-medical "medicine" already!

The money is gone, granny's hip is still bad, and now what?As a society, we have long ago decided we are not going to let her suffer and say, "Well, it's your fault so just take the misery."Unless we are going to change our culture and let people permanently suffer and die from their stupid choices, I am not sure such direct payments for medical care can work.

Nor do I like the idea that Medigap insurance has to go.Why shouldn't free people be free to make the financial arrangements they find best?If there are problems with the way the insurance is packaged or used, let's address them.But I am not sure that outright abolition of such insurance is the right way to go.

As I say, maybe I am getting this wrong.But this little book as I read it, did not win me over.

Reviewed by Craig Matteson, Ann Arbor, MI
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This book analyzes the federal health policies followed by Reagan, Bush, and Clinton and by the Democratic-controlled Congress. The book shows the connection between the crisis of health care and the correlation of class forces in America. He also explains and evaluates the health care reforms put forward by the Clinton administration, describing the political process and forces behind those reforms.

The book challenges the major positions held in the social and political sciences regarding the nature of power in western capitalist developed countries and its impact on public policy. In great detail and with extensive documentation, the text shows how the welfare state continues to be extremely popular, that the causes of our economic predicament cannot be attributed to the welfare state and that class, continues to have an undiminished relevance in explaining public policies in general and health policies in particular. ... Read more

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Public silence in policymaking can be deafening. When advocates for a disadvantaged group decline to speak up, not only are their concerns not recorded or acted upon, but also the collective strength of the unspoken argument is lessened - a situation that undermines the workings of deliberative democracy by reflecting only the concerns of the status quo. But why do so many advocates remain silent on key issues they care about and how does that silence contribute to narrowly defined policies? What can individuals and organizations do to amplify their privately expressed concerns for policy change? In "Healthy Voices, Unhealthy Silence", Colleen M. Grogan and Michael K. Gusmano address these questions through the lens of state-level health care advocacy for the poor. They examine how representatives for the poor participate in an advisory board process by tying together existing studies; extensive interviews with key players; and an in-depth, first-hand look at the Connecticut Medicaid advisory board's deliberations during the managed care debate.Drawing on the concepts of deliberative democracy, agenda setting, and nonprofit advocacy, Grogan and Gusmano reveal the reasons behind advocates' often unexpected silence on major issues, assess how capable nonprofits are at affecting policy debates, and provide prescriptive advice for creating a participatory process that adequately addresses the health care concerns of the poor and dispossessed. Though exploring specifically state-level health care advocacy for the poor, the lessons Grogan and Gusmano offer here are transferable across issue areas and levels of government. Public policy scholars, advocacy organizations, government workers, and students of government administration will be well-served by this significant study. ... Read more

Customer Reviews (1)

A serious-minded scrutiny of state-level health care advocacy for the poor
Colleen M. Grogan (Associate Professor in the School of Social Service Administration at the University of Chicago) and Michael K. Gusmano (Assistant Professor of Health Policy and Management, Mailman School of Public Health, Columbia University) Healthy Voices, Unhealthy Silence: Advocacy and Health Policy for the Poor is a serious-minded scrutiny of state-level health care advocacy for the poor, particularly with regard to Medicaid, and how public silence can have a devastating effect. When advocates for a disadvantaged or a disempowered group do not speak out, the weight of their argument is lessened, and the consensus of the more powerful interests gains ground, a process that is ultimately harmful to deliberative democracy itself. Examining the principles of deliberative democracy, agenda setting, and nonprofit advocacy, Healthy Voices, Unhealthy Silence reveal instances where the silence threatens to become deafening, offers advice to restore balance to the participatory process, examines how capable nonprofit organizations are at influencing policy debate, and much more. Highly recommended. ... Read more

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The welfare state has come under increasing pressure. This raises numerous questions with regard to how to reform it. At an international conference held in Prague, the Czech Republic, a group of experts discussed some important reform issues. Their analyses and proposals are presented in this volume which deals with the following questions: What types of welfare states are there? To what extent does moral hazard limit the provision of social insurance? What are the pros and cons of a negative income tax? What are the characteristics of the "Swedish Model" of a welfare state? Is this model dead? What are the objectives of the welfare state in Germany? Why and how should a pay-as-you-go old-age pension system be transformed in to a capital reserve system? What trends in reforming health care systems can be observed? ... Read more

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Unhealthy Housing presents an analysis of the research into the health implications of housing and the significance for legal regulation of housing conditions. Key experts present short papers, together with an overview to give an evaluation of the significance of housing on the health of occupiers. ... Read more

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Many commissions have been formed to recommend changes in the health care system, and many reports and recommendations have been issued, but with little impact. This study seeks to understand the sources of this resistance to change and recommends measures based on this analysis. Contents: The Structure of Medical Care in Israel; The Ministry of Health; The KHC and the Histadrut; Structural Causes of the Crisis in the KHC; The History of Reform Efforts in the KHC; Reducing Surgical Queues; A Case Study; Alternatives to Public Medicine: The Private Sector; Conclusions and Recommendations. Co-published with the Jerusalem Center for Public Affairs. ... Read more

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• How does residential care in England compare with that of other European countries?
• What is social pedagogy, and how does it help those working with children in care?
• How can child care policy and practice be improved throughout the United Kingdom?

Working with Children in Care is key reading for students, academics and professionals in health, education and social care who work with children in residential care. ... Read more

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This is a commentary on the first years of NHS reform, from a health insider with a patient's perspective. John Spiers addresses the key issues of social consent, patient power and the challenges of determining what is clincally effective. He offers discomforting and constructive perspectives for managing change. He argues for both policy and practice to be science-based, open, cost-effective and based on standards set in close consultation with patients. Power, he asserts, must be passed to the consumer wherever possible. This work proposes further ways in which this can be achieved, especially by giving patients influence on how much money is spent. Spiers' concepts of "the invisible hospital" - which patients experience but managers often do not see - and the "secret garden" - the mystique of medicine which limits necessary change - develope the debate on fundamental cultural issues. ... Read more

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The escalating cost of medical advances and new methods of delivering acute care services is forcing most developed countries to use hospital beds more effectively and to reduce the number of sites. This practical book draws on previous experience to show how rationalization can be achieved with a minimum of disruption and without a reduction in service. It provides managers and planners with a framework within which to implement change, either themselves or by employing outside consultants. The financial implications of the process are considered at every stage. ... Read more

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England and France have contrasting systems in community care for elderly persons as in other areas of social policy. The aims of this book are: the comparison of community care service and financing systems; the comparison of reform arguments and history over the last decade; the comparison of who uses how much of what services; and with what impact on their needs and the probability of having to enter institutions for long-term care. The book compares systems and describes contemporary reform arguments and proposals. It presents evidence from a collection and analysis of quantitative data, made for the comparison of the two countries, and based on matched area samples collecting comparable information about cohorts of new users on two or more occasions. The book also shows how the need related circumstances of users differ between countries and within each country between areas. The book also shows how and why the French care benefits for community care have more effect on the central policy goals of community care policy than its British equivalent, and how the French services have smaller effects on this outcome than the British equivalents. ... Read more

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Best Care Anywhere, 2nd Edition demonstrates how an ongoing quality revolution in the nation’s veterans hospitals provides deep lessons for reforming the U.S. health care system as a whole. The new edition is particularly timely with the winding down of the national debate over health care insurance reform, which will necessarily shift focus of reform to the practice of medicine itself.The VA, by making extensive use of electronic medical records and evidence-based medicine, has developed a model of 21st century health care that boosts safety, cost effectiveness, and patient satisfaction.And in so doing, it has proven that most of we think we know about health care is just wrong.

New to this edition:
• Discussion of vast changes in health care politics since 2007, and how the VA model of care fits in.
• New insights on how the VA model will shape 21st century health care.
• How Bush administration policies undermined many successful aspects of VA health care, and how the Obama administration is beginning to put matter right for our wounded warriors.
• Updated coverage of federal information technology initiatives in health care, and the lessons provided by the VA’s “open source” software development.
*New information on the continuing consequences of exposure to Agent Orange, and its deeper implications for rethinking who should have access to VA care.
*A proposal for rolling out a new civilian version of the VA that now has gained political viability in light of the overall failure of other approaches to health care reform. A civilian VA is a true “public option” in health care for which Progressives and other Americans must rally.

About the Author

Phillip Longman, a senior fellow at the New America Foundation, is the author of numerous articles and books on health care, demographics, and public policy. His most recent book, The Next Progressive Era, was published by PoliPointPress in April 2009. He is also the author of The Empty Cradle, published by Basic Books in March 2004. The book examines how the rapid yet uneven fall in birth rates around the globe is affecting the evolution of culture and politics.

Mr. Longman is also the author of Born to Pay: The New Politics of Aging in America (1987) and The Return of Thrift: How the Collapse of the Middle Class Welfare State Will Reawaken Values in America (1996). Mr. Longman’s work has appeared in the Atlantic, the Financial Times, Foreign Affairs, Foreign Policy, the Harvard Business Review, the New Republic, the New York Times Magazine, the Wall Street Journal, Washington Monthly, the Washington Post, and the Wilson Quarterly.

He is a frequent public speaker, including addresses to the National War College, the Department of Health and Human Services, PopTech, and Fortune Magazine’s annual “Brainstorm” conference. He is also frequently interviewed by both foreign and domestic media, including National Public Radio, MSNBC, the BBC, the Canadian Broadcasting Corporation, Der Spiegel, and many others. Formerly a senior writer and deputy assistant managing editor at U.S. News & World Report, he has won numerous awards for his business and financial writing, including UCLA’s Gerald Loeb Award and the top prize for investigative journalism from Investigative Reporters and Editors. ... Read more

Customer Reviews (2)

LJS
Good value/service/speedy delivery--recommend to all VA, other medical center employees, veterans, and others interested in US health care

Delivers on its central premise and way more
Best care anywhere? The VA? You better believe it.

The second edition of "Best Care Anywhere: Why VA Health Care I Better Than Yours" just hit the bookstore shelves and I just lapped it up. I was offered the first edition of this book back in 2007 when I was new to working in health care and so very uninformed about it. This book really swept away the cobwebs in my mind in that I had no concept that the incentives imbedded in our system of medical care delivery did not always encourage the *best* care. It, in fact, encourages *more* care which as we know from decades of work in comparing medical effectiveness (see Dartmouth Atlas of Health Care) actually suggests a negative correlation to outcomes.

In that way, this book very much undersells itself - it's about way more than just the VHA. It does what it sets out to do by spelling out what researchers have found which is that in a broad range of metrics, the care provided our veterans in the Veterans Health Administration is the best care available in America today. It's also telling that this second edition is made available some 3+ years after the original and the data still hold true.

What is this data, you might ask:

* New England Medical Journal noted that the VHA was "significantly better" in all measures connected with fee-for-service Medicare
* Annals of Internal Medicine reported that the VHA was the best in all seven measures of quality in comparison to its private industry counterparts
* RAND study concludes that the VHA outperforms all other sectors of American health care in 294 measures of quality
* National Quality Research Center in Michigan found that the VHA had the highest patient satisfaction of any public or private sector health care system
* Journal of the AMA wrote in 2005 that the VHA "quickly emerged as a bright start of patient safety"

That's not even the whole list. And, by the way, they do it at a per-member cost that is 8% less than private sector counterparts. More value at lest cost. I thought that was only supposed to be possible in the private sector.

Well, as it turns out, another thing the author succinctly points out is medical care does not behave like other markets. The author refers to this phenomenon as Roemer's Law. Put succinctly: in typical markets, increased supply leads to lower prices, in medical care more supply just results in more utilization and higher costs. See, all this stuff in a very small package - and extremely quick read - and you have the makings of a classic. And it is.
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Product Description
Most Latin American countries are now attempting the radical reform of their healthcare financing and delivery systems. In many cases, these reforms complement and contribute to broader neo-liberal orthodoxies of economic and social reform. Key strategies include decentralising hospital administration and the promotion of private health insurance. However, experiences across the region are quite diverse, and countries such as Cuba persist with a system of healthcare based on very different principles.

This book identifies key problems facing healthcare systems in the region and evaluates the reforms that have been implemented to date. It pays particular attention to problems of implementation and the impact that changes to health policy are having on poor and vulnerable groups. ... Read more

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Proposals to reform the health care system typically focus on either increasing private insurance or expanding government-sponsored plans. Guaranteeing that everyone is insured, however, does not create a system with the quality of care patients want, the flexibility clinicians need, and the internal dynamics to continually improve the value of health care.

In Total Cure, Hal Luft presents a comprehensive new proposal, SecureChoice, which does all that while providing affordable health insurance for every American. SecureChoice is a plan that restructures payment for medical care, harnessing the flexibility and responsiveness of the market by aligning the incentives of clinicians, hospitals, and insurers with those of the patient. It uses the accountability of government to ensure transparency, competition, and equity.

SecureChoice has two major components. A universal pool covers the major risks of hospitalization and chronic illness, which account for almost two-thirds of all costs. Everyone would be in the pool, irrespective of employment, income, or health status. The second component emphasizes choice, flexibility, and responsibility. People will be able to choose any physician to serve as their “medical home,” to keep track of their health records, provide much of their care, and suggest referrals. Clinicians will have the information and incentives to continually enhance quality. SecureChoice also facilitates improvements in areas ranging from malpractice to pharmaceuticals and establishes new roles for key stakeholders such as health insurers.

Customer Reviews (3)

To change the health care system, combine the collective action potential of government with...
"Total Cure" is on the ROROTOKO list of cutting-edge intellectual nonfiction. Professor Luft's book interview ran here as a cover feature on January 6, 2009.

The Remedy!
You don't know health care policy reform until you know Luft!

ps - Thanks Beth!

Amazingly careful and complex view
Not for the basic consumer public - it is complex - as is the problem and solutions. This book clearly moves the dabate of health care coverage into a new realm.Not just tinkering around the edges - but a clearer view of how to move health care coverage and quality into the 20th century - where it has not been. ... Read more

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Discusses the necessity and urgency of Medicare reform, offering differing solutions to ensure the fairness and efficiency needed to preserve the program. DLC: Medicare. ... Read more

Customer Reviews (1)

We're In Trouble
Sometimes the worst problems are the ones that are just plain ignored. That is apparently the case with Medicare, possibly the least discussed, but largest crisis facing government today. In Medicare in the Twenty-first Century: Seeking Fair and Efficient Reform, a collection of authors ranging in profession from economic analysis to health insurance professors elaborate on differing solution to this troubled government program.

The compilation of essays begins with an introduction describing just how inefficient the government’s second largest entitlement program has become. According to government actuaries, Medicare’s ability to cover hospital funds will expire in 2015. This expiration has major implications considering that the program covers and estimated 39 million elderly and disabled persons, according to the book. Furthermore, as the baby boom generation ages into its retirement years the number receiving care will grow substantially and that is not taking into account the rising costs of health care. Judging by this information alone, it becomes apparent to the reader that something must be done. Yet what?

In the first essay, Joseph Antos and Linda Bilheimer outline the differing policy changes that could be possible solutions or at least the very least corrections to the program as it works presently. To correct the problem, they explain, either requires reducing the costs or improving efficiency. Efficiency is achieved when the marginal cost of producing an additional unit of care is equal to the additional unit of care that the patient receives. They then group the solution into three categories; ones that reduce costs without improving efficiency, ones that reduce costs and improve efficiency, and ones that simply restructure the way Medicare is financed. After describing all these policy changes the authors note a pathetic truth. None of the policy changes they outlined have even been looked at by congress â€" even after, congress passed the Balanced Budget Act of 1997, which was intended to address this exact point. By the end of the second chapter it becomes frightening clear to the reader, if it had not already, how bad Medicare is functioning.

The remainder of the essays expand on the ideas put forth by Antos and Bilheimer, but also go further in asserting the idea of fairness. By fairness the authors’ mean the disparities between the rates of return for high-income individuals compared to those with lower incomes. Due to their higher tax rates, the richer see a lesser return in health care from the government. Mark Pauly, a professor in health care systems, says this problem is due to the politics of Medicare. If a courageous politician took a stance and said that those who paid more should receive better benefits, then he or she is vilified as being indifferent to the plight of the needy. Conversely, if a politician declared that the wealthier members of society should pay more money for the care of others, then he or she loses support from those higher income earners.

Medicare in the Twenty-first Century: Seeking Fair and Efficient Reform takes a critical, unbiased look at the situation Medicare is faced with today. The authors seek innovative policy changes to the second largest government entitlement program. But after reading the collection of essays and the mountain of difficulties their policies would have to surpass to be implemented, it seems Medicare is not likely to escape from its current crisis situation. ... Read more