The Future of Health Policy.

• Author: McCready, Douglas J.

Fuchs enters into a discussion of a number of critical policy issues from U.S. governing bodies in this brilliantly-written treatise. There is absolutely no doubt in my mind that Fuchs has an understanding of the issues and the feasibility of dealing with them. Yet, he brings to the debate the inquiring mind and careful attention to detail that typifies good economics.

Besides being a book about health policy alternatives, Fuchs has made this book readily accessible to non-economists by exploring definitions about health and health economics. His discussion of poverty is excellent too. He moves from empirical studies to policy analysis. Here, he misses a chance to examine the influence the elderly have on health care costs and usage as it seems that as society ages this group will be increasingly responsible for additional costs. His chapters on reproduction and children add to understanding but a chapter on the elderly and alternatives for financing the care of the elderly would have added to the analysis immensely.

I was particularly impressed with the comparative data in Chapters 6 and 7. In these chapters, Fuchs determines that in the case of physician's services, fees in the U.S. are double those of Canada while incomes are only about a third higher and in the case of hospitals, the U.S. hospitals treat a more complex case mix and pay more in labor and other resource costs while Canadian hospitals have a lower impatient to outpatient ratio. There are some interesting comparisons hospital by hospital, attempting to find comparable case mix and size.

Of course, Fuchs has to conclude that one cannot say that one system is better than the other since there are still issues which need investigation - including the issue of quality. For instance, the percentage of general practitioner care in Canada amounts to about two-thirds, whereas in the U.S., about two-thirds of care is generated by specialists and internists - which has the higher quality outcome on any given procedure? These two chapters are extremely well-done and certainly provide information which is not generally available elsewhere.

I was also extremely impressed with Chapter 14, National Health Insurance Revisited in which Fuchs examines some of the factors which are holding back the U.S. policy from adopting a national health insurance scheme. Fuchs believes that conditions are still not ripe in the U.S. for a national health insurance scheme. The factors which Fuchs see as...