Sunday 9 December 2007

Review of Comparative Health Policy


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

*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 11th October 2007]

The name is NICE!

While NHS serves healthcare in most of area in UK, there is an independent organisation named NICE to improve people's health and prevent illness. NICE establishes many practice guidelines related to public health, technology and treatment based on Evidence-based Medicine.

According to information from the website of NICE, these guidelines are categorised into 3 section; (Available at: http://www.nice.org.uk/aboutnice/about_nice.jsp)

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
For us, as Japanese physicians, 'The Guideline' shows how to diagnose and treat particular diseases and symptoms. However, contents in NICE are more than you imagine!

In addition, most of guidelines are revised and up-dated regularly. I would like to know how this system is organised and managed with skilled professional human resources and funding.

Administrators, Executives, and clinical professionals would not have to follow these guidelines exactly; however, budgeting is based on the outcome of Audit, thus their performance would follow the quality which NICE's guideline shows.

Furthermore, it could be important suggestion for us to learn how to implement guidelines into practice. There are skills sets on the web to support administrators to apply and implement guidelines into practice. They provide not only guideline itself, but also practical skills for clinical professionals to fill the gap in real clinical setting.

Also, an individual physician is not only person to take responsibility for clinical quality outcome and up-to-date their ability at clinical setting. Many professionals support quality control system and manage based on specific knowledge.

I think, a clinical quality is very depending on individual physician's attitude and moral in Japan. IN NHS, there are huge amount of examples and failure related to education, quality control and management of systems which we could learn and apply into our healthcare system.

*Japanese version: http://fp2hcm.blogspot.com/2007/11/nice.html