Journal of Health Politics, Policy and Law 25.1 (2000) 256-261
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Health, Health Care, and Health Economics:
Perspectives on Distribution
M. L. Barer, T. E. Getzen, and G. L. Stoddart, ed. Health, Health Care, and Health Economics: Perspectives on Distribution. Chichester: John Wiley and Sons, 1998. 551 pp. $110.00 cloth.
More than two hundred papers were presented at the inaugural conference of the International Health Economics Association in Vancouver in 1996. Nineteen of these, including the main plenary papers, have been edited and published in this volume. Along with a foreword by Joseph Newhouse, the editors and contributors include many of the best-known names in health economics. [End Page 256]
Producing a good volume of articles from the disparate offerings at a conference is never easy. Some editors are content simply to put the articles into some kind of order. A better strategy is to edit heavily, and to ask contributors to revise the material in the light of feedback from the meeting and upon sober reflection. To a large extent, these techniques have been used in this volume, and the articles included make a useful and interesting collection. The conference was successful, and made a good start to the new association. Some of the enthusiasm and spirit of the meeting comes through in these essays. The extent to which they reflect the theme of the conference varies, but, unusually for published conference papers, they include material that reports new ideas and findings, and most could be published in mainstream journals. The target audience varies somewhat, but the tone of most of the articles is light and the style readable.
Uwe Reinhardt may be the funniest health economist around, and much of his writing includes heavy doses of irony. In a long first chapter he explores the issue of equity and distribution, and the difficulties in fitting this into the frameworks typically used by health economists. He is critical of the application of conventional welfare economics in health care, and he provides a particular warning about the use of apparently value-free terminology (such as efficiency). To some extent, he sets up a straw man and knocks it down. I know of few serious health economists who interpret (or misinterpret) welfare economics in the slightly simplistic way implied by the author. All subjects have their own language, and their own special use of common words. Reinhardt's illustrations are drawn mainly from U.S. health care, although he contrasts the prevailing assumptions in America to that in other industrialized countries. Certainly the use of simplistic analysis in support of existing systems and interest groups has been more of a problem in the United States than in some other industrialized countries. At the end of this piece, Europeans will reach for their usual prejudice--learn from the United States by observing carefully and recommend doing the opposite. Those of us who have been used to living in health care systems that at least aspire to provide access to care according to need tend to find the American debates and disputes puzzling and a little sad. In this article the reader feels shouted at for the assumed narrowness of his or her understanding, and feels accused of naiveté. Even those who agree with the main thrust of Reinhardt's argument are not allowed to feel complacent. The thing that spoils this chapter is its tendency to sound like the introduction to Health Economics 101, especially in the [End Page 257] somewhat labored exercise in welfare economics. Like all polemic, it is fun but deep down a little unsatisfying.
Despite the inevitable dominance of North American and European topics at the conference, a wide range of articles explored issues from different settings, many of which are included in this volume. For example, David Mayston analyzes the patterns of disadvantage and health status among Australian aboriginal peoples. Relative (as well as absolute) disadvantage seems to be important--a result that is familiar in other countries. David Bishai looks at the effects of...