The Politics of Healthcare in Britain – By Stephen Harrison and Ruth McDonald
The Politics of Healthcare in Britain . London : Sage Publications . x + 206 pages. ISBN 9780761941590 , $99.95 cloth. ISBN 9780761941606 , $34.95 paper . and . 2008 .
Studies of health policy in one country generally travel poorly because they require more knowledge than most of us can muster of a nation's history and political culture as they explain the pathologies of that nation's policy experience. Harrison and McDonald's text, The Politics of Healthcare in Britain, is a worthy exception. Instead of burying us in details of obscure acts of Parliament and the complexities of public–private relations in Britain, they take the more helpful tack of offering us a variety of public policy frameworks with which to evaluate the British experience. The specialist will not be disappointed because the discussion of Britain's struggle to provide effective and efficient health services is quite penetrating. The nonspecialist seeking to reach even less informed undergraduates will be delighted by their very clear explanation and application to the British case of important and broadly useful public policy concepts.
Harrison and McDonald's outline of the key issues facing the National Health Service (NHS) in Britain is done in such a way that we are tutored in generic health care system problems as well as the particulars of the NHS experience. The range of issues is large including the techniques for rationing the use of health system resources in order to control costs, the growing struggle by physicians to maintain professional autonomy, the continuing search for the right organizational structures, and the elusive quest for meaningful public and patient participation. Although a bit less self-aware than some might wish, Harrison and McDonald describe the NHS's troubled journey from being the vanguard of the apparently advancing socialist army to being the test market for various rational choice schemes. Through it all we learn how difficult the underlying issues are to resolve.
The burden on health system policy makers is large. No matter the system's structure, free market or not, governmentally subsidized or not, health care consumes a significant and expanding share of society's resources. The political symbolism that can be attached to nearly any action is potentially overwhelming because heath systems offer access to vital, life-sustaining services to fearful, vulnerable people. The public's expectations about a system's potential for fairness, effectiveness, and responsiveness are likely to be both unrealistic and easily exploitable by political entrepreneurs. Harrison and McDonald show us the current limits of policy analysis in assisting officials searching for tolerable responses to the ceaseless demands for improved access, greater cost control, and enhanced quality that constitutes healthcare politics.
The authors, both affiliates of the National Primary Care R&D Center at the University of Manchester, have no policy solutions of their own to promote for the British health service. Instead their contribution is an accessible textbook that challenges specialists and students to improve the tools with which health policy makers in Britain and elsewhere have to work.
