Health Care USA: Understanding Its Organization and Delivery, ed 3. (Reviews).

Sultz HA, Young KM. Gaithersburg, MD 20878, Aspen Publishers Inc, 2001, paperback, 479 pp, illus, ISBN: 0-83421912-3, $52.

This book is designed to serve as an introductory text on the organization of health care for students and beginning practitioners of public health, medicine, nursing, dentistry, and allied health. The authors, who have backgrounds in academics and health care administration, use a straightforward, readable style, supplemented with appropriate charts and graphs, to convey their message. Their ambitious goals are to provide an overview of the fundamentals of health care delivery while exploring the interplay of economic, technological, political, and social forces that is creating dramatic changes within the industry.

Because of the expansive and complex structure of health care, the authors note they had to make difficult decisions about what to leave out of the book. Consequently, they acknowledge that nurses, dentists, pharmacists, physical therapists, occupational therapists, and others may be disappointed to find so little about their professions included in the book. Indeed, the authors write very little about physical therapy, and this alone may preclude it from being chosen as a text for a physical therapy program.

The authors state that the book reflects their own viewpoints, which are solidly from the "population" or public health perspective, rather than from an "individual" perspective. This may be the strongest point of the book. It is refreshing to read a text that so clearly spells out the strengths of the system while unabashedly pointing out the flaws. Although the authors identify the paradoxes and competing priorities that characterize modern health care, they often question the status quo. Rather than advocating a particular position, the authors stimulate the reader to think critically, to see "the big picture," and to seek solutions. Given the challenges the physical therapy profession has faced over the past few years, this strategy could serve us well, so for this reason I would consider this book as a text in a health care management course.

The book progresses through 13 chapters from an overview of health care to specific sectors such as hospitals, ambulatory care, long-term care, and mental health. Those clinicians with any experience in these areas would feel like they were reading a series of sound bites without much depth. However, for the beginning students, this information, presented as a mosaic, could provide valuable perspective on the industry.

The strongest chapters cover financing, managed care, public health, and research. Even those readers with experience in health care would enjoy the historical information and the challenge of a public health viewpoint, The final chapter on the future of health care raises several provocative societal issues such as changing demographics, costs, the uninsured, employment trends, ethics, and quality. Because each chapter is designed to stand alone, there is some redundancy, but it is not burdensome.

Although ambitious and stimulating, this book has some shortcomings as a text. The short introductory abstracts to each chapter lack learning objectives. Furthermore, there are no chapter summaries or discussion questions, leaving the instructor to use supplements heavily to achieve this structure. On the positive side, the chapter references are adequate, the appendix of abbreviations and acronyms is useful, and it would be easy to supplement the reading with current events to bring the text to life.

Despite the paucity of references to physical therapy, the book warrants a look from those instructors who would like to bring a broader viewpoint to their students in management or business classes. The "population" or public health outlook on wellness and prevention, disease management, primary care, teamwork, and cost effectiveness is a natural fit for the physical therapy profession. Our profession in particular and health care in general needs forward-thinking clinicians with a comprehensive understanding of the health care system in order to forge new alliances and find unique solutions to difficult problems. This text could serve as an impetus for those eager students, both beginning and experienced.

Ann M York, PT, PhD
Crawford Memorial Hospital
Robinson, Ill

Dr York is in senior management overseeing outpatient services, human resources, and compliance. She is also an adjunct faculty member at Lincoln Trail College.