Article Text


Getting Health Economics into Practice
  1. T Wilson
  1. Strategy Unit, Department of Health. London, UK; tim.wilson{at}

    Statistics from

    Kernick D, ed. Abingdon, Oxon: Radclife Medical Press, 2002. Pp 324. ISBN 1 85775 575 8

    It was with a somewhat heavy heart that I accepted the challenge to write a review of an economics book. Although I knew the editor wrote well, a book on economics was not at the top of my reading list. It would do me some good, I thought. In the end it wasn’t a challenge—I read the book in two weeks, enjoying the punchy, well written text, and—yes—it did me good. But unlike many self-betterment schemes, it was painless.

    What stood out were the clear aims at the start of the book and the introductions to each section and to most chapters. Sometimes this can be laboured (tell them what you’re going to say, say it, and then tell them what you said). On this occasion it felt as if it worked in a coherent manner, and aided me to understand better the text and where the following chapter fitted in with the big scheme of economic things.

    For much of the book I was introduced to new ideas that helped me think about how health care could work. Sometimes, though, the book gave words to issues that are often discussed in the “hurly burly” of health care (the “swamp lands”, as David Kernick puts it). For instance, the concepts of moral hazard (where someone doesn’t have to pay for a service) and principal agent (where someone carries out a task on behalf of others) were particularly helpful. Chapters on well worn issues like the transfer of activity to primary care and skill mix also breathed new life into areas I had stopped properly thinking about.

    Criticisms? Very few. The book is too focused on primary care. Although it is relevant to the whole of health care, the examples belie the editor’s roots which might wrongly limit its appeal to other readers. Astonishingly, I found some of the chapters too brief. I cannot decide whether this was a fault of the book or whether it has whetted my appetite to look further. Although the book was well laid out, sometimes the connections between the chapters were not clear and they were lumped together in a section that might more appropriately be considered miscellaneous. But this is nit picking. Inevitably in a multi-authored book there was repetition, but even this was generally helpful to an ignorant reader like myself, especially because—where it occurred—it was thankfully consistent (good editing I presume).

    In their instructions QSHC asks book reviewers not to end with the well worn phrase “this should be on the shelves of every departmental library”. I agree. For many this book would be of little interest and, for accountants, there should be a health warning because of the unflattering comparison made with economists on page 7 (a cause of much celebration with economically minded colleagues for whom Dr Kernick is a new hero). But I finish with an alternative cliché—“this should be required reading for everybody” making healthcare resource decisions at (primary and acute) trust, health authority and department levels.

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