”Every social mechanism appears to have a dual potential for good and evil. Prepayment for medical care is no exception. On the one hand, it provides assurance of necessary care as a safeguard to health, economic well-being, and peace of mind. On the other hand, it opens the way to wasteful and harmful care, to price inflation, and to concealed redistributions in socially undesirable directions. The problem is to devise a plan that allows us to reap the most advantages while we incur the fewest drawbacks.”

Benefits in Medical Care Programs is a comprehensive treatment of this problem. Dr. Donabedian begins with a clear and straight forward analysis of his own assumptions about the social mandate for medical care benefits, the objectives of medical care programs, and the magnitude and distribution of the unmet need that these programs are designed to alleviate. The problem of defining and measuring the need for care is considered within the con text of the data yielded by alternative definitions. The analysis then shifts to the impact of benefits on certain key features of the medical care system.

Program benefits are weighed against program objectives, and policy implications are drawn from this comparison. We are shown what can and cannot be accomplished through medical care benefits and what goals are served by specific aspects of existing or proposed plans. Although Dr. Donabedian counsels a fairly thorough reform of existing systems, he remains skeptical about the possibility of designing a perfect system, and he does not hesitate to point out that increased access to care "increases exposure to both what is good and what is bad in our system of medical care. . . The machinery of medical care has a sinister potential for those who fall into it in the wrong place at the wrong time.

Dr. Donabedian's previous book Aspects of Medical Care Administration has been called the "bible" of its field. Benefits in Medical Care Programs should prove equally invaluable.

Chronic Condition provides a compelling analysis of the causes of the current health care crisis and of the shortcomings of reform proposals. It also offers an ingenious new framework for reform that, while minimizing government interference, would provide a means for financing care for the less affluent.

Sherry Glied shows that rising health care spending is consistent with a rising standard of living. Since we can, as a nation, afford more health care, reform must address not the overall level of health care costs but the distribution of health care spending.

Prior reform proposals, Glied argues, have failed to account for the tension between the clearly manifested desire for improving the quality of health care and the equally widespread interest in assuring that the less fortunate share in these improvements. After careful analysis of the ill-fated Clinton plan, Glied proposes a new solution that would make the willingness to pay for innovation the means of financing health care improvements for the less affluent. While rejecting the idea that the distribution of health care should be perfectly equal, Glied's proposal would enable all Americans to benefit from the dynamics of the free market.

Ethnicity and Medical Care equips health professionals with the ethnographic data they need to deliver better health care within American communities of urban blacks, Chinese, Haitians, Italians, Mexicans, Navajos, and Puerto Ricans. Each chapter, dealing in turn with one of these seven American subcultures, reviews the available demographic and epidemiological data and examines sociocultural influences on each major phase of illness.

Topics range from culture-specific syndromes such as susto or “evil eye,” to concepts of disease based on blood perturbations or God's punishment, to lay-referral networks, consultation of mainstream and non-mainstream sources of medical care, and adherence to treatment regimens. But ethnic behavior often entails general styles of interaction—attitudes toward authority figures, sex-role allocations, and ways of expressing emotion and asking for help—that are carried over into the healthcare setting. Accordingly, Ethnicity and Medical Care also offers general guidelines for providing more personalized, culturally relevant care for any ethnically affiliated patient.

This revised volume, originally published in Sweden, consolidates multidisciplinary research on gender inequalities in health. Reviewing previous research and presenting new empirical data from Sweden and elsewhere, the authors examine basic concepts, possible hypotheses, explanatory models, and policy solutions for the biological and social causes of the differences in health between men and women. Along with discussions of reproductive, mental, and occupational health, this book reviews critical issues such as violence and asks important questions, such as why men are dying younger.

The volume also analyzes how Sweden’s labor market, social structure, and health care system have contributed to these gender differences, and what effects these factors will have in the future. Sweden’s experience as a pioneer in health achievement and gender equality provides valuable insights into the health-related challenges remaining for the rest of the world.

In Reinventing Care, David Barton Smith offers brilliant insights into those questions by examining the realities of assisted living in New York City. Encompassing the largest, most concentrated population of elderly in the United States, New York spends more per person caring for its seniors than any other urban center. Yet, while the size of the city's care system boggles the mind, it nevertheless contains the same elements that exist in other metropolitan areas and thus provides valuable lessons for the nation as a whole.

Smith's study draws on twenty-five years of research, including hundreds of interviews and visits to representative facilities. He provides a succinct overview of how care is presently organized for New York's aging population and traces the history of the system up to the present. Among the key issues he addresses are the role of market forces and government regulation, the impact of class differences on access to quality care, and the ways in which perceptions of community affect the creation and management of assisted living programs. At the heart of the book are ten fascinating case studies, half of them focused on private-pay facilities and the other half on public-pay institutions.

While finding that the actualities of assisted living rarely match the rhetoric of its proponents, Smith sees much to admire in its goals. He suggests tactics and strategies--such as promoting family- and community-based models of assisted living and adopting a standard of licensure for certain facilities--that could point the way to a better future.