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"The definitive overview of health technology assessment in the U.S. and Europe, the biotech industry, adoption and use of medtech in health care."
---The World Future Society, Best Books and Reports

"This excellent book provides a broad overview of the development, impact, and evaluation of health technology in the United States. . . .The authors take a well-organized and thorough approach to address these topics, combining reviews of each with case examples of particular technologies. . . .Given the broad scope of the book, it could serve as a text for students, an introduction to the field for healthcare professionals, or a tool for academics and policymakers wishing to fill knowledge gaps outside their disciplines. . . .The book makes a compelling case for the logic and potential benefits of medical technology evaluation as a tool for improving health care."
---Journal of the American Medical Association

"By being comprehensive in their review, the authors chart a clear path to understanding the future of health care technology in America. They clarify the technical methods for evaluation and provide insight into the sociopolitical aspects of development and diffusion. Case studies are informative. Excellent reading for students and health professionals either as a textbook or as an off-the-shelf guide to methods for deciding among alternative technologies."
---Norman W. Weissman, University of Alabama

"Technology today dominates every aspect of health care. This useful book offers a diverse range of perspectives for students, professors, and medical practitioners who wish to understand how to evaluate medical technology."
---Joel Howell, University of Michigan Medical School

Technology in American Health Care is a comprehensive, multidisciplinary guide to understanding how medical advances-new drugs, biological devices, and surgical procedures-are developed, brought to market, evaluated, and adopted into health care.

Cost-effective delivery of evidence-based health care is the sine qua non of American medicine in the twenty-first century. Health care decision makers, providers, payers, policymakers, and consumers all need vital information about the risks, benefits, and costs of new technologies in order to make informed decisions about which ones to adopt and how to use them. Alan B. Cohen and Ruth S. Hanft explore the evolving field of medical technology evaluation (MTE), as well as the current controversies surrounding the evaluation and diffusion of medical technologies, including the methods employed in their assessment and the policies that govern their adoption and use.

The book opens with an introduction that provides basic definitions and the history of technological change in American medicine, and a second chapter that explores critical questions regarding medical technology in health care. Part I discusses biomedical innovation, the development and diffusion of medical technology, and the adoption and use of technology by hospitals, physicians, and other health care organizations and professions under changing health care market conditions. Part II examines the methods of MTE-including randomized controlled trials, meta-analyses, economic evaluation methods (such as cost-benefit, cost-effectiveness, and cost-utility analyses), and clinical decision analysis. Part III focuses on key public policy issues and concerns that affect the organization, financing, and delivery of health care and that relate importantly to medical technology, including safety, efficacy, quality, cost, access, equity, social, ethical, legal, and evaluation concerns. All three parts of the book provide a historical perspective on the relevant issues, methods, and policy concerns and contain examples of technologies whose development, adoption, evaluation, and use have contributed to our understanding of the field.

This book will be invaluable in making MTE more accessible to individuals who are directly involved in the evaluation process and those who are touched by it in their professional lives-policymakers, clinicians, managers, and researchers.

We hear plenty about the widening income gap between the rich and the poor in America and about the expanding distance separating the haves and the have-nots. But when detailing the many things that the poor have not, we often overlook the most critical—their health. The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. In nearly four decades as a doctor at hospitals serving some of the poorest communities in Chicago, David A. Ansell, MD,  has witnessed firsthand the lives behind these devastating statistics. In The Death Gap, he gives a grim survey of these realities, drawn from observations and stories of his patients.

While the contrasts and disparities among Chicago’s communities are particularly stark, the death gap is truly a nationwide epidemic—as Ansell shows, there is a thirty-five-year difference in life expectancy between the healthiest and wealthiest and the poorest and sickest American neighborhoods. If you are poor, where you live in America can dictate when you die. It doesn’t need to be this way; such divisions are not inevitable. Ansell calls out the social and cultural arguments that have been raised as ways of explaining or excusing these gaps, and he lays bare the structural violence—the racism, economic exploitation, and discrimination—that is really to blame. Inequality is a disease, Ansell argues, and we need to treat and eradicate it as we would any major illness. To do so, he outlines a vision that will provide the foundation for a healthier nation—for all.

Inequality is all around us, and often the distance between high and low life expectancy can be a matter of just a few blocks. But geography need not be destiny, urges  Ansell. In The Death Gap he shows us how we can face this national health crisis head-on and take action against the circumstances that rob people of their dignity and their lives.

Severe and persistent mental illnesses are among the most pressing health and social problems in contemporary America. Recent estimates suggest that more than three million people in the U.S. have disabling mental disorders. The direct and indirect costs of their care exceed 180 billion dollars nationwide each year. Effective treatments and services exist, but many such individuals do not have access to these services because of limitations in mental health and social policies.

For nearly two centuries Americans have grappled with the question of how to serve individuals with severe disorders. During the second half of the twentieth century, mental health policy advocates reacted against institutional care, claiming that community care and treatment would improve the lives of people with mental disorders. Once the exclusive province of state governments, the federal government moved into this policy arena after World War II. Policies ranged from those focused on mental disorders, to those that focused more broadly on health and social welfare.

In this book, Gerald N. Grob and Howard H. Goldman trace how an ever-changing coalition of mental health experts, patients' rights activists, and politicians envisioned this community-based system of psychiatric services. The authors show how policies shifted emphasis from radical reform to incremental change. Many have benefited from this shift, but many are left without the care they require.

 

Americans at the end of the twentieth century worried that managed care had fundamentally transformed the character of medicine. In The Medical Delivery Business, Barbara Bridgman Perkins uses examples drawn from maternal and infant care to argue that the business approach in medicine is not a new development. Health care reformers throughout the century looked to industrial, corporate, and commercial enterprises as models for the institutions, specialties, and technological strategies that defined modern medicine.

In the case of perinatal care, the business model emphasized specialized over primary care, encouraged the use of surgical and technological procedures, and unnecessarily turned childbirth into an intensive care situation. Active management techniques, for example, encouraged obstetricians to accelerate labor with oxytocin to augment their productivity. Despite the achievements of the childbirth and women’s health movement in the 1970s, aggressive medical intervention has remained the birth experience for millions of American women (and their babies) every year.

The Medical Delivery Business challenges the conventional view that a dose of the market is good for medicine. While Perkins is sympathetic to the goals of progressive and feminist reformers, she questions whether their strategies will succeed in making medicine more equitable and effective. She argues that the medical care system itself needs to be fundamentally "re-formed," and the reforms must be based on democracy, caring, and social justice as well as economics.

This distinguished collection stands out from the recent flurry of books on health reform by its sustained and sophisticated analysis of the political dimension. In The Politics of Health Care Reform, some of America’s best-known political scientists, historians, and legal scholars make sense of our most turbulent policy issue. They dig below the jargon and minutiae to explore the enduring questions of American politics, government reform, and health care.
The Politics of Health Care Reform explains how successful reforms occur in the United States and shows what is unique about health care issues. Theoretically informed, politically astute, historically nuanced, this volume takes an inventory of our health policy infrastructure. Here is an account of the institutions, ideas, and interests that shape health policy in the 1990s: Congress, the federal courts, interest groups, state governments, the public bureaucracy, business (large and small), the insurance industry, the medical profession. The volume offers a fresh look at such critical matters as public opinion, the politics of race and gender, and the lessons we can draw from other nations.
The Politics of Health Care Reform is the definitive collection of political science essays about health care. Expanded from two special issues of the Journal of Health Politics, Policy and Law, the most prominent scholarly journal in the field it helped create, this collection will enliven the present debate over health reform and instruct everyone who is concerned about the future of American health care.

Contributors. Lawrence Brown, Robert Evans, William Glaser, Colleen Grogan, Robert Hackey, Lawrence Jacobs, Nancy Jecker, Taeku Lee, Joan Lehman, David McBride, Ted Marmor, Cathie Jo Martin, James A. Morone, Mark Peterson, David Rochefort, Rand Rosenblatt, David Rothman, Joan Ruttenberg, Mark Schlesinger, Theda Skocpol, Michael Sparer, Deborah Stone, Kenneth Thorpe

Celebrated as a major work since its original publication, The Sanitation of Brazil traces how rural health and sanitation policies influenced the formation of Brazil's national public health system. Gilberto Hochman's pioneering study examines the ideological, social and political forces that approached questions of health and government action. The era from 1910 to 1930 offered unique opportunities for public health reform, and Hochman examines its successes and failures. He looks at how health became a state concern, tying the emergence of public health policies to a nationalistic movement and to a convergence of the elites' social consciousness with their political and material interests. Politicians weighed the costs and benefits of state-run public health versus the burdens imposed by disease. Physicians and intellectuals, meanwhile, swayed them with warnings that endemic disease and official neglect might affect everyone--rich and poor, rural and urban, interior and coastal--if left unchecked. The book shows how disease and health were and are associated with nation-state building in Brazil.