EUROPEAN JOURNAL OF PUBLIC HEALTH VOL. 14 2004 NO.

through the lens of personal entitlement and not as an expression of social solidarity. At a time when the future of European health care systems are increasingly being questioned, causing policy-makers to revisit the fundamental principles underpinning national health services, these excellent chapters are profoundly disturbing, and not only for those residing in the United States. In the section of the book that examining the ethics of how policy is made the chapter that resonates most for me is John Kingdons. He argues persuasively that keeping goals fuzzy while making policy is necessary. The reason is that clear goals (such as equitable health care provision) which are incompatible with cultural imperatives (such as Americas attachment to notions of individualism, choice, and distrust of government) cause policy breakdown. He cites the failed Clinton initiative as illustrative of this point. The final section of the book deals with ethical controversies in health policy. Of note in this section, Dan Brock has contributed a wide-ranging and extremely thought-provoking chapter on resource allocation for vulnerable populations, drawing extensively on work by Amartya Sen. This book represents an important step in the debate over what health policy is, what it should seek to achieve, and what fundamental ethical principles should underpin such policy. I hope that it may provide something of the foundations for a much-needed bridge to cross the chasm that exists between moral theory and concern for social well-being to effective practical policies that address health inequities. The contributions in this book highlight clearly the complexities of the issues involved. Lets hope that this book falls, metaphorically, on receptive political ears and that the thinking that has informed it influences policy-makers beyond US shores. Richard Coker, London School of Hygiene and Tropical Medicine, London, UK

Mossialos E, Dixon A, Figueras J, Kutzin J, editors. Funding health care: options for Europe. European Observatory on Health Care Systems Series. Open University Press, 2002. 328 pp. ISBN 033 5209246

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In the last decade, many European countries undertook reforms aiming to improve the sustainability and equity of their health care systems, responding to ageing populations, new technology and rising public expectations. The resurgent interest in comparative studies was exemplified by a series of key OECD and WHO studies. This book makes a sub-

stantial contribution to the international debate on health financing, consolidating earlier experience and bringing forward new evidence. The analysis draws broadly on the experience of industrialised countries, with frequent reference to Eastern Europe, the former Soviet Union and other low- and middle-income settings worldwide. Despite the enormous diversity of health systems included, the authors succeed in identifying the common challenges of adequate funding of health care systems and the lessons to be learned from different reform strategies. The contributing authors represent a wide range of views from both academia and development agencies. Building on earlier work on comparative health systems, the book uses a clear conceptual framework, separating revenue collection, pooling of resources and their transfer to the health care system through purchasing. The book addresses an exhaustive range of financing models ranging from taxation and social health insurance, through voluntary insurance and medical savings accounts, to user charges and informal payments. The evidence on the advantages and disadvantages of each model are illustrated by empirical case studies representing a range of typical settings. The book shows genuine understanding of how the underlying concepts of funding translate into the political and institutional realities of European health care systems and traces the influence of traditions, values and other contextual factors. To illustrate this, some chapters explore specific issues in a particular region, such as financing reform trends in Central and Eastern Europe. In many cases authors take a clear stance on contentious issues, such as informal payments. In the concluding chapter, the book reviews the balance of evidence and assesses each financing model according to a range of efficiency and equity criteria, seen as critical in most European countries. However, this is balanced by the recognition that comparison of health systems is highly dependent on the countrys institutional capacity and societal values, so that ready-made solutions are not transferable. This book is an indispensable tool for understanding health care financing both in Europe and the wider world. It contains a wealth of factual information. The study tackles complex issues in a concise and accessible style and the result is a wellstructured and readable book, without being superficial. Its pragmatic approach to health systems comparison and its practical guidelines to assess suitability of financial arrangements would appeal to academics, policy-makers as well as a wider audience. It also represents a coherent source of

references for anyone with an interest in health care reforms. Undoubtedly, this book is a major contribution to the area of comparative health systems research and a valuable reference point for those engaged in country-specific research and the international debate on health financing reform. Dina Balabanova, Health Systems Development Programme, London School of Hygiene and Tropical Medicine, UK

Ellis N. Work and health Management in Australia and New Zealand. Oxford University Press, 2001. 418 pp. ISBN 0 19 550767 3

There is a wide range of books concerned with work and health. Some follow the traditional clinical format such as Hunters Diseases of Occupation, others concentrate on Occupational Health Practice such as the books edited by Schilling and others in the UK and Levy and Wegman in the USA. Then there are books on Safety and books on Management, some of which recognize the health dividend of good workplace health care whether it is the effect of health on work or work on health. Few people have attempted to write a book for managers which incorporates much of occupational health (OH) practice but goes further and argues that traditional OH practice is outmoded. Outmoded because the traditional workplace is increasingly hard to find. More people work flexible hours, and more work under psychological threat than toxicological threat. That is, the standard methods of preventing ill health at work are ill suited to the modern world of work. Niki Elliss book Work and Health Management in Australia and New Zealand succeeds brilliantly in creating a new milieu to view this complex multidisciplinary multi-faceted subject of work and health. Dr Ellis is a highly experienced OH physician whose extensive practical experience of dealing with workplace problems is exemplified by the wide range of case studies she uses to illustrate solutions not just problems. Her approach to this wide range of subjects from toxicology to psychology to work organization issues shows, in part, just how narrow minded some of us have become and how out of touch we are with the problems of the modern world of work. Yet the individual sections on law, risk management, common problems of organizational development and case management are skilful summaries of technically complex areas written with great clarity and focus. The book concludes with a rare section on continuous development through planning and evaluation. Each