In this classic book, Professor Victor Fuchs draws on his deep understanding of the strengths and limitations of economics and his intimate knowledge of health care institutions to help readers understand the problems every nation faces in trying to allocate health resources efficiently and equitably. Six complementary papers dealing with national health insurance, poverty and health, and other policy issues, including his 1996 presidential address to the American Economic Association, accompany the original 1974 text.

Health professionals, policy makers, social scientists, students and concerned citizens will all benefit from this highly readable, authoritative, and nuanced discussion of the difficult choices that lie ahead.

A growing body of evidence suggests that managed care can reduce overall health care costs but provides little insight into how this could happen. One possibility is that managed care influences the adoption of new medical technologies. In examining the relationship between health maintenance organization (HMO) activity and market-level availability and use of magnetic resonance imaging (MRI), we find that high HMO market share is associated with low levels of MRI availability and use. This suggests that managed care may be able to reduce health care costs by influencing the adoption and use of new medical equipment and technologies.

Signs of a managed care backlash in California are increasing. This paper reports and interprets the recently completed work of the California Managed Health Care Improvement Task Force, focusing on the managed care backlash and the state's regulatory response. Although cost containment was a contributing factor, the causes of and solutions to the backlash differ among consumers, physicians, health care workers, politicians, and health plans. The recommendations of the task force could improve the market for health insurance. However, lasting solutions to the profound problems causing the backlash will require fundamental cultural and systemic change.

Signs of a managed care backlash in California are increasing. This paper reports and interprets the recently completed work of the California Managed Health Care Improvement Task Force, focusing on the managed care backlash and the state's regulatory response. Although cost containment was a contributing factor, the causes of and solutions to the backlash differ among consumers, physicians, health care workers, politicians, and health plans. The recommendations of the task force could improve the market for health insurance. However, lasting solutions to the profound problems causing the backlash will require fundamental cultural and systemic change.

Objective: To determine whether physician gender and patient gender influence the process of communication and parent and child satisfaction during pediatric office visits. DESIGN: Content analysis of videotaped pediatric office visits.

Setting: University-based pediatric primary care practice.

Subjects: Videotaped communication between 212 children, ages 4 to 14 years, parents, and physicians. Thirty-eight percent were child health supervision visits, and 62% were for the management of minor or chronic illnesses.

Main Outcome Measures: An established coding system of physician-patient communication and measures of parent and child satisfaction with medical care.

Results: Female physician visits were 29% longer than those of male physicians (P .001). Compared with male physicians, female physicians engaged in more social exchange (P .01), more encouragement and reassurance (P .01), more communication during the physical examination (P .05), and more information gathering (P .01) with children. Male and female physicians engaged in similar amounts of discussions regarding illness management. Children were more satisfied with physicians of the same gender (P .05), while parents were more satisfied with female physicians (P .05).

Conclusions: Children communicate more with female than with male physicians and show preferences for physicians of the same gender. These findings are consistent with communication patterns in adult patients and may have a significant influence on gender disparities in health care. Efforts at improving the process and outcome of medical care should address gender differences.

This book presents cutting edge thinking on the management of health care organizations. Practical and conceptual skills are taught to help students focus on more efficient health care delivery. Also covered is development of leadership skills, future trends in health care management, guidelines for designing effective work groups and a section on managing conflict.

The purpose of the Handbook is to provide systematic overview of medical and health informatics for health care professionals and for students in medicine and health care, who will be the clinical professionals of the next millennium. Health care professionals will use computers to support patient care, assess the quality of care, and enhance decision making, management, planning, and medical research. Computer-based patient records and electronic communications will be the most visible developments in the years ahead. The Handbook has been written by a host of renowned international authorities in medical and health informatics. The editors took much care that the Handbook would not be merely a collection of separate chapters, but rather would offer a consistent and structured overview.