Health Care USA: Understanding Its Organization and Delivery, 4th ed, by Harry A. Sultz and Kristina M. Young. Sudbury, MA: Jones and Bartlett Publishers; 2004. 497 pages, paperback, $63.95 (call 978-443-5000 or see http://www.jbpub.com).

When we first began reading this book and realized that it was written by a dentist (DDS, MPH) and a clinical assistant professor of social and preventive medicine (MS), we were skeptical that they might be up to the task of providing an understanding of the organization and delivery of the health care system in the United States. We needn't have been. This book, with chapters on a population perspective overview of the health care system; benchmark developments in US health care; the origin, organization, and performance of hospitals; ambulatory care; medical education and the changing practice of medicine; financing health care; managed care; long-term care; mental health services; public health and the role of the government in health care; research and how health care advances; and the future of health care provides at truly breathtaking and comprehensive overview of the evolution and development of health care in the United States. The book even includes appendices of abbreviations and acronyms in health care as well as health care Web sites.

This book is well written and lucidly laid out. The authors say that their goal for the book is to provide an introductory text for courses at the graduate and undergraduate levels on the organization, financing, and delivery of health care. The intended audience includes students in schools of public health, medicine, nursing, dentistry, and pharmacy, as well as schools preparing therapists such as occupational therapy, physical therapy, respiratory therapy and speech therapy and medical technologists, health care administrators, and many others. The goal of the book is to provide an introduction to the health care system in the United States, including an overview of the professional, political, social, and economic, as well as ethical forces that have shaped and continue to shape it. The authors have intentionally left out such topics as epidemiology, the history of medicine, program planning and evaluation, quality of care, and other topics that have their own extensive literatures and cannot be covered in a volume such as this. The book includes a large number of graphic and valuable tables and charts, pulling together a great deal of information we have not seen before at all or have never seen collected in one volume (eg, the natural history of any disease in humans; ownership status of US registered hospitals; percentage distribution of emergency department visits by immediacy with which the patient should be seen; and employment settings of registered nurses; deaths from preventable causes in the United States for 1990). Some of the most important charts are included on page 229: where the health care dollar went in 2000 and where the health care dollar came from in 2000-these are real eye-openers, for both of us.

The health care industry in the United States currently consumes 13% of the GDP of the nation and now exceeds at least $1.3 trillion and is rising. The main problems with the health care system focus, as always, on quality, access, and cost. However, due to extremely complex funding streams and conflicting goals and agendas, as well as to a public that is hopelessly confused about the nature of the health care system, it may be virtually impossible to reform without scrapping and starting all over. The authors discuss the major stakeholders in the American health care industry, including the public or consumers, employers, providers, hospitals and other health care facilities, government at every level, alternative therapies, managed care organization and other insurers, the long-term care system, mental and behavioral health, voluntary facilities and agencies, health professions education and training institutions, professional associations, and other health industry organizations such as pharmaceutical enterprises and research communities. Threaded throughout the book is a history of managed care and its impact on health care in the United States. The authors also spell out the impact of technology, as well as the aging population and diversifying demographics, on the future of health care delivery.

There are surprising nuggets throughout this book. For example, the authors do not forget to discuss the needs of rural and ethnically/racially diverse populations. In addition, they have included a valuable section (pages 102-105) on geographical variations in medical treatment nationwide, as well as the little known and little discussed hazards of hospitalizations and medical errors. The authors also take on the important topic of workforce shortages and staffing crises in all fields, from physicians to nurses to pharmacists and others. Also included is a discussion, albeit short, of advances in technological capability. Interestingly, the authors also include several sections on alternative therapies and alternative therapists and their roles in modern medicine. The authors have even included sections on what is going on with long-term care insurance as well as alternative health care settings such as adult day services, CCRCs, and assisted living facilities. Most importantly, mental health services have their own chapter, along with a diagram showing percentages of the US adult population with mental disorders and severe mental disorders. It is clear that for Sultz and Young, mental/behavioral health services need to be discussed right along with medical care in the United States. Final sections include the different types of health care research and research ethics. They also discuss the major challenges facing health care today, such as the growing number of uninsured and the demand for greater fiscal and clinical accountability. The authors end with a list of the most pressing questions currently being asked of the health care system, as well as a list of the 7 most commonly mentioned solutions to some of our problems (see page 451).

We would highly recommend this book to anyone who is trying to understand the origin and development of the US health care system and the kinds of issues that are now so pressing. The book uses a population-based perspective to show how the system has been practiced, financed, and delivered. The book would be of particular value to students at the undergraduate and graduate levels, as well as to foreigners who are seeking to understand the system and its ongoing problems and issues. Clearly written, with excellent headings and subheadings, this book is a tour de force of clarity and wisdom.