Surviving Health Care, by Pamela Armstrong. Concord, Calif: Chestnut Ridge Books, 2005. 317 pages, softcover, $19.95.
While its attention-grabbing title may suggest that this is just another tabloid-style expose full of horror stories, this book is anything but that. Surviving Health Care is designed to inform and empower consumers of health care services, and its author does a good job of it. She has used case studies, sidebars, and illustrations to good effect in this work. These devices make the book inviting to the reader, and relieve the potential weightiness of a serious discussion. The book's subtitle, "How to Take Charge and Get the Best From Your Doctor, Your Hospital and Your Health Insurance," tells you what to expect. Each of the 7 major parts of the work starts out with a concise summary of its contents.
The first of the 7 parts into which the work is divided, "The Healthcare Landscape," serves as an introduction and orientation. The serious flaws in the present health care delivery system are outlined. With a couple of realistic case studies, Armstrong shows the value of ongoing, comprehensive, coordinated care. She argues for effective, conscientious management by the primary care physician, a feature that is not found often enough in current health care.
Having described the basics of good primary care, Armstrong lays out a plan for obtaining it. She emphasizes the consumer's role in evaluating and choosing a primary care physician. Her description of the ways in which she believes many consumers make this choice is rather patronizing, but in the absence of broad-scale data, who is to say she exaggerates?
The role of preventive care is emphasized. The author urges the consumer to become acquainted with his own risk factors, and to use this knowledge in planning. Part III, "Preventing a Problem Is Better Than Trying to Fix One," includes excellent, informative charts showing risk factors, preventive measures, and management measures. Armstrong's idea of a physician's reaction to receiving a patient's list of risk factors may be optimistic, but it is worth a try.
In Part IV, "The Elements of Medical Quality," Armstrong delves into the measurement and evaluation of medical and hospital care. She provides a wealth of valuable information about the evaluation and accrediting bodies. Internet sources of information on hospital accreditation or approval are cited. Clinical issues in evidence-based medicine, medical errors, and patient safety are discussed at length. Addressing the organizational aspects of the provision of care, the author discusses coordinated care, patient-centered care, managed care, and integrated care systems. This is an extremely valuable collection of 16 short chapters, full of information that should be provided to consumers of health care services.
Which type of plan to choose is the subject of Part V. Here Armstrong describes and compares traditional indemnity insurance plans; health management organizations; preferred provider organizations; point-of-service plans; consumer-directed plans; and the newer "VIP" plans, with member patients paying an annual retainer to the physician. She points out the pros and cons of the various systems from the consumer's point of view.
Parts VI and VII provide "other helpful information" and resources to aid the consumer in the decision-making process. Both are comprehensive and useful. This book is filled with valuable information and advice for those who are responsible for making health care decisions for themselves or their family. It is unusual to find such authentic information and informed discussion about a wide spectrum of health care issues gathered in one place.
Jean Gayton Carroll, PhD, Editor
Quality Management in Health Care, Chicago, Ill