Health Economics provides a comprehensive overview of the US healthcare system and also delves into the underlying economic issues that have overwhelmed this fragmented system. However, those expecting to see the use of economic theories or models to explain the workings of the healthcare industry will be disappointed since the focus of the book is primarily on the cost of healthcare and the unique financial mechanisms found within the different healthcare sectors. This book can be considered an introductory discourse on the healthcare system that presents a clear and insightful picture of the healthcare sectors and their critical issues.

This book gives an excellent historical overview of healthcare financing (chapter 1) and offers interesting insights to the historical development of health planning in the 1970s (chapter 10). Both of these chapters provide more meaning to the current healthcare reform that is referenced throughout the text. Chapters 2 and 3 discuss the cost of healthcare and explore the reasons for the upward spiraling of the healthcare costs in the United States. The most bothersome component of health care expenditure for the author is the apparent racial and ethnic disparities in accessing healthcare in the United States, especially when this country spends the highest percent of gross domestic product on healthcare of any industrialized nation. The author acknowledges that the rising costs coupled with decreasing access is attributable to a variety of factors including the elderly, health insurance, healthcare services, and public programs like Medicaid and Medicare. The author exudes optimism that more states will follow the Massachusetts model of requiring every resident to have health insurance.

Chapters 4 through 9 provide detailed analyses of the different components of healthcare including physicians, hospitals, nursing care, home and hospice care, prescription drugs, and medical technology. The strength of the book may be its focus on the supply side of healthcare; providing service details, financing mechanisms, and occasionally comparing these services to those provided in the socialized healthcare system of Great Britain.

Chapters 10–13 present a very balanced observation on the private health insurance and public programs such as Medicare and Medicaid. The author identifies the shortcomings of the insurance companies, their inadequate health coverage, and their impact on private businesses. The author makes a case that the public may want the government to intervene (through national health insurance) if the insurance companies fail to meet society's needs.

The focus on healthcare fraud and abuse in Chapter 14 provides the greatest value since these problems are generally neglected during most healthcare discussions. The author provides an excellent description of the fraud and abuse that are rampant in private and public programs, and the initiatives the government is enacting to combat the problem. The author warns that the problem may not go away and will likely continue, but with the right initiatives, it is possible to cut down on wasteful expenditures and improve the efficiency of the healthcare system.

The final chapter describes the forces behind the national health insurance proposal and outlines 3 major goals of President Obama's healthcare proposal. The author poses that only time will tell if the new plan will work and if the reform will make healthcare affordable to all. The author could have detailed the pros and cons of the different world health systems (mostly those with national health insurance) and critically reflected on whether national health insurance could or could not provide efficient and quality care at a lower cost, and the lack of this in depth discussion is a shortcoming of the book.

As a whole, Health Economics is an easy-to-read text that can help practitioners, teachers, and students understand the changing nature of medical care, especially at a time when the US healthcare system is being reformed and restructured. The book is a valuable source and is almost certainly the most comprehensive review of the US healthcare system available.

• © 2010 American Journal of Pharmaceutical Education