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Regulating entrepreneurial behaviour in European health care systems
  1. Luke Clancy
  1. Dublin University Crest, Clinical Directorate St James’ Hospital, Dublin 8, Ireland

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    Edited by R B Saltman, R Busse, E Mossialos. (Pp 240; £22.50 (pbk), £65.00 (hbk)). Open University Press, Buckingham, 2002. ISBN 0-335-20922-X (pbk); 0-335-20923-8 (hbk)

    This is a hugely interesting book on health care systems in Europe

    It is fascinating from a clinician’s point of view to read a book full of detail about health care that hardly mentions patients, doctors, nurses, or indeed any other healthcare workers. It is not easy to read from cover to cover but is rewarding.

    Given the recent history of the UK NHS it is a bit surprising that so many of the examples are based on the UK “reforms”. Partially no doubt this is due to the fact that the NHS has experimented extensively in systems change.

    The authors present a detailed and clear understanding of the very differing healthcare systems in Europe and help us to understand the consequences of these differences.

    The structure of the book seems somewhat unusual in so much as part 1, written by the editors, embodies material that is presented and analysed by invited contributors later in part 2. Part 2 is labelled “conceptual issues” and looks at entrepreneurial activity and regulation in a number of contexts including hospitals, the pharmaceutical industry, general practice, and oral health.

    There are extremely valuable chapters on factors that have an impact on entrepreneurial behaviour in the health sector such as regulation, accreditation, and corruption. It aspires to an evidence based approach embracing clinical management and audit and clearly lays out the danger in entrepreneurialism without appropriate regulation in the healthcare setting.

    An obvious absence in the book is a significant contribution from patients or healthcare providers with the notable exception of dentists. When doctors are mentioned it is to point out that they are always a problem when efforts at reform are attempted. There is no analysis as to why doctors seem to be negative. Nevertheless, I highly recommend this book to any healthcare professional who wants to begin to understand the healthcare “big picture” even if they will have to endure such beauties as “negative opportunistic behaviour”!

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