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Distributing health care. Economic and ethical issues
  1. Christel Protiere

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    P Dolan, J A Olsen. Oxford University Press, Oxford, 2002, pp 153, £26.50. ISBN 0-19-263253-1153

    Firstly, a remark on the form: the presentation of this book is very agreeable particularly with a synthetic conclusion at the end of each chapter, which emphasises points related to the distributional aspects. Moreover, the chapters could be read independently, which makes the book a good instrument for work. The objective is to make accessible to a wide audience analyses of the question of how health care could be distributed in a public healthcare system. Despite the difficulty of such an exercise the goal is reached. The main interest of this book is to explore the subject not only in depth but also to clearly show the nature of difficulties an economist is faced when they enter the health field, including recognising that adopting a distributive rule is always a product of a value judgement (the real question became the underlying justification of this choice). My main reproach is about the exposition of some of the arguments in the current debate among health economists with regard to “welfarism” compared with “extra welfarism”. While I naturally agree with the existence of limits in the application of welfare theory, it has to be recognised that the QALY, which finds its theoretical foundation in welfare economics, shares a number of these limitations and is based on the hypothesis that health interventions only affect health and not other aspects of wellbeing. So I regret that the debate was not more clearly (and impartially) exposed. Whatever, this book represents a good contribution that could be a starting point for reflection in order to move toward a way to elicit preferences to help resources allocation decision in health care. This is a relevant book that I recommend to economics students or general economists who are newly interested by the health field. It should also be of interest to physicians and public health workers as well as our health economics colleagues.