Political Economy of Health Care: A Clinical Perspective
by Julian Tudor Hart
Policy Press, £14.99
I first met Dr. Julian Tudor Hart as a newly qualified medical doctor, when he gave a lecture for a student meeting at Bristol University. Even then, he impressed with his knowledge and commitment to the health service.
Since, he has devoted his life to working as a GP in south Wales, not only providing a service of excellence to local people but researching patterns of common diseases affecting those living in the south Wales valleys and sharing his research in numerous articles for leading medical journals.
There have been a number of books on the state of our health service, some good, but none written by someone like Tudor Hart, who has an extensive knowledge of the NHS at the point of delivery, combined with an extensive knowledge of the service as a whole.
He also brings to this work a life-long commitment to socialism and a Marxist understanding of social forces.
He warns of the creeping commercialization of the health service - the privatization of a growing number of spheres and the application of market economics to procurement, delivery and management.
He sets out to explore how the NHS might be reconstituted as a humane service for all, rather than a profitable one for the few, and a civilizing influence on society as a whole.
He makes a vital and critical distinction between "wants" and "needs." The mantra of "choice" feeds into the idea of individual wants. But markets and the drive for profit can never deliver what for the majority can only remain a mirage of choice. He points out that the NHS can deal efficiently with needs but hardly with often artificially stimulated "wants."
I have made documentaries in the US on the health care system and have seen how cynically the market deals with people's health there. The recent Michael Moore film Sicko provides one of the most eloquent damnations of this inhumane system.
In his conclusion, Tudor Hart undertakes a fascinating exploration of what is possible – the threats and opportunities.
So much is packed into this book, it is impossible to cover everything. He is clearly a man who knows what he is talking about and no mere pontificator.
Tudor Hart's central thesis is that rational and effective health care cannot follow a pattern of market competition. His study is also, by implication, a critique of society as whole and he views health care as a barometer and integral part of that. Combining clinical, political and economic arguments, he proposes his own economic analysis of the NHS, "derived not from classical theory but from experience of the real health service."
This book is not just for those in the health service or for academics but addresses us all. It is written in a vivid and easily accessible style. The author's aim is to provide a "big picture" for students, academics, health professionals and NHS users that will also inspire them to challenge received wisdoms about how the NHS should develop in the 21st century.
