Harwood-Nuss' Clinical Practice of Emergency Medicine, 5th ed, A.B. Wolfson. Wolters Kluwer/Lippincott Williams & Wilkins (2009), 2080 pages, $229.00 ISBN-13:978-0-7817 8943

WITH THE PASSAGE OF THE PATIENT PROTECTION AND Affordable Care Act (ACA) and the continued growth in the Medicare and Medicaid budgets, it is critical that clinicians, public health professionals, and the public at large understand health policy. Many medical schools and schools for associate practitioners have introduced some coverage of health policy topics into their curricula, and knowledge of health policy and management are core competencies for students in schools of public health. Jonas & Kovner’s Health Care Delivery in the United States, now in its 10th edition and edited by Anthony Kovner and James Knickman, is highly recommended for these audiences. It distinguishes itself from other health policy texts based on its breadth and up-to-date coverage of the ACA and trends in the organization of health care delivery. Traditionally, health policy textbooks have devoted limited attention to the health care system, even as research on the determinants of health has accumulated and influenced policy and clinical practice. Health Care Delivery in the United States includes a population health section with coverage of socioeconomic status and health; obesity; the legal, organizational, and theoretical basis of public health; and approaches to changing harmful health behaviors. The book also includes chapters on health care quality, quality improvement, governance, and information technology, all of which increase the relevance of the text to students in health management programs looking to gain exposure to health policy and policy students who need to learn basic management concepts. Most chapters include a discussion of relevant provisions of the ACA and their probable influence on the US health care system. Chapters on organizations and integrated delivery systems describe existing arrangements and how they may be transformed by accountable care organizations. A chapter on access describes the multiple pathways toward increased coverage under the ACA. The book includes contributions from 28 authors. Many are or were formerly employed by the Robert Wood Johnson Foundation, and the book shares the foundation’s priorities and world view. It emphasizes patient access over cost control, external factors (eg, “food deserts”) over preferences and culture as explanations for obesity, and the benefits of the ACA over the act’s financing mechanisms and fiscal impact. The book has many features that will increase its ease of use in the classroom. The chapters are short and there is some repetition, so instructors can pick and choose among chapters without having to assign them in a predetermined sequence. Each chapter begins with learning objectives and concludes with a set of discussion questions and a case study. Although the book is broad in scope, some subjects receive relatively scant attention. Adverse selection, moral hazard, antitrust and competition, and managed competition are mentioned briefly or not at all. Some of the authors work in health care but not health policy. They bring some unique strengths and perspectives to the book, but their chapters would have benefited from collaboration with full-time experts. A chapter on geographic variation, written by a communications consultant, states that the “high costs of employee and retiree health benefits limit corporate expansion” (p 17). (Health economists agree that the cost of health benefits, which is borne by workers in the form of lower wages, does not significantly impede the competitiveness of US businesses.) A chapter on health care costs, written by an academic health system administrator, mentions cost savings from outsourcing hospital laundry services but never discusses the factors responsible for increasing health care costs or major policy approaches for reducing costs. The book includes several statements that will make for good “teachable moments” on correlation and causation. A chapter on population health states that because health varies between regions, “where people live matters to their health” (p 96). Another chapter states that “As the proportion of specialists in a state increases, the state experiences higher overall age-adjusted mortality” (p 192). Despite these limitations, Jonas & Kovner’s Health Care Delivery in the United States is one of the stronger health policy texts on the market. Readers and instructors looking for an up-to-date, broad-based overview of US health policy should strongly consider using the book.