Health Care Delivery Systems—Evaluation Criteria

In Health Care Delivery Systems-Evaluation Criteria Dr. Lapatra attempts to study evaluation criteria of existing health care delivery systems and apply the technology of operations research and systems analysis to its evaluation. He attempts to show how he can "apply systems concepts to the study of the U.S. health system" with an ultimate goal of defining the necessary variables to improve outcome. The author reviews many important aspects of health in America today with special emphasis on systems and their evaluation. He discusses much of the previous work which has concentrated on evaluation of nurse and physician performance and patient need. He ends with a discussion of some new thoughts on how better to deliver health care with the use of paramedical personnel and the team approach. While an ambitious project, I feel the book falls short of educating the physician in the tools of systems analysis and also fails to educate the systems analyzer as to the problems of applying this technology to medicine. The text is replete withjargon, most of which is defined for people who already are familiar with it, and difficult to understand for anyone else. There are countless lists of criteria with no careful attempt to evaluate which are really worthwhile, and very little attempt to direct the reader as to which of these systems criteria to pay attention to and which to discard. The overall look into the problems is quite superficial and lacks a critical analysis of which prior efforts the author feels were most useful and why. On the positive side, the book carefully considers the complex problem ofevaluating health care delivery. The author points out the difficulties not only in collecting data and verifying it, but also in even knowing what one should consider "health." He leaves the reader with the definite feeling that prior attempts to quantitate health with equations or composite lists fall far short of defining what most people would consider health. He points out the need for better understanding of outcome, and the need for patient participation in defining and implementing standards for health care. The author does make the point and successfully, I think, that it is still premature to assume that health care delivery, as we know it, can be quantitated, but that it is also too early to give up on this rather lofty goal. I feel the book suffers from a lack of clear hypothesis, direction and from a somewhat clumsy style, but does provide a good look into the problems and prior inadequate solutions, and serves to direct where we should go from here. HENRY R. BLACK Department of Internal Medicine Yale University School of Medicine