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J Epidemiol Community Health. 2007 November; 61(11): 1014.
PMCID: PMC2465620

The political economy of health care. A clinical perspective

Reviewed by Gerry Richardson

Julian Tudor Hart, Bristol: The Policy Press, 2006, £14.99, ISBN 1861348088

Not surprisingly, this is a socialist view on the history, current state and future of the National Health Service. The book provides interesting insights into the working of the National Health Service (NHS) and its aims and objectives, which, Tudor Hart argues, are almost entirely “hard” health outcomes (healthier births and so on) with perhaps some role in the legitimisation of the state. Little attention is given to process outcomes of the NHS or to outcomes that may be beneficial outside the healthcare sector. Happiness, in Tudor Harts' view, is a part of health, in that someone who is unhappy is not healthy. This simplifies the arguments around the subject and runs counter to a substantial literature in which happiness is the ultimate aim and good health a part of this.

The book contains numerous similar simplifications and generalisations. Economists are in general portrayed as right wing pro‐marketeers who advocate the restructuring of the NHS on industrial lines. This simplification leads Tudor Hart to the conclusion that we need an “entirely different from of economic theory” for healthcare, and that health economists to date have contributed little. This is despite a huge amount of work in health economics examining inequity and inequality in health, largely due to the realisation that markets do not work adequately, as well as a large literature on the evaluation of healthcare reforms worldwide comparing the relative merits of different healthcare systems.

Private medicine and its practitioners fare even worse than health economists in Tudor Harts' world. They can only exist as a “parasitic adjunct” to the NHS (or similar). “Healthcare defeatists” or nihilists also receive short shrift, with their arguments despatched with a couple of references and the anecdotal “people's daily experience”.

Nevertheless, the author makes some interesting points. The “creeping commercialism” of the NHS and the intrusion of profit as an objective to be maximised at the expense of “motivation, thrift, caution and scepticism” are worthy of attention. Seeing the NHS as a means of regaining the solidarity or community spirit of our society is another attractive concept in a book that certainly lives up to the billing that it challenges conventional wisdom!


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