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Logo of jmedethJournal of Medical EthicsVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Med Ethics. 2007 August; 33(8): 496.
PMCID: PMC2598164

Medicine and the market – equity v. choice

Reviewed by Søren Holm

Daniel Callahan, Angela A Wasunna. Baltimore: The John Hapkins University Press, 2006, $35 (hardback) ISBN 0‐8018‐8339‐3, pp 321.

In this book, the authors' aim is to assess the evidence for the positive effects of market practices in healthcare and to provide an ethical evaluation of these market practices. It is clear from the beginning that the authors are not setting up a simple, and thereby false, dichotomy between market provision and equity in healthcare, but that they are genuinely interested in exactly what elements of market practices are useful and ethically acceptable. They argue convincingly that in order to provide such an analysis it is necessary to look in detail at a wide range of healthcare systems – systems that differ both in attitudes towards market competition in health care and in the resources available. One of the book's strongest points is that it moves away from an analysis focused almost exclusively on the USA, Canada and the UK, and provides evidence from many different healthcare systems in Europe, Central and South America, Africa and Asia. By widening the scope of interest, it becomes possible to see that market practices that are ethically acceptable in some circumstances may have such severe distributional effects in other contexts that they become unacceptable. What we have to ask therefore is the specific question: will the introduction of this market approach in this healthcare system have generally positive effects? In most cases, the authors answer this question in the negative, as could probably be predicted from Daniel Callahan's previous work, but they always provide extensive arguments to back up their assessments. The authors' most severe criticism is levelled at those on both sides of the argument who propose or oppose market practices purely on theoretical or ideological grounds.

This is an excellent book and very reasonably priced. It should find a place on the shelf of everyone seriously interested in resource allocation in healthcare and in the design of healthare systems. My only criticism is that it could probably have been around 10% shorter. Some of the material concerning individual healthcare systems could probably have been cut, or the number of healthcare systems analysed curtailed to some degree.

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