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The Health Care Handbook

Elisabeth Askin and Nathan Moore

Washington University Press, St Louis, 2012, 239 pp., $15.99, paperback.

As I entered my medical career, I was embarrassed to reveal how much I did not know about various aspects of the health care system. As an early medical student, I could not describe to family and friends the difference between an intern, a resident, and a fellow. Nearing the end of medical school, I was unable to properly explain to patients the difference between an HMO and PPO. As a resident, I was constantly confused by the dual roles of licensing and certification. And now as a practicing physician, I still struggle with things such as my role in the larger system and how my practice fits into continual delivery reforms.

At some point along the way, I realized that if these things were confusing to me, imagine how confusing and frustrating the health care system is to patients who are trying to navigate its complexities. Hence The Health Care Handbook, “a thorough overview of the American health care system,” written by two medical students for the general public, as well as health care professionals and students. The introduction describes the book’s purpose as “to provide a baseline level of facts and analysis so that readers may go forth with the ability not only to understand and evaluate what they read but also to form their own opinions.” This is accomplished through a broad summary of five areas of health care (Systems and Delivery; Health Care Providers; Insurance and Economics; Research, Pharmaceuticals, and Medical Devices; and Policy and Reform). The authors make it clear that this book is not intended to provide comprehensive knowledge of these issues, but they do support their brief synopses with suggested follow-up readings to provide further study on the given topics when desired.

The book fulfills its stated purpose reasonably well. The descriptions are concise and well informed, with good use of understandable examples and graphs. The prose is clear and readable, with some passable attempts at humor to keep it interesting. The authors’ attempts at full objectivity are commendable but predictably fall slightly short. While they do discuss common pros and cons to complicated issues to support readers’ understanding, the descriptions of the Affordable Care Act (ACA) and other sundry topics belie their stated neutrality. Thankfully, these are likely not severe enough infractions to cloud basic comprehension of the issues.

As ever, the practice and structure of health care is evolving. Any book on this topic therefore faces an expiration date at which time it will no longer be relevant, especially now as the original intention of the ACA gives way to the politics of policy implementation. Due to this continual change, these topics have received little attention in medical training, in anticipation that experience in the field will provide the necessary education. Despite that, this book does fill a necessary void of an urgently needed and practical resource for patients and health care professionals alike, on issues that go above and beyond the ACA.

This book can be an excellent resource to help family medicine educators teach residents and other learners the appropriate context for practice enhancement, quality improvement, and the patient-centered medical home. The book’s structure can help learners see the system as it currently is, thereby facilitating comprehension of their place in it and their evolving role in further care reform. It is a resource that can be used both in informal clinical settings, as well as more formal didactic instruction.

The Health Care Handbook is therefore fundamental for every doctor’s office to inform all members of the expanding medical team, particularly for those with less formal medical training. It allows all of us to better understand the complex system of which we are a part, thus allowing us to better serve our patients and work to simplify the barriers that they face.

Kyle Bradford Jones, MD

University of Utah

Copyright 2018 by Society of Teachers of Family Medicine