BOOKS

Public and Private Roles in Health Care Systems Reform experience in seven OECD countries By Claudia Scott Publisher: Open University Press. ISBN: 0335204597.£16.99.

Claudia Scott was either lucky or highly prescient to start to work on a book about the public-private interface in healthcare some years ago.

It arrives at just the right time to offer a refreshing antidote to the polarised, dogmatic and rather silly debate that rages about he private sector's role in the NHS.

There are two viewpoints.

First, the private sector is a satanic conspiracy of moneygrabbers out to destroy the NHS and all the loyal, heroic public sector workers in it.

Second, the NHS is the last refuge of bloated, inefficient public sector bureaucracy, about to collapse through its own incompetence, and can only be saved by the efficient and decisive private sector.

Scott's book might bring some sanity to the issues - if only the protagonists could be persuaded to read it. She describes how both public and private sectors contribute to healthcare funding, purchasing and provision in seven Organisation for Economic Co-operation and Development countries - Germany, the Netherlands, the US, Canada, Australia, New Zealand and the UK.

For each, she gives a succinct overview of how the health system works and then goes on to describe the interplay between government (local and central), non-profit institutions (charities, mutual organisations, and public corporations), and commercial entities (insurers, companies, medical groups, and so on).

It is a great world tour, but only in the final chapter do the wider lessons begin to emerge.

Scott identifies an international trend towards private sector involvement in healthcare, with greater competition and contestability, even in countries where most healthcare organisations are government or non-profit institutions. She finds that governments everywhere are moving away from a direct role in provision or management towards a more strategic role, focused on planning, regulation and oversight.

She warns against the pitfalls and high risks of 'big bang' reforms, notes widespread change fatigue, and says governments everywhere focus on structural reform at the expense of cultural and developmental issues. Let's hope someone at the Department of Health reads this bit.

Perhaps the main value of the book to the NHS is that it might influence the puerile, yah-boo debate about private sector involvement, and help make policy development in this area rather more evidence-based.

Private sector involvement is neither the death knell for the NHS, nor a panacea for all its ills. The truth, as always, is not that simple.

The academic in me would like the book to be more comprehensively referenced, while the manager in me would like shorter, snappier prose, but these are minor quibbles.

Overall, Scott's book is a breath of fresh air on a topic where we have a shortage of evidence and a surfeit of opinion.