BOOKS - Kieran Walshe Senior research fellow, health services management centre, Birmingham University

US Managed Care and PCTS: lessons to a small island from a lost continent Edited by Jonathan Weiner, Richard Lewis and Stephen Gilliam Publisher: The King's Fund ISBN:1 85717 443 7.50 pages.£6.99.

The US healthcare system is enormously costly, wildly inefficient, hugely inequitable, performs badly in comparison with the UK or Europe on almost any health indicator you care to mention, and is impossible to reform.

It is therefore a bit odd, to say the least, that planeloads of British policymakers and academics cross the Atlantic to learn from the US experience and to get ideas that they then try out in the NHS.

The subtitle of this report on US managed care and the lessons for primary care trusts - 'lessons to a small island from a lost continent' - ruefully acknowledges this paradox.

However, the content also demonstrates that there is a reason for looking outside the NHS because, despite the huge differences in context and culture, we have got a lot to learn from other countries - even those as dysfunctional as the US.

Jonathan Weiner and his colleagues provide a great primer on managed care, which helps the British reader to make sense of the alphabet soup of models and to understand the essentially straightforward dynamics of managed care organisations.

But it is the second half of the report that makes the most interesting reading.Weiner and his co-authors discuss the development of primary care trusts - which in two years' time seem likely to be running almost everything in the NHS and social care - and draw some important lessons from the US experience of building similar organisations.

PCT chief executives may be chastened by their observation that in the US organisations serving a population of around 100,000 would have 30-50 administrative staff (compared with an average of 4.4 for primary care groups of that size).

They may also be interested in the argument that the average PCT should serve a population of 350,000 - at least if it is to achieve useful economies of scale or have real market clout.

Weiner and his co-authors put forward a good case for new ways of paying and using GPs, changes to skill-mix and contracts, better use of IT, and the wider use of comparative data in clinical governance in primary care.

But the biggest lesson to be learned from the US managed care experience for new PCTs is that if you antagonise and disadvantage your doctors, driving down their income, increasing their workload and making life generally more difficult while offering few if any compensating benefits, they will eventually fight back.

And then you have real problems. . .