books

Dictionary of health economics

By Alan Earl-SlaterRadcliffe Medical Press 159 pages£19.95

The language of economics seems to have colonised health policy discussions in recent years. No decision is complete without a full consideration of its cost-benefit implications and an assurance that it will represent a cost-effective use of resources.

When considering the use of scarce resources we are urged to consider not only the benefits that will accrue but also the opportunity costs.

More generally, the era of the internal market spawned a whole new lexicon: terms such as contestability, spot purchasing and transaction costs became staple components of health management-speak.

Although this era has now passed, it has left a legacy in terms of the continued quest for productive and allocative efficiency. In short, a passable level of economic literacy is a must for an aspiring health service manager.

If you fit into this category and are not sure of the difference between cost-effectiveness and cost-utility analysis, this book may help you out. It is aimed at a wide range of health professionals and practitioners who may need speedy clarification of an unfamiliar health economics term that they encounter.

To this end, it offers brief descriptions of a range of terms and concepts used by health economists and those working in related disciplines. In fact, it is rather more than a conventional dictionary, offering potted explanations with diagrams, which cover up to three pages, of terms such as indifference curves and Gini co-efficients.

The sub-discipline of health economics is on the edge of mainstream economics drawing on material from, for example, epidemiology, statistics and psychology. The dictionary reflects this eclectic tradition.

Its coverage of mainstream economics is far less comprehensive and thorough than the earlier Penguin Dictionary of Economics - and it gets some definitions wrong, such as a potential Pareto improvement. There are also some surprising omissions - for example, econometrics, regression analysis, and some strange inclusions - such as tax avoidance and evasion.

Set against these limitations, the book covers many terms used by health economists and not found in mainstream economics texts, such as quality of life measures, numbers needed to treat, and the Jarman index. These will no doubt be of use to busy people looking for a brief introductory explanation of such terms.

My main reservation about the book is not with its contents and how they are presented, but with the underlying idea.

It presents economics as a cook-book subject, which it is not. It is a theory-driven subject, comprising a rich set of analytical concepts, that proceeds through deductive reasoning. Encouraging people to dip into the subject through a dictionary completely loses this essence. My advice is: if you are going to use this book make sure you have a good health economics or micro-economics text to hand as well.

Professor Ray Robinson

London School of Economics