Effective Clinical Practice
BOOK REVIEW
Chronic Care in America:
A 21st Century Challenge
The Institute for Health and Aging, University of California, San Francisco, for the Robert Wood Johnson Foundation, Princeton, New Jersey. 1996; 76 pages; free.
Spiral bound for easy reference, this book describes chronic care and chronic conditions in the United States. It is an excellent overview that aims to acquaint the reader with the breadth of the issues and provides many definitions, footnotes, and graphs in a brief, easy-to-read text. The book discusses a highly complex policy area and comprises the following elements:
- An introduction to chronic conditions (an overview of illnesses and impairments, including what they are, who is at risk for them, and how much they cost)
- A description of the chronic care "system" (the source of care, how it is financed, and trends of care)
- Stresses in the system (unmet need, potential for tradeoffs of lower-cost interventions, the demographic shift that will radically reduce the ratio of potential caregivers in the population)
- Policy challenges and 11 short profiles of groups that have had innovative responses to these challenges.
Clinicians in HMOs may want to use this book in establishing their plan's formulation of policy for population and disease management. It pulls into one place a disparate body of information about a subject that consumes three quarters of direct medical care resources. HMOs must have creative policy responses for managed care to gain leverage in resource management.
Robert A. Ludwig
Senior Vice President for Information Services
Health Care Plan
Buffalo, NY
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