Coping accountably in a dangerous world

The world is a dangerous place, and so is the health system; hospitals in particular.This was not self evident to this author before observing 20 years of health policy evolution in Western countries, together with some personal experience. This perspective is furthered by the two volumes reviewed here. In the view of this author, health policy is moving beyond, or at least supplementing, the structure and process emphasis, provided mainly by economists, but with under-girding from other disciplines, that has dominated during the last two decades. The new focus in health policy is not only on quality, but on what to do when quality breaks down and we cannot rely, however much we desire, on a clear systematic framework of standards, incentives, regulations, and controls (Chinitz, 2002). How do we go forward in a realm where the stakes are so high? While not providing all the answers, the two volumes examined by this essay certainly lay out the dilemmas and provide some realistic propositions, for moving forward in health policy and management. And, not surprisingly, economics loses its pre-eminence to other disciplines, especially law, organizational theory, and management.