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Published 12/1/2013
Douglas W. Lundy, MD, FACS

New Primer on Health Policy a “Must-Read”

Book Review

An Introduction to Health Policy: A Primer for Physicians and Medical Students

Manish K. Sethi, MD, and William H. Frist, MD
2013, 387 pages
ISBN–13: 978-1461477341

A significant deficiency in medical education today is an adequate understanding of health policy and the entire litany of issues that health policy encompasses. Medical students enter residency without this information, and residents/fellows start practice with limited knowledge of how payers process claims, how quality is measured in health care, how healthcare reform is developing, or how the political system affects what they do on a daily basis.

Some may argue that understanding policy is less relevant than assimilating a massive amount of clinical information. Unfortunately, this means that most clinicians have only a superficial education about the sociopolitical paradigm that will govern their practices.

Editors Manish K. Sethi, MD, and William H. Frist, MD, substantially address this issue in their book, An Introduction to Health Policy: A Primer for Physicians and Medical Students. Dr. Sethi, an orthopaedic trauma surgeon at Vanderbilt University Medical Center, is director of the Vanderbilt Orthopaedic Institute Center for Health Policy, and has frequently written for AAOS Now. Dr. Frist currently practices cardiothoracic surgery at Vanderbilt University Medical Center, but has also held political office, serving as U.S. Senator from Tennessee (1995–2007) and as Senate Majority Leader (2003–2007). They have recruited a collection of authors who outline health policy concepts in an easy-to-understand format.

The text is well written and should be a must-read for all orthopaedic residents, fellows, and practicing orthopaedic surgeons across the United States. The issues are explained clearly and concisely, providing sufficient depth for the reader to gain a practical understanding of the issue. In the current era of healthcare reform, such an understanding of social and political issues is integral for the survival of organized medicine.

Four sections
The first section addresses the history of health care in the United States and provides readers with a comprehensive understanding of how the current U.S. payment system operates. Chapters cover Medicare, Medicaid, and private insurance systems so that readers understand how and why these systems developed.

For example, Kevin J. Bozic, MD, MBA, and Benedict U. Nwachukwu, MD, describe the different parts of Medicare, how they developed, and where Medicare is heading. The section ends with an explanation of the interrelationships between healthcare quality and cost.

The next section addresses many current healthcare policy issues. This section exposes the reader to the background of concepts such as preventive medicine, comparative effectiveness research, health information technology, and pharmaceutical policies, the economics of health care, and the issues of health disparity.

The next two sections address the issues of healthcare reform and provide salient information on the evolution of the current system and the principles governing its reform. After reviewing the history of the U.S. healthcare system, the book outlines proposed alternatives designed to correct some of the problems in the U.S. healthcare delivery system. In addition, it covers the pros, cons, and lessons from other healthcare systems in developed countries around the world. The section concludes with a chapter on reimbursement.

Finally, the book turns to the politics of healthcare reform. The authors discuss the political process on both federal and state levels. They also provide background on the 2006 Massachusetts Healthcare Reform Act and the lessons learned from that experiment. The last chapter provides a clear, understandable explanation of the 2010 Patient Protection and Affordable Care Act and its impact on patient care.

Just what we needed
In conclusion, I believe this book is long overdue. Many new physicians—and even some established physicians—have the clinical expertise to treat patients, but are clueless about the U.S. healthcare system and its impact on their practices. An Introduction to Health Policy: A Primer for Physicians and Medical Students is, in my mind, a must-read for orthopaedic residents and fellows.

Those of us already in practice will quickly gain an understanding of the issues that have confused us since we finished residency. Written by doctors for doctors, the book addresses what we want and need to know without getting lost in minutiae. Based on principles that will not quickly become outdated, this book will be valuable for physicians and students into the future.

Douglas W. Lundy, MD, FACS, is a member of the AAOS Council on Advocacy, liaison to the Communications Cabinet, and a member of the AAOS Now editorial board.