In this well-documented book, Alain Enthoven develops the ideas of consumer choice and managed competition of alternative health care financing and delivery systems, as well as describing ways to improve quality and reduce the cost of health care. He demonstrates how these ideas could be applied in the American employment-based health insurance model, how similar ideas have been introduced in the British National Health Service; how these ideas have been applied in the Netherlands; and the need for integrated comprehensive care systems. This unique anthology traces the development of two important and related themes. Firstly, the 'output' of the health services industry has been produced by disaggregated physicians, nurses and other health professionals, hospitals, drugs and device companies that somehow combine to serve the patient. Progress in quality and the economy requires the services of these components to be integrated into coherent systems in which the incentives of all providers are aligned with the needs and wants of patients for quality affordable care. Secondly, the book argues that the framework that can provide such incentives, is an appropriately designed form of market competition among systems of care seeking to serve value-conscious patients. Public officials, scholars and policy analysts from developing countries will find here a set of ideas for how to improve incentives for greater value for money. Students of health economics, policy and organization, as well as journalists and public officials interested in the use of public policy to improve efficiency in health care systems, will also find much to interest them in this book.

After reviewing the growth of health care spending and the causes of that growth, Enthoven (health policy, international studies, and public and private management, Stanford) sets out elements of the fundamental reform he finds necessary to solve the problem. Primarily that involves freer choice for

Originally published in 1971, and now published with a new foreword, this is a book of enduring value and lasting relevance. The authors detail the application, history, and controversies surrounding the Planning, Programming, and Budgeting System (PPBS), used to evaluate military needs and to choose among alternatives for meeting those needs.