FUTURE ISSUES IN HEALTH CARE: Social Policy and the Rationing of Medical Services

Mechanic's approach to health care dilemmas reckons with the complex realities of cost containment factors, physician attitudes, and health and illness behavior. As in Medical Sociology (1969), this regard for interrelationships gives him an edge over socialist theorists like Eliot Krause (Power and Illness, 1977), who believes nationalization a viable solution, or articulate doctors like John Knowles (Doing Better and Feeling Worse, 1977), who perhaps underestimates human resistance to the best prescriptions. Mechanic (Sociology, Univ. of Wisconsin) stresses the importance of understanding behavior in implementing policy; he questions assumptions about the ability of consumers to make informed choices--to use seat belts or drink moderately--and recognizes that increased government regulation of the existing morass will only extend and perpetuate an essentially flawed system. In considering integration of the mentally ill into the community, for example, he acknowledges why both hospital employees and neighborhood residents resist such efforts and, in assessing alternatives to institutionalization, he suggests that communities need incentives to make such programs attractive. Mechanic doesn't have all the answers but his ways of approaching the problems are rigorous, taking into account such variables as the centrality of doctor/patient communication or the reasons why health services research attracts critics. A dry text but not a stiff one, and the accumulated insights are estimable.