Hospital care is a crapshoot for most Americans, according to Pulitzer Prize-winning investigative journalist Bogdanich of The Wall Street Journal, who says here that the myth that all hospitals are equally good and deserving of our trust is medicine's ""great white lie."" Bogdanich pulls no punches, naming hospitals, administrators, professional associations, doctors, nurses, technicians, and others in his thoroughly documented exposÃ‰. The problems are manifold--reliance on unqualified temporary help; improper training and supervision of pharmacy and lab technicians; life-threatening patient-discharge policies; and fraudulent billing practices. Competition among hospitals has even pushed some to bribe doctors for patients and to offer bonuses for meeting surgery quotas. Bogdanich cites the failure of the medical establishment to regulate hospitals, and faults the government for relying on such self-regulation. The Joint Commission on Accreditation of Healthcare Organizations, which rarely denies a hospital accreditation, comes in for some sharp criticism, as does the US Department of Health and Human Services, which Bogdanich asserts has recently been headed by people without will or vision. Although Medicare--the nation's largest buyer of hospital services--could dramatically reform care by reimbursing only those hospitals able to demonstrate high quality, prospects for change are poor. One solution Bogdanich explores is an effort by corporations in Cleveland, concerned about rising medical-insurance costs, to direct employees to the highest-quality, low-cost hospitals. In this instance, hospitals and businesses are working together to define and measure quality and by 1992 will be distributing information on quality and costs to employees. Meanwhile, Bogdanich counsels, if there's hospital care in your future, scrutinize it as carefully as you would any other prospective purchase. Hard-hitting and fact-filled indictment of a system overdue for reform.