ABSTRACT
Any writer on health care in the USA has to overcome the natural inclination to concentrate on the differences with the British National Health Service (NHS), which can quickly lead to the erroneous conclusion that we can learn nothing of value from this complex, fragmented and expensive industry. The use of the term 'industry' is deliberate and is meant to convey both the financial sums involved, and the management techniques and operating philosophies displayed by those working within it. It remains unfashionable to think of the NHS in such terms, but this book sets out to demonstrate that both systems share certain common concerns - and that this is particularly true when looking at the role and methodologies used by managed care companies in general, and health maintenance organizations (HMOs) in particular. It should also be borne in mind that the US health care system has operated in a market environment for many years. As a result it has developed some advanced micro-management techniques and an operating philosophy dominated by the knowledge that patients can - and often will - move company/provider if they are dissatisfied with the service they receive and/or consider it too expensive. Only those married to the most rigid of preconceptions as to what constitutes 'good health care' would consider such experience irrelevant to the UK.
