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Four Strong Winds: Understanding the Growing Challenges to Health Care

by Michael B. Decter

Few Canadians remain untouched by the turbulent state of our health care system. Constant reports of crisis have resulted in widespread disillusionment. However, Michael B. Decter’s look at the forces behind health care changes takes a calm and reassuringly positive approach. Although his attempts to compare systems in different countries are sometimes disjointed, his book provides valuable information about health care today and tomorrow.

A Harvard-trained economist, experienced in both the public and private sectors, Decter knows his subject. He writes clearly but does not oversimplify as he describes the “winds of change” affecting health care worldwide – new ideas, changing public expectations, technological advances, and financial constraints. As the title suggests, Decter employs nautical analogies – he taught sailing as a youth – for clarity throughout his text. If he risks overusing the motif, it certainly offers a breath of fresh air to a very dry topic.

The book explores the Canadian system, with its spending cuts, hospital closures, and downloading of health care to the provinces, without sensationalizing. Viewing issues from various angles adds credibility to Decter’s conclusions; he looks at health care in the United States, throughout Europe, and beyond, and the United Kingdom appears to get the highest marks. Case studies are limited to four countries, however, and the attention given other nations is uneven throughout. The book’s charts and tables can be difficult to interpret, and the glossary of terms, while useful, is not extensive.

Decter predicts more turbulence in health care over the next decade. Patients – or consumers – must learn to handle their own care, and the book provides fascinating details about home care, telehome care, tailor-made disease treatment, and human genetics. This is hardly the book to take on summer vacation, but those who stay the course through its complexities will emerge better equipped to understand the changing nature of health care.