“Every social mechanism appears to have a dual potential for good and evil. Prepayment for medical care is no exception. On the one hand, it provides assurance of necessary care as a safeguard to health, economic well-being, and peace of mind. On the other hand, it opens the way to wasteful and harmful care, to price inflation, and to concealed redistributions in socially undesirable directions. The problem is to devise a plan that allows us to reap the most advantages while we incur the fewest drawbacks.”
Benefits in Medical Care Programs is a comprehensive treatment of this problem. Avedis Donabedian begins with a clear and straightforward analysis of his own assumptions about the social mandate for medical care benefits, the objectives of medical care programs, and the magnitude and distribution of the unmet need that these programs are designed to alleviate. The problem of defining and measuring the need for care is considered within the context of the data yielded by alternative definitions. The analysis then shifts to the impact of benefits on certain key features of the medical care system.
Program benefits are weighed against program objectives, and policy implications are drawn from this comparison. We are shown what can and cannot be accomplished through medical care benefits and what goals are served by specific aspects of existing or proposed plans. Although Dr. Donabedian counsels a fairly thorough reform of existing systems, he remains skeptical about the possibility of designing a perfect system, and he does not hesitate to point out that increased access to care “increases exposure to both what is good and what is bad in our system of medical care… The machinery of medical care has a sinister potential for those who fall into it in the wrong place at the wrong time.”
Dr. Donabedian’s previous book, Aspects of Medical Care Administration, has been called the “Bible” of its field. Benefits in Medical Care Programs should prove equally invaluable.