Home Care for Older People in Europe

The subject of health services evaluation is curiously lacking a book near to being described as a standard textbook. The interested reader, at all levels, must refer to a range of discipline based texts. The gap in the market is there, but has it been adequately met by Leger and colleagues? To be fair, the authors do not claim the grandeur of textbook status for their book. It would seem closer to being a "taster" for those involved in decision making (eg, clinicians and managers), commissioning research, and students. The content of the book is extensive, covering a general overview of health services evaluation, routine information sources in the United Kingdom, study design, and methodological issues (mainly statistical and economic), and it has an interesting discussion of the role of health services evaluation in decision making. A serious omission is a reasonably detailed discussion ofhealth status measurement. The material on routine information and quality adjusted life years fail to do this essential subject justice (eg, the Nottingham health profile only gets a mention in the appendix). A key quesion is whether this book provides an adequate introduction to the main discipline for health services evaluation and hence at this level avoids reference to other texts. There is very little on the sociological literature. My own discipline of health economics had an entire chapter but has contained unnecessary material on market theory and yet was deficient on the area of prime interest, economic evaluation. I will continue to refer students to journal articles and Drummond's text. Throughout, the authors succeed in avoiding unnecessary technical language, diagrams, or mathematics. The chapter on methods is especially readable. However, chapters 1 and 2, which introduce health services evaluation, are difficult to read and contain some poor definitions and odd mistakes. As an economist, my sensibilities were upset by the absence of cost in the definition of evaluation and the statement "Costeffectiveness is the financial cost for a given outcome". (This error was not repeated later, where non-financial costs were acknowledged.) The authors failed to convince me that the often contrived distinctions between goals, aims, and objectives add anything to Donebedian's framework for health services evaluation. The authors are clearly committed to evaluation and its growing importance. In overall tone the authors have a sensible and pragmatic view of practical health services evaluation. However, as an introduction to the subject this book is unlikely to replace existing disciplinary texts.