Strategy and management are important issues during a period of reform and change throughout the health systems of the industrialized world. This volume of 23 papers presents the global range of interpretation of strategy and management. A number of the papers present information and research results not available elsewhere and deserve mention: Toni Ashton's description of the introduction of user charges in the New Zealand health service is vital reading for policy-makers considering similar changes. Richard Janssen and Martin den Hartog's methods to analyse degrees of concentration and rivalry and hence the competitive potential in the Netherlands can be applied to any system that is considering the introduction of market mechanisms. More important, they draw clear conclusions from this analysis because of the increasing importance of strategic management in both hospitals and insurers. Lawton Burns, Jon Chilingerian and Douglas Wholey's presentation of multiple regression analysis of data from Arizona on physician efficiency in hospital resource use provides a surprising finding: there was no tendency for more experienced physicians to utilize hospital resources more efficiently, and physicians who concentrated their activity in one hospital used more resources than those with dispersed practices. Their techniques could be applied to the data bases generated by the Resource Management Initiative in the United Kingdom and elsewhere in Europe. Svein Raknes's paper on incentives in hospitals in Norway presents an interesting experiment. The issues are similar to those faced by managers of Clinical Directorates in the NHS, and replication of this work and other work in this volume in other systems is desirable.
The collection does have some deficiencies. It might have been useful for the editors to encourage the authors to tie their papers more clearly into issues of strategy and management: in some ways this is a collection of quite independent papers on health services, with no common threads. The preface simply gives a listing of the papers, and there is no afterword or commentary. This is unfortunate, as there are several places where commentary by the editors or the authors of each other's papers would have been very useful. For example, Martien van Tits and Wim Nuijens describe regional care planning in the Netherlands, and Frank Denton, Amiram Gafni and Byron Spencer present a planning model from Canada: a reader cannot help but wonder what do they think of each other's methods and approaches? A dialogue on planning would have been useful. There are several papers on technology and its assessment. While all are good, the lack of connections between them is disappointing. James Seldon and Greg Stoddart present a well-thought out argument that technology is not the major source of health care cost problems: how do they react to the difficulties in Greece, as clearly analysed by John Kyriopoulous and Dimitris Niakas? Quality assurance and quality improvement are discussed in six papers from Germany, England, the Netherlands and the USA, yet, there is no comparison of the techniques nor discussion of the differences and similarities to the approaches taken in the different studies. Some of the papers assume that the reader has an in-depth knowledge of the health system that is the context for the research: a few introductory paragraphs in those papers should have been added by the editors. Another drawback is that some of the quantitative research papers do not provide enough detailed information on their meth-0 1995 by John Wiley & Sons, Ltd.