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The book is. in fact. a fruit salad of papers. The editors suggest the volume originated wilh Ihe Mining Industry Council gran~ but Ihey appear to have taken Ihe opportunity to reassure sundry other grantors that the work they funded. in whole or in part. has seen the light of day, although oomplete attribution of funding amongst alllhe grantors mentioned, and even the grantees. is \D1.cenain.

The cynical reader may form the view that this is a publication of expedience. rather than ooherence.

The book taken as a whole is to me unsati,factory and represents a lost opportunity. Its chapters considered as individual papers. however. do have lhe professional merit one would .xpect. T .G. Bergstrom', "Property Rights and Taxation in th. Australian Minerals Sector" and D.C.L. Nellor', 'Taxation of the Australian Resource, Sector" are useful oontributions 10 debate on a topical issue. "Some Quantitative Estimates of the Effects of Changes in the Minerals Sector" were dealt with by L.H. Cook and V J . Lees, and Cook also eollaborated wilh E. Sieper in a significant chapter on "Minerals Secror Growth and Structural Change".

A.O. Kruger and M.G. Potter contributed an .legant discussion of 'Th. Asset Theory of Exchange Rate Determination and the Resources Book". ThiJ iJ, naturally, a paper of im owo time. Pemaps. however, some readers will teflect a little on me wider contexl Amongst the "changes in the international economy" that "have evoked considerable attention among economists over the past decade" is the fact that "some countries have experienced either sizeable shifts in their terms of trade or the discovery of new natural resources". Nonh S •• oil, Om.dh JIIS and Ausualian minerals are cited. The Roman Empire, the Spanish push inro the ~,iWorld, the Industrial Revolution, British power in India: what w.re the implications of iIaMe....,nontic phenom.na under different international trade and payments systems? This book ..... ,of course not the place to pursue th ... matters, but it iJ wonh remembering that the phenmnena diacussed are not new, merely cIiff ..... t in manifestation and associated parameters.

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Susan Bambrick, Depanment of Eoonontics. The Faculties, Australian National University, GPO Box 4, Canberra, ACT 2601 .

ECONOMICS, MEDICINE AND HEALTH CARE by Gavin H. Moon.y. (Wheatsheaf Books, Brighton, 1986). pp. xi + 171. Paper $23.95.

The purpose of this book iJ to .mploy the discipline of economics to provide tho medical profession and other health care staff with insight into some of the problems facing health services around the world. It is Mooney" .xpressed hope that a better understanding of econontics can help health care professionals to punltJe better, more .fficient and fairer delivery of health care.

;Early in the book Mooney notes an apparent conflict between econontics and medicine, a <l0JI!]ict rooted in the different ethical bas.s upon which the two disciplin •• are founded. ';Eoonontics, based on a Utilitarian .thic, rcpr.senta a rational approach to the F.blem of allocating scarce resources among alternative us .. , Medicin., bued on an indlvidualiJtic medical . thic rather than a ,doctrin. of the common good, promote. in.fficiencies in the ,provision of health services. Emphasi,ing that health needs cannot always be met in. world of scarce r •• ource" Moon.y sugg.sm that the medical prof •• sion can no longer .rford lAI ignore economic realities whIch create choice. fundamentailAl human w.lfare. Without. wider use of economics health care inefficiencies will abound. The cosl of ineffipiency, inexplicitness and irrationality in health care is sickness and death. It is Ihe nature,'source, problems and resolution of this con/lict that are the central them.s of the book.

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In an introductory chapter written for non-e.conomists. Mooney discusses how markets operate and the techniques of economic appraisal . He rejects the historical conception of economics as "the dismal science" in favour of the view of economics as "the joyful art", since it attempts to maximise social benefit from the resources available subject to reasonable concerns with justice. In the following chapter he discusses the nature of the commodities "health" and ''health care". He orgues thai while no single feature or characteristic of health care is unique to health care there are rew goods, if any. which possess all the characteristics of uncertainty. irrationality. unpredictability. significant monopoly elements. paternalism and important externalities. It is argued that the combination of all those features makes health care unique as a commodity.

Mooney then addresses the problem of quantifying health and developing health status indices. Measurement is difficult for three reasons. viz. health is a value-laden concep~ health is multidimensional, and cardinal rather than ordinal measurement is required. The measurement of health has become a major interdisciplinary study with economists making their contribution alongside psychologists. operations researchers. sociologists and others. Mooney explores some problems in measuring health and outline. the requirements of a good health status index. His verdict is',that there is large scope for improvement in the area of health status measmement.

The next issue addressed i. that of values in health care. perhaps the area of health economics which is most distwbing for health care professionals. Mooney focuses on three questions. viz. the question of "whose values?", lhe question of how we elicit values from the relevant valuers. and Ihe question of how we might use one particular approach in practice. With respect to the fIBt question Mooney suggests thai not only may individuals be unable to evaluate the utility and/or disutility associated with different health states, but they often take the view that health care professionals are better placed to make judgments on their behalf. (This leads to the "agency relationship" between doctor and patienL) This casts doubts on the appropriateness of conventional demand theory. based on the consumer sovereignty assumption. to an evaluation of the commodities health and health care. With respect to the question of how we value outputs in health care Mooney provides a brief overview of the most common approaches to valuing human life. viz. the implied values. the human capital and the willingnes.-to-pay approaches. He sugg.sts thai the most appror.nale method to use at the present time is the unplied values approach. This approach, which' teases out" the values of saving life and reduced morbidity implied by past decisions. thereby yromoting cost­effective decision making in the provlsion of heallh services. has the merit 0 being based on the existing decision makin$ procedures and value structure of health care. Mooney then presents a method of weightmg health statu. which is based on this approach and suggests that an obvious place to begin 10 employ this method is at the clinical level where clinicians must make decisions as to how best to allocate their time and other resomces across the needs and demands of their various patients.

Mooney then goes on to argue that the concept of "need" as well as "demand" is important in analysing and evaluating health care policy and the implications of different patterns of health care. He argues that the cost-benefit approach off ... the most comprehensive method of coping with the problems raised in devising and using social indicators and measuring and using the concept of "need".

We are now in a better position to appreciate what Mooney refers to as "the inefficiency of medical ethics". He laments the fact that there is little or nothing thai can be identified as a doctrine of the common good in the contemporary ethics of health care. While the health care industry in all developed countries is a major social service. and where the qua1ity and appropriateness of both health care and the institutional 8Jl'angements for its delivery are subject to public debate. the medical profession continues to uphold inappropriate codes of conduCL More specifically. the primacy of the individual patient in health care has thwarted eflons to promote genuine social choice in this area. Mooney argues that medical ethics should admit an important role for Utilitarianism in health care valuation and consequently for the ethics of the common good. He suggests that a health care ethics is required. the basis of

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which is equal access for equal need. The primary advantage of a health care code is that it will help to restrict the cooe of medical ethics to where it belongs. essentially in the context of the relationship between the individual doctor and the individual patient. In order to protect the community's hea1th and foster efficient use of resources, priorities. planning and evaluation in health care should be subject to the principle that only those policies should be pursued which yield greater benefits than if the resources were devoted to alternative uses. Mooney's code of health care ethics is: simply the rational application of cost·benefit analysis to health care.

In a final chapter on "furore cha11enges" Mooney spells out some of the ways to pursue more efficient and equitable health care. One recommendation is that economics Conn part of the curriculum of medical. nursing and health service management courses. He also expresses regret concerning the shortage of trained health economists. A major challenge facing economists is to make the cost-benefit approach to the provision of health care services a practical reality.

Mooney's book is lucidly written in non-technical language. These are no small virtues considering the fact that the literature of health economics is becoming increasingly inaccessible to non-economists. with the result that health care professionals and health service management often fail to appreciate the relevance of economics to their decision making. The discussion of the role of value judgments in cost-benefit analysis should prove enlightening to many economists. The discussion of the different ethical bases of cost-benefit analysis and medical practice should interest medical persoMel and health service management as well as economists. although it is to be regretted that Mooney does not relate these differences to current work in ethics, especially the literature on SOClal choice. In what non­Utilitarian ttadition do we place medical ethics1 What sort of ethics is capable of integrating Utilitarianism with medical ethics? What extant theories of ethics and social choice are capable of infonning us about the possible ethical bases of health care systems? Mooney does not answer these questions. Nonetheless his discussion should serve as a useful springboard to more detailed analysis of the economic implications of alternative health care ethics.

Mooney's views are likely to be resisted by those who. for various reasons, are sceptical as to the use of cosl-benefit analysis in general. and its application in the health care area in particular. However. as the author himself would respond, the fact that the cost-benefit .pproach c"""o~ ti presen~ be applied to all the urious sorts of health care problems does not mean that it cannot be made to play an increasingly important role in determining resource allocation in this area. Clearly much effort is needed in the areas of measuring health status and valuing the outputs of health services. While these tasks are formidable it is up to economists to b}' to meet the challenge and for health service persoJUlCI to make greater use of economic appnusal where it is necessary for informed decision making in the health care area. Mooney's book is a valuable starting point for both purposes and should promote greater understanding between health care staff MId economists.

LanyDwyer. School of Business and Technology. MlICarthur Institute of Higher Education.

PO Box 555. Campbelltown. NSW 2560.

WATER PLANNING IN AUSTRALIA: FROM MYTHS TO REALITY edited by W.R.D. Sewell. J.W. Handmer and 0.1. Smith. (Centre for Resource and Envirorunental Studies. Canberra. 1985). pp. x + 263. Paper $16.95.

An overall review of the changes which have been made in planning the use of Australia's water resources is long overdue. Water Planning ;nAuslralia attempts to fulfill Lhis need by