378 BOOK REVIEWS

discussion further, focusing on a specific model such as a stress adaptation model or the use of a developmental model; while other chapters deal with a specific situation such as a model for health visiting or a model for accident and emergency nursing. A third group of chapters follow through on the discussion of the use of models by considering, for example, ‘Nursing models and multidisciplinary team work,’ and ‘Exploring the issues’. Concluding the volume is a chapter by Professor McFarlane, entitled ‘Looking to the future’.

The contributors cover a wide range of expertise and experience. Some, such as Alan Pearson and Steve Wright, are actively involved in clinical nursing, while others are working in academic nursing departments, Some are employed in the hospital setting, whilst June Clarke is actively working within the community; two, Nancy Roper and Jane Salvage, are writers. With such a variety of backgrounds it is perhaps inevitable that the structure and content of the chapters vary both in quality and quantity, and this makes for a certain unevenness when reading the book. Nevertheless, all are very clearly written, and line drawings, diagrams and charts are clear and easy to understand. In addition, chapter 6 has some very amusing drawings and it is a pity that these are not more evenly distributed throughout the rest of the book. At the end of each chapter there is an adequate list of references drawing to the reader’s attention the articles or books in which the models were first developed. These references are essential for the reader to get a comprehensive picture of the ways in which models for nursing have evolved.

As June Clarke says in her chapter, ‘A model for health visiting’, the value of a model should be measured not by the way it looks on paper but by its usefulness in practice; one of the strengths of this book is that there is a very real attempt to demonstrate how the models can be used in practice.

The index is reasonably comprehensive and the total production is clear and easy to follow, also, the price is moderate and well within the reach of the pocket of most nurses. This book will be of great value to nurses in training, as well as for those who are qualified and wish to know more about models for nursing. There should be a copy in every nursing library.

CHRISTINE CHAPMAN, Professor and Head,

Department of Nursing Studies, University of Wales College of Medicine,

Cardiff, Wales.

M. F. DRUMMOND, ANNE LUDBROOK, KAREN LOWSON and ANNE STEEL, Studies in Economic Appraisal in Health Care, Volume 2, Oxford: Oxford University Press, 1986, 303 pages. Price (UK) f25 hardback.

Health economics has a major contribution to make to evaluating the alternative uses of scarce health care resources. This platitude trips off the tongue of any self-respecting health economist, but sceptics must now be asking what their contribution has been, particularly since the publication of Principles of Economic Appraisal in Health Care (1980), written by Drummond, co-author of this second volume of studies.

The volume on ‘principles’ was intended as a guide for non-economists interested in economic appraisal. It had a companion volume, also written by Drummond, entitled Studies in Economic Appraisal in Health Care (1981), which summarized the methods and results of 101 studies undertaken prior to 1979. This latest volume now examines a further 100, and more recent, studies.

The format of the book is as follows. The introduction is largely unchanged from that appearing in volume 1. It emphasizes that the aim of the book is to raise questions about the methods and results for potential users, rather than confront authors with marks out of ten for their study. The next chapter is entitled ‘Current methodological issues in economic appraisals in health care’. This is an addition to the format in volume 1: it reviews developments in the methodology of economic appraisal in health

BOOK REVIEWS 379

care since the publication of the 1980 volume, whilst drawing attention to common weaknesses of many of the studies.

Most of the book is taken up with summaries of published work, but in a format that differs from the previous volume in two important aspects. Firstly, the studies are divided into sections (four edited by Drummond and two by Ludbrook) according to the subject area of the evaluation: burden of disease and alternatives in public policy; prevention; diagnosis; therapy; locations of care; and health service organization. Some overlap of these subject areas is inevitable. The second new feature is a short introduction to each section, which deals with pertinent methodological problems, the current state of the art, and the contribution to decision-making of the studies summarized.

The classification scheme used for each study is the same as in volume 1, and has the following steps; study design, assessment of costs and benefits, allowance for differential timing and uncertainty, and results and conclusions. Under these headings Drummond et al. discuss the virtues and shortcomings of each study, covering the well-trodden methodological issues of whether the study in question was a randomized controlled trial, whether it included all costs and benefits regardless of where they were felt, the validity of the costing and outcome measurement, the use of incremental analysis, the presentation of results.

To have a single framework by which to judge economic evaluations in health care must be the envy of other social science disciplines. Inevitably the economic framework can be criticized for being too reductionist and detached from health service decision- making, and the authors do not consider alternatives such as the pluristic approach to evaluation. This is because they are solely concerned with the ‘economic’ approach, and this restriction allows them to examine 100 studies from a diverse range of subject areas in health care taken from many different countries (mainly the UK, USA and Canada) in a book of some 300 pages.

At the same time, they are able to stress the technical problems of reproducing localized and experimental results to the service environment, whilst acknowledging that factors other than economic efficiency often determine decisions, such as equity and the cost of managerial or organizational change. The authors do recommend that, in any economic evaluation, the calculus of costs and benefits is derived for different viewpoints as well as for society as a whole (such as health authorities, family practitioner commit- tees, local authorities, patients’ families), in an attempt to understand the incentives and disincentives to achieving the potential improvement.

The authors do not state explicitly their intended readership for the book. In volume 1, Drummond was less modest and considered the studies discussed to be of value of medical research, health service planning, and for resource allocation decisions. For any researcher in the field of evaluation this book is an important reference: it is the most comprehensive and up-to-date assessment available of studies in economic appraisal in health care; for health service planners it is an important part of the information base required for rational planning; and, clinicians should be interested in studies related to their medical practice since this book is written in a style which is easily accessible to non-economists. However, it cannot be a substitute for studying the original published papers, or a substitute for enlisting the help of health economists on the evaluation of specific health care interventions.

REFERENCES Drummond, M. F. (1980). Principles of Economic Appraisal in Health Care. Oxford:

Drummond, M. F. (1981). Studies in Economic Appraisal in Health Care. Oxford: Oxford University Press.

Oxford University Press.

JOHN BRAZIER, Department of Community Medicine,

United Medical and Dental Schools of Guy’s and St Thomas’ Hospitals,

London, England.