This volume is a further addition to the McGraw-Hill/Open University Press ‘State of Health’ series, the whole of which is described by the series editor as intended to ‘contribute to debate about the future of health services through an analysis of major issues in health policy’ and to be ‘accessible to students and informed lay readers as well as to specialists’ (p. x). The book title is odd (perhaps a case of publishers’ insistence on something snappy and eye-catching) since the author rightly makes it clear as early as page 2 that health policies and health system reform across the world have in fact been rather varied. The overall structure of the book is conventional, with an Introduction and Conclusion (each containing some conceptual material about political philosophies and organisational forms of health care) sandwiching six thematic chapters. The choice of themes is interesting, including some topics (such as funding, governance and public health) that are the staples of this type of book, and others (such as quality/safety, information/ICT and the private sector) that are certainly important but have perhaps attracted less coverage in competing volumes. The themes are illustrated with examples, mainly drawn from Britain, the US and New Zealand. The book, then, sets itself a highly ambitious agenda: to inform a widely varied audience about a wide range of health policy topics across several countries, and to analyse all this in terms of contemporary political ideologies and theories of organisation.

Unfortunately, descriptions of health policies seem impressionistic and unsystematic and are not systematically compared across countries. The result is that the reader is not given details that are essential for any real understanding of the policies under discussion. Thus we are told (correctly) that British GPs are now subject to a radical pay-for-performance system (p. 141), but given no information about how ‘performance’ is defined in this context. Similarly, an official document from 2000 is (again correctly) cited as setting an aspiration for patients to be able to choose between hospitals, but I could find no description of the subsequent policy of so-called ‘choose-and-book’ or any of its effects. Moreover, the focus of the thematic accounts is predominantly on policy and organisational forms, rather than on impact, and some potentially important assertions (concerning rising demand for care, and a shift towards ‘network’ organisational forms) are not buttressed by evidence or citations (pp. 8, 12).

Perhaps inevitably in a work of such breadth, there are factual errors. The Primary Care Groups established in the NHS after 1997 were not responsible for commissioning secondary care (p. 30), ‘practice-based commissioning’ does not in practice devolve commissioning to NHS general practice level, but usually to consortia of multiple practices (p. 31), and the UK General Medical Council does not ‘oversee the range of professional colleges’ (p. 93), but maintains registers of qualified medical practitioners. And surely John Snow's famous 1854 investigations of the Broad Street pump in London concluded that cholera was ingested by drinking the water rather than from the pump handle (p. 107)?

Nor is the book conceptually rigorous. For instance, ‘patient involvement’ is defined as relating to the treatment and care of individuals (p. 95) but then employed to include patient opinion about service configuration (p. 97). Again, ‘governance’ is initially defined as ‘structures for governing services’, such as boards of management (pp. 84–5) but then discussed in the rather different political science sense of ‘governing without government’ (pp. 85–6). Elsewhere, large public hospitals (in the postwar period) are classified as ‘classic’ bureaucracies (p. 7), whereas many analysts would consider them to have been (after Mintzberg) professional bureaucracies, with areas of professional work ungoverned by bureaucratic rules.

Regrettably, this book does not really succeed in its considerable ambitions. Perhaps no book could do so. In any event, accurate and systematic coverage of a single country, or of a more restricted range of policy themes, would have been preferable.