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After reviewing the growth of health care spending and the causes of that growth, Enthoven (health policy, international studies, and public and private management, Stanford) sets out elements of the fundamental reform he finds necessary to solve the problem. Primarily that involves freer choice for

In this well-documented book, Alain Enthoven develops the ideas of consumer choice and managed competition of alternative health care financing and delivery systems, as well as describing ways to improve quality and reduce the cost of health care. He demonstrates how these ideas could be applied in the American employment-based health insurance model, how similar ideas have been introduced in the British National Health Service; how these ideas have been applied in the Netherlands; and the need for integrated comprehensive care systems.