BOOK REVIEWS 389

Evaluation of Health Care, edited by Walter W. Holland. Oxford: Oxford University Press, 1983, 289pp, $45.00 (hardcover)

Reviewer: Hugh Freeman

The particular focus of this volume, which is edited by Professor Holland of St. Thomas’s Hospital, London, is that of concepts and methods of evaluation in health care. It was conceived by the Commission of the Euro- pean Communities (EEC) and follows an earlier col- lection of papers from the same stable on health care and epidemiology. As an EEC enterprise, it includes 27 contributors from 10 European countries; there are, of course, both positive and negative aspects to such international cooperation, which becomes obvious in the course of reading this present book. The editor points out that a valid form of evaluation is essential before formulating planning decisions on health ser- vices, particularly when resources are scarce-as they are now, relatively speaking, in most countries. Only when this has been done will it be possible to develop more rational service structures and more appropriate forms of providing health care to populations.

Of the book’s three sections, the first is concerned with concepts and meanings, the second with available methods of evaluation, and the third with descrip- tions of ongoing evaluative work in different areas of health care. Sections 1 and 3 were, in fact, compiled by a committee; in the manner of such cooperative ef- forts, they are generally informative and comprehen- sive but rather dull. Topics included here are disease models, formulating objectives, manpower, efficiency and effectiveness, acceptability, principles of measure- ment, criteria of outcome, economic evaluation, RCTs, and non-randomized trials. These sections would provide a useful resume of the subject for medical postgraduate students in disciplines outside public health, and for other professionals at a similar level.

Section 3 consists of 15 chapters by separate authors, sometimes in pairs, dealing with the applica- tion of evaluation in specific fields of health care,

which are worth detailing- primary care, acute hos- pital care, emergency care, geriatric services, hazard control, prevention of meningococcal disease, ob- stetrics, child-welfare clinics, diagnostic services, laboratory services, medical training, drug use and monitoring, mental health care, nutritional services, and occupational health services. The chapter of greatest interest to myself was that on issues in the evaluation of mental health care by Norman Sartorius and Timothy Harding of the World Health Organiza- tion, Geneva. This points out that evaluation in psy- chiatry was originally focused on the closed institution of the mental hospital, but as the specialty developed, diagnosis became more important in terms of treat- ment and prognosis. With the ending of the mental hospital’s monopoly as the supplier of mental health services, their evaluation became a much more com- plex and debatable issue. Although the principles governing the evaluation of health services in general all apply to the evaluation of psychiatric care, there are additionally certain specific features of mental health problems; these include the fact that the greater part of psychiatric morbidity is handled outside the specialist services, yet mental health services in many countries find themselves handling a large proportion of “social” problems, while the boundaries between mental dis- order, personality type, and personality disorders are difficult to define. Guidance is given as to how evalua- tion should be planned as a series of linked processes. This chapter is written with the erudition that would be expected of its authors, yet at the same time is lucid and jargon-free.

This volume generally focuses primarily on Euro- pean experience, and the majority of its references are to European work. As such, it could be particularly valuable to those studying or working on evaluation in North America, where the subject tends to be rather insular in its orientation-if a continent can be con- sidered an island.

Program Evaluation: A Practitioner’s Guide for Trainers and Educators, by R. 0. Brinkerhoff, D. M. Brethower, T. Hluchyj, and J. R. Nowakowski. Boston: Kluwer-Nijhoff, 1983. Design Manual, 154pp., $17.95 (paperback); Sourcebook and Casebook, 385 pp. $35.95 (hardcover).

Reviewer: Emil J. Posavac Center of Western Michigan University when these volumes were written. The authors are to be lauded for

The purpose of these volumes is to make progam making an important contribution to the teaching of evaluation methodology available to non-researchers evaluation. Their presentation is straightforward, conducting, monitoring, or funding programs to train practical, and non-threatening. At other times, teachers. The four authors were affiliated with the however, the material is complex and overwhelming. Evaluation Training Consortium at the Evaluation Although the tone and style of the presentation make