Excellus Health Plan, Inc.

Health Insurance by Michael A. MorriseyReview by: Curtis FlorenceInquiry, Vol. 46, No. 2 (Summer 2009), pp. 241-242Published by: Excellus Health Plan, Inc.Stable URL: http://www.jstor.org/stable/29773422 .

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Book Reviews

Health Insurance. By Michael A. Morrisey. Chicago: Health Administration Press. 2008. 409 pp. $94.

For the past eight years, I have taught a course on health insurance to master of public health students. During that time, the continual frustration of students (and the instructor) has been that there was no textbook available for the course. Students at this level are not accustomed to reading articles from the research literature, so assigning journal articles is of limited value. Therefore, it is quite difficult to compile and organize appropriate readings for this audience. It was with great interest then that I received Health Adminis? tration Press' release of Health Insurance by

Michael A. Morrisey. Not only is the textbook vacuum now filled, but also the author is a well-known researcher on the subject. The book's preface states that it was "designed for master's students in health administration and health policy programs." In this review, I discuss the merits of the book in teaching these

particular audiences. Health Insurance is organized around both

the historical development of private health insurance in the United States, and the economic analysis of the demand for insur? ance and the market failures of adverse selection and moral hazard. The economic focus of the book will make previous exposure to introductory economics a practi? cal necessity for students, even though it may not be a formal requirement in some pro? grams. The book is also somewhat unique in that it directly ties the material to results from the empirical research literature in economics and health policy, which also makes famil?

iarity with regression analysis helpful for student comprehension. The range of topics centers around the development of public

policy and health plan design features to deal with extending coverage and limiting cost

growth. For that reason, the book is probably better suited for students in policy-oriented programs than it is for students in health care administration programs, who may be more interested in health plan operations. Given the book's disciplinary and topic

focus then, how well does it accomplish communicating this information to the reader? The historical introduction takes the reader to the genesis of health insurance in the United States during the Progressive movement, and carries through to the present day. The main

implication is that very little is new about the health insurance issues that we deal with

today. Debates about what should be covered, and especially how providers should be

compensated for these services, have been around since Babe Ruth was in pinstripes. The

subsequent chapters on the demand for

insurance, adverse selection, and moral hazard contain economic presentations similar to those found in numerous health economics

textbooks, but they are well supplemented with a summary of evidence from the research literature. Particular highlights are the chapter on risk adjustment, which describes the

development of Medicare's adjusted average per capita cost (AAPCC) measures, and the

chapter on utilization management, which summarizes the consensus from the literature that gatekeeper requirements have done little to reduce use of specialty care. Where the book

really hits its stride, however, is with its section on managed care and selective contracting. The weight of the evidence presented here shows the impact that the introduction of price competition among providers can have on health care spending.

There is also an extensive section on the

employer-sponsored health insurance system,

Inquiry 46: 241-243 (Summer 2009). ? 2009 Excellus Health Plan, Inc.

0046-9580/09/4602-0241 www.inquiryjournal.org 241

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Inquiry I Volume 46, Summer 2009

with a detailed description of the implicit tax

subsidy and how it affects premiums. This is

very effective in showing students that even the

"private" health insurance system in the United States has a substantial public component.

A set of chapters on "special topics" covers

subjects such as the individual insurance

market, high-risk pools, and health insurance

regulation. Recent innovations such as con?

sumer-driven health plans are covered as well. The breadth of material in these chapters allows the instructor to adapt the course material to student interest and current policy discussions. Finally, Medicare and Medicaid are discussed in some detail as well. Although the author focuses on how the existence of these programs affects private insurance

plans, there is more than adequate discussion of the structure of the programs themselves.

In total, I believe that Health Insurance is an outstanding first textbook in this subject area. Two other audiences for this book should also be mentioned, however. The author states in his preface that the book is "useful as a foundation text in doctoral and health services research programs." This is

undoubtedly true, as it represents what must be the best one-volume summary of empirical research on health insurance available any? where. I also would like to suggest that this book be required reading for anyone involved in our current round of health care reform discussions. If they do read it, policymakers will learn that just about anything they suggest has been tried before, with varying degrees of success. This book can show them what is likely to work, and what will not.

Curtis Florence, PhD.

Adjunct Associate Professor Rollins School of Public Health

Emory University Atlanta, Georgia

Public Health Genomics: The Essentials. By Claudia N. Mikail. San Francisco: Jossey Bass/A Wiley Imprint. 2008. 304 pp. $75

(paperback).

The sequencing of the human genome in 2001 provided researchers, clinicians, policy

makers, ethicists, and public health practi? tioners with a myriad of information to

potentially improve disease outcomes on an individual and population basis. Genomics is a burgeoning field of study that examines the interactions among the genetic material in the human body, including interactions with environmental and behavioral factors. The role of public health in this new field of study is complementary, since population trends, health disparities, and the social determinants of health contribute to our understanding of the underlying causes of disease provided by genomic research. Thus, the new discipline of

public health genomics has improved our

ability to carry out the health professional's mission to promote health and prevent disease. Public Health Genomics: The Essen tials is a recent book that describes this

emerging "interface between science and

society."

In order to practice public health effective?

ly, agencies and organizations such as the Centers for Disease Control and Prevention, the Institute of Medicine, and the Council on

Linkages between Academia and Public Health have determined that the public health workforce should be competent in public health genomics via knowledge and the

application of relevant skills. The author?a clinician and clinical assistant professor in the School of Public Health and Health Sciences at the University of Massachusetts at Am herst and a clinical instructor at the Univer?

sity of Southern California, Keck School of Medicine?contributes to this goal by pro? viding an introduction to the discipline of

public health genomics for public health students, medical students, genetic counsel? ors, and public health professionals.

The book is well-written and organized into three parts, with seven chapters in the

introductory section that emphasize the scientific and social aspects of genomics; five

chapters on the role of genomics in maternal, child, and adult health; and four chapters on areas of general interest. The chapters are

concise, and consist of a set of learning objectives and a list of key terms, names, and concepts to emphasize important points for the reader. The questions at the end of each chapter are thought provoking and

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