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timing research and consultancy in health and social services organisations, one might expect an abundance of practice examples, and in that the book does not disappoint. John Ovretveit draws repeatedly upon his experiences within the Brunel Health and Social Ser- vices Management Programme. What is more difficult is to achieve the correct balance between including suffi- cient theory and references to satisfy a research audi- ence while ensuring the text is sufficiently concise and practice relevant to appeal to managers and pro- fessionals. In considering its size (202 tightly packed pages), its most appropriate use for practitioners might be as a reference source. The introductory and con- cluding chapters should be regarded as compulsory reading, with the intervening chapters to be studied sel- ectively, dependent upon an individuals interests and position and status within an organisation.

The intervening chapters do include much that is rel- evant. As the author suggests practitioners may wish to begin with the chapter on team member roles, while managers of practitioners in teams may wish to use the chapter on team leadership and management accounta- bility as introductory reading. There is an interesting section on formulating priorities in collective service teams, which defines the priority setting process in an organisational context, without recourse to the language of, ‘rationing’ which some practitioners find

so distasteful. This section also introduced me to the delightful phrase ‘prioriphobia’, which is described as, ‘the inability to decide or act on the decision that one person’s needs are more urgent or severe than another’s’.

The success of the volume was in the ability of the author to draw upon organisational and management theories, and illustrate their relevance to the provision of health and social care services through practical examples. Its treatment of other disciplines is less comprehensive. For instance, while the extent of any economic analysis is simple and understandably so given the objectives of the exercise, less easy to under- stand is the absence in certain areas (unit costing, for example) of any references to guide further reading. Its intended audience is managers and practitioners, yet this should not deter readers from other disciplines. There are few who would not benefit from a greater understanding of how structure can influence perform- ance within the provision of community care services. Moreover, in a broader sense, the lessons are relevant for organisations far removed from the spheres of health and social care.

CHRISTOPHER JONES Centre for Health Economics

University of York

The Making of Medibank by R. B. SCOTTON and C. R. MACDONALD. School of Health Services Management, University of New South Wales, Australia, 1993. No. of pages: 320. ISBN 0-85832-081-9.

In December 1972 a Labor government was elected to power, federally, for the first time in twenty three years. A whole generation had come of age under a govern- ment of unchanging (and conservative) political persua- sion. The change in government ushered in a period of major social change, in defence (withdrawal of troops from Vietnam and ending of conscription), in edu- cation (free tertiary education), in immigration (accep- tance of non Europeans), in the arts (government support for), to name just a few. It was an exciting time, one which changed the Australian way of life, a time of great political drama which climaxed in the dis- missal of the Labor government by the Governor- General in November 1975.

Part of Labor’s platform for change was the estab- lishment of universal compulsory health insurance administered through a public agency. This scheme, known as Medibank, operated from mid-1975 until late 1976. Its demise gave Australia, at least at that time, the distinction of being the only country to dismantle a single, universal insurer. Subsequent political change

led to the establishment of a similar scheme in 1984, known as Medicare, and since then health care finan- cing has remained relatively stable. However, this does not mean that health care financing has left the Australian political agenda; the non-Labor opposition offered a return to private competing insurers as its policy in this year’s national election.

The Making of Medibank chronicles the development of this health policy, its beginnings in academic research in 1967, through to its implementation and its demise. Dick Scotton, one of the authors of this volume, lived the making of Medibank, from its start in academe from whence he was transported to full time ministerial adviser. Scotton has now returned to an aca- demic post. Thus this publication can provide an unusual insight into the making and implementation of major policy.

The nine years of the development and implemen- tation of Medibank are covered, as well as a brief review of the earlier history of health care financing. The final chapter considers the impact of Medibank from the perspective of twenty five years on and, all too briefly, the lessons for the future.

The enormity of logistical problems in moving from policy to government programme are well documented. The new scheme had to be capable of enrolling 13 mil-

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lion beneficiaries and processing 90,000 claims per day across the country on its first day of operation. Detailed plans had to be developed to cover every aspect of the scheme’s operation, including the operation of six different public hospital systems (in Australia’s six different states).

However, the main battles for Medibank lay in the legislative and political arena. Implementation also required the preparation of the appropriate legislation and its subsequent passage, and the negotiation of the hospitals agreements with six state governments, not all of the same political party. There was entrenched and strident opposition to Labor’s health policy principally from the established medical profession. This led to the defeat of the enabling legislation by the Upper House of Parliament in 1973. Then followed campaigns waged by both sides to win popular support. But it was only under extraordinary circumstances-another general election and a joint sitting of both houses of parlia- ment-that the legislation was eventually enacted.

Scotton and Macdonald record these events in great detail; this is a blow by blow description. The cast of characters is large, as in an epic novel. There is a useful reference list of names but unfortunately I could not find everyone named in the text listed here. This makes it a difficult volume to read in snatches and too long for a single sitting.

The Australian system of government, and conse-

quently our system of health care, is a complicated tangle of federal and state relationships and responsi- bilities. Most visitors to Australia find it complex, some describe as it as chaotic. But chaos is, once understood, workable. And this book describes the complexity in operation.

The time that saw the making of Medibank was a time of great social change and political drama. Medibank, as Scotton and Macdonald comment was both a component and a reflection of this change. The authors describe the forces at play here, maintaining the detached tone of scholars even when the drama unfolding is worthy of a racy novel.

Those who do not learn history, it is said, are des- tined to re-live it. Medibank was not an isolated inci- dent in the development of the Australian health care system. The forces which operated to make and unmake Medibank have continued to shape and be shaped by further developments in health care finan- cing. The interest and appeal of this book would have been increased by more analysis of Medibank in the making of Australian health care.

JANE HALL Centre for Health Economics

Research and Evaluation NS W, Australia