The 2010 Patient Protection and Health Care Affordability Act still remains a bit of a mystery to most people, and it is hard to tell just exactly where the US is headed with health care. Budrys (sociologist, DePaul Univ.) has done a remarkable job in providing a 10,000-foot snapshot of the system as of June 2011. In two previous editions (2nd ed., 2005; 1st ed., CH, Dec'01, 39-2219), the author rendered images of the forces that helped to shape US health care. Building on those prior descriptions, this work focuses on the origins of reform legislation and subsequent changes. The book begins with an overview across an array of disciplines and then discusses effects on various components of the system including hospitals, health care professions, and public/private insurance. One chapter focuses on opinions regarding the new legislation. The last two chapters review health systems in other countries and provide case studies on the dilemmas of reform. Budrys captures the plenum nature of the system across economic and political landscapes, and the policy choices that the country faces. The text is clearly written and indexed with chapter references. A valuable resource for academic readers and health professionals, especially those in the social sciences. Summing Up: Highly recommended.

Choice Reviews

This fourth edition of Our Unsystematic Health Care System maintains the accessibility to undergraduate, interdisciplinary audiences from the previous editions. Grace Budrys explains health care reform in a very understandable way without sacrificing the complexity and continued debate around the implementation of the legislation. New to this edition is a well-balanced assessment of whether health care reform is working. Budrys asks readers to consider what they want reform to accomplish, then lays out the empirical findings related to access, cost containment, and quality, and leaves it for the reader to decide what is ‘working’ and what is left unresolved.

Lara Foley, University of Tulsa

Our Unsystematic Health Care System provides a comprehensive and critical introduction to the institutions of the US health care system. It is an indispensable resource for advanced students in economics or politics embarking on the study of health and health care (as well as for sociologists, its primary audience). Throughout, Budrys poses thoughtful questions and identifies interesting paradoxes and conflicts in the arena of health care. Budrys's book explains not only where we are but how we got here.

Michael Ash, University of Massachusetts, Amherst

This fourth edition of Our Unsystematic Health Care System is a concise yet comprehensive review of the health care delivery system in the United States. In it, Budrys presents all of the critical elements of the Affordable Care Act (ACA) and explains what each means for health care users, providers, and policymakers. This book is a must-read for those who want to understand the current status of the ACA, how health care got to this point, and how it continues to evolve. It provides readers with the facts about the ACA and its political, economic, and social context to make every reader a more informed participant in the discussion on current and future health care in this country.

Kimberly R. Barber, PhD, director of research, Genesys Regional Medical Center; professor of health sciences, University of Michigan