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September 8, 1978

A Healthy State: An International Perspective on the Crisis in United States Medical Care

Author Affiliations

Wright State University School of Medicine Dayton, Ohio

JAMA. 1978;240(11):1187. doi:10.1001/jama.1978.03290110085033

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Dr Sidel is professor of community health at the Albert Einstein College of Medicine, and Ms Sidel is a graduate of the Boston University School of Social Work. They have written a timely, thought-provoking, and readable account of the health care system in the United States, comparing it with systems in four other countries. Their incisive analysis of data reveals, for some major diseases, higher morbidity, mortality, and disability rates in the United States than in Britain, which spends considerably less per capita for health. The American system is fragmented, has little public accountability, neglects health maintenance, is devoted more to technology than to care, and is grossly maldistributed geographically and socially. The Sidels do not neglect physicians. Referred to are impersonal care, high costs, inappropriate therapy, unnecessary surgery, incompetence, and fraud. No documentation of incidence is provided other than "one hears stories of."

At times the Sidels appear to