xv, 296 pages ; 24 cm

Inescapable Decisions examines the disarray in the American health care system and proposes major corrective strategies. Mechanic shows that the high-technology interventionist type of medicine commonly practiced in the United States has lost its sense of priorities and balance. Expensive and sometimes dangerous procedures of unknown efficacy are used excessively and often inappropriately, while many basic preventive and primary care services remain unavailable to those who need them the most. This incredibly complex system of care operates in an environment of heavy-handed rules and regulations and enormous waste of resources. Mechanic argues for a transformation of the medical paradigm, including how health affairs are addressed. Strategies for preventing illness and limiting disabilities are needed for both communities and individuals. He maintains that health care costs cannot be brought under control without a budgetary ceiling. Such limitations offer the most realistic, appropriate, and nonintrusive way to allocate services. Mechanic shows that much of the neglect of sick and disadvantaged populations results from an approach to health and welfare issues that encourages fragmentation of services. The goal of a workable health system is now a national priority. Inescapable Decisions illustrates how to forge a better, more caring system that will be adaptive to future problems, one that brings the disadvantaged into the mainstream of health concerns. This path-breaking book will be of wide interest to health care officials, policymakers, and professionals in social welfare

Essays adapted from previously published materials

Includes bibliographical references and index

Medical care system in disarray -- American medical care system -- Sources of countervailing power in medicine -- Professional judgment and the rationing of medical care -- Need for a new paradigm -- Conceptions of health -- Promoting health and independence -- Socioeconomic status and health -- Special populations -- Adolescents at risk -- Deinstitutionalization of the mentally ill: efforts for inclusion -- Health care for an aging population -- Conclusion -- Inescapable decisions -- Appendixes -- Medical sociology: some tensions between theory, method and substance -- Role of sociology in health affairs

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