Reforming health care

Abstract

Near doubling of health-care spending in OECD countries over the past 30 yr has put pressure on public-sector budgets. Spending growth is accounted for and various problems are identified. Cost-control and efficiency can be achieved by reforms of health funding and delivery structures. Most OECD countries have introduced macro-economic controls on expenditure, but several factors have undermined their effectiveness so many countries have resorted to micro-economic improvements in the ways in which health-care resources are assessed, deployed and funded. The advantages and disadvantages of various types of initiative are outlined. Demand-side measures are examined, and it is concluded that turning health funders into active purchasers of health services may be the best means of ensuring that health care continues to be available in a truly equitable and affordable manner. -D.G.Price