HEALTH SECTOR REFORM. THE CONTENTS OF OUR WORKSHOP. What is reform? Why reform is common in the health sector Why change is difficult in the health sector A definition of health sector reform Features of successful reform Features of unsuccessful reform
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A process of making significant changes to overcome agreed weaknesses.
It is different from a review.
A review might lead to significant changes. But we are unsure whether there are agreed weaknesses.
It is different from a plan.
A plan is the product of an ongoing process to overcome weaknesses. It is therefore less likely to involve significant changes.
If we only change health financing, it’s not reform.
If attitudes and behavior are the same, nothing has really been achieved. Nothing important has changed.
Doctors and nurses and citizens are not to be trusted.
For example, the central planning model of norms and standards used in the former communist countries.
For example, Margaret Thatcher's health sector reform policy in 1990 in the UK.
(She personally chaired the committee designing the reform strategy.)
UK government policy on patient choice:
If waiting more than 1 month
You can be advised where to go to get quicker access
Costs of transport paid for patient
“Why not move services to people?”
“2000 pages about choice BUT no mention of its costs”
“If I choose the best surgeon, I reduce choice for the less articulate”
“Once Downing Street had decided, the economics was irrelevant” …
“… but economists were falling over themselves to prove Blair right”