ABSTRACT
Health care system reform has emerged as a primary concern in industrialized democracies. Australia, Spain, Italy, and Germany introduced major systemic reforms during the 1980s and are contemplating further change. The proposed and implemented reforms differ according to their cultural, social, historical, and political circumstances, and they must take into account both the advantages afforded by existing institutions and political realities. The chapter describes the universal principles and trends in the reform strategies that were developed to address the common issues in the health systems of industrialized democracies. It presents the background to the reforms of health care systems. The chapter discusses the emerging paradigm, both its philosophy and its application to the financing, organization, and management of health care systems. It concludes by anticipating the major challenges facing health care systems that operate under the new framework.
