ABSTRACT
Trade-offs in health reform In the last three decades, health systems in the European region have gone through a num ber of m ajor reforms in pursuit of a range of objectives. Since the early 1990s the emphasis of m any of these reforms has been on achieving financial sustainability, improving quality and social responsiveness, whilst at the same time m aintaining equity and access, which are seen as central tenets of Europe's health systems. M any com m entators have argued that these objectives are not com plem entary, that often they stand in direct contradiction to one another. They identify the need to make explicit trade-offs between them, and assert that these trade-offs should reflect societal values and the relative priority assigned to them .
