ABSTRACT
Introduction This book, written over 20 years after the publication of a similar collection of essays,1 examines again the complexities, frustrations and progress of healthcare systems in a leading group of rich countries. Like its predecessor, it offers few panaceas, but the insights of its authors show that the political and economic challenges of healthcare reform are now better articulated, if still often largely unmet. The resilience of some of the obstacles to efficient reform articulated over 20 years ago and examined again here demonstrates the power of public and private interest groups in resisting changes that will benefit the patient. The ongoing battle between funders, providers and consumers is the business of healthcare, like many other markets. The characteristic of healthcare, however, is its resistance to change and the preservation of inefficient practices by manage ment techniques appropriate for Dickensian times.
