ABSTRACT
Health systems in many developed countries are undergoing major structural reform. While some changes remain regulatory in character, a new feature is the large number of reforms that rely upon market-derived instruments to Improve the performance of health care institutions. The shift toward Incentive-oriented reforms is particularly pronounced In publicly operated health systems. Current reforms can be analysed in terms of 2 conceptual frameworks: the policy objectives governments seek to attain, and the changes introduced within each of 3 basic building block components of a health system. Viewed through these lenses, the current reform process has emphasized market-derived approaches In the pursuit of micro-economic efficiency on the production side of health systems and in the allocative mechanism that links finance to production. Conversely, market-style instruments appear to have little to offer on the finance side of systems. Adequate evaluation has yet to be conducted to determine the impact of specific market-derived reforms on equity or on health-related effectiveness.
