ABSTRACT
This chapter aims to describe recent trends in healthcare reform in developed countries and the implications for medical leadership. It argues that there is a gap between the rhetoric and reality of reform in that the impact of many of the policies that have been pursued is more limited than promised or expected. The lesson from healthcare reform is the need to combine top-down and bottom-up approaches. Health reform in England followed an incremental path until the election of the Thatcher government in 1979. The story of health reform in England in the last three decades is a story of a permanent revolution in which governments have used a wide variety of policies in the hope of improving performance. Experience of healthcare reform since the 1970s highlights the need to engage doctors more effectively in the process of reform at all levels. This includes making greater efforts to develop medical leadership in microsystems, healthcare organisations, and at the systems level.
