The agenda for policy reform for health in all but the richest countries includes: a) increasing overall rates of economic growth and expanding basic schooling, particularly for girls; b) reallocating government spending for health from tertiary care and specialist training to public health measures and essential clinical services; c) encouraging more diversity and competition in the provision of clinical care and the development of cost-containing approaches to insurance; d) increasing the efficiency of government health services; e) and fostering greater involvement of communities and households in promoting healthier behaviour on their own part and in managing their local health services.
Policymakers face a number of difficult challenges in pursuing health policy reform. The changing demographic profile, including the ageing of the population, is creating new patterns of disease. Emerging microbial threats, such as AIDS and drug-resistant strains of tuberculosis and malaria, call for changes in personal behaviour, new drugs and new ways of delivering services effectively. In virtually every country, interest groups will resist health policy reforms. Health workers will object to changes that threaten their job security, income levels and degree of professional autonomy. Drug companies, medical equipment manufacturers and other suppliers will try to block policies that they see as having an adverse effect on their markets, revenues and profits. Political and economic elites and organized labour groups will seek to preserve existing public subsidies for insurance and health services from which they benefit and to maintain their privileged access to clinical care.
Recent broad health sector reform has been carried out in developing countries such as Chile, Tunisia and Zimbabwe, as well as in many OECD countries.
There is not simple paradigm for health policy. Free markets of public health activities and clinical care often fail, and when government intervene in financing and deliver, as they frequently do, they can fail just as badly. Effective government regulation of private suppliers of health services and inputs, combined with public financing of cost-effective packages of public health and essential clinical services, is needed to deal with these failures. But this in turn requires strong private and public institution—and institutional capacity is seriously lacking in many developing countries.