In all societies, the health sector faces two demands: firstly, to provide expanded and equitable access to quality healthcare services and, secondly, to reduce or at least control the rising costs of healthcare services.

Changing demographics, particularly age structures, lifestyles, changing epidemiological profiles, urbanization, growing industrialization, and demand for greater access to patient-oriented quality care have been the main drivers in the ongoing efforts to reorient the operation of health systems. In high- and middle-income countries about 40 percent of the population has one or more chronic conditions and in many societies, chronic conditions account for up to two-thirds of healthcare expenditures. In each care setting, a limited set of health conditions account for most of the cost due to the growing demand on the healthcare system for high-cost diagnostic and therapeutic resources.

In developing countries, there are still a considerable number of preventable diseases and premature deaths, both in absolute and relative terms and there is great inequity of access to basic health services resulting in regions, communities, and social groups being left without access to the most basic healthcare. In most countries the health sector is underfinanced - this has led to quantitative and qualitative deficiencies in the delivery of health services and to growing gaps in basic care. There is inefficient allocation of scarce resources and lack of coordination between health subsectors, institutions, and other social agents and stakeholders with duplication of efforts, overlapping responsibilities, and resource wastage.

Most countries, developed or developing, are at some stage of health sector reform, aimed at introducing substantive changes into the health sector and in the relationships among stakeholders and the roles they perform, with a view to increasing equity in benefits, efficiency in management, and effectiveness in satisfying the health needs and expectations of the population. Health reform processes have many facets and there is no single model being adopted by all countries.

Each country is moving at a different pace in the implementation of its own particular health system model but the economic and globalization changes of the last years have brought a new urgency to the reform processes. There are, however, common trend-setters and responses that characterize most health sector reform processes: (a) the universalization of a high cost-benefit basic package of health services; (b) a set of standardized public health interventions; (c) cost containment and recovery; (d) administrative decentralization and operation of healthcare services; (e) recognition of the role of the private subsector and the intersectorality of health interventions; (f) health models oriented towards primary care and centered on people; (g) focus on quality and accountability; and (h) moving away from the reactive delivery of care to a more proactive management approach of the health status of individuals and population groups. New roles are expected for users and providers and the involvement of new professional categories and local governments. Competition, merger of provider organizations, aggressive contracting by payers, and increasing involvement of employer and public purchasers have characterized changing processes in health services management.




Information Technology in Health
Trends in the Organization and Delivery of Healthcare
The e-Health Imperative
The Growing Practice of e-Health