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1、GettingHealthReformRightByMarcJ.RobertsWilliamHsiaoPeterBermanMichaelR.ReichOxfordUniversityPress(October2002)Chapter1SettingtheScene1.IntroductionThroughouttheworld,governmentsareengagedinhealthsectorreform(Mills,Bennett,andRussell2001;OECD1996;Berman1995).ThetransitionaleconomiesofEasternEuropear
2、efullofnewsocialinsuranceschemes.NationsinSouthAmericaareexperimentingwithwaystoextendhealthinsurancecoveragetoboththeruralandurbanpoor.InAfrica,experimentswithfiscaldecentralizationhaveproducedadditionalrevenuesforhospitals,butalsoadditionalinequalitybetweenrichandpoorregions.Toimproveefficiency,m
3、anynationshavealsoexperimentedwithbothnewpaymentsystemsandnewwaystoorganizehealthcaredelivery.Toooften,however,conflictingpoliticalcalculations,economicimplications,andethicalconcernshaveledtoaconfusednationaldebate:Howshouldwedealwithdoctors’demandsformoremoney?Whatstrategiesexisttoreducecostsform
4、edicalcarewhileexpandingsocialinsurancetocoverthepoor?Shouldweexpandthesystemofpubliclyprovidedhealthcenters,ormovemoretoprivatepracticefamilyphysicians?Shouldweaskpatientstopaymoreoutofpocket,ormakemoreuseofgeneraltaxrevenues?Istheanswermorenewtechnologyorless?Moredoctorsorfewermedicalschools?Buil
5、dingnewhospitalsorspendingmoreonanti-smokingcampaigns?Thisbookisintendedtohelphealthreformersdeveloptheskillstheyneedtoanswerthesequestions.Itintroducesasetofconceptsthatcanfacilitatesystematicandcriticalthinkingabouthealthsectorreform.Ourexperienceinmanycountriesisthatcarefulanalysisisbothpossible
6、andpotentiallyveryuseful,aswehopetodemonstrateinthepagesthatfollow.Ourdiscussiondrawsonarangeofdisciplines.Foranunderstandingofhowmoneyisraisedandspent,wemakeextensiveuseofeconomicanalysis.Forinsightintohowindividualsandorganizationsreacttothoseincentives,wedrawonsociology,psychology,andorganizatio
7、naltheory.Forguidanceonhowtogetpoliciesadoptedandimplementedintherealworldofgovernmentdecision-making,werelyonpoliticalanalysis.Inaddition,forhelpwiththinkingabouthowtodefineproblems,wedevotesignificantatte
