Effective ways to realise policy reforms in health systems

This chapter investigates the factors that can help or hinder the reform of health systems in OECD countries. “Reform”, here, refers to changes to health systems which aim to improve their performance in one or more dimensions. The chapter is written mainly from a prescriptive point of view – what should governments do to increase the prospects for successful reforms? It is also written mainly from the perspective of economics, although a few selected references are made to political science literature. The first part of the chapter considers the need for reform in health systems. It goes on to set out a general framework for examining the determinants of success and failure in health reforms and to focus on the governance of reforming health systems, identifying some enabling and disabling factors that are likely to be partly under the control of governments. The second part of the chapter presents five case studies of the factors associated with successful and unsuccessful reforms, based on five recent OECD Reviews of Health Systems – in Finland, Korea, Mexico, Switzerland and Turkey. Two final sections discuss the findings that emerge from the case studies and draw some conclusions.