Medical ethics manual.

Getting health reform right: a guide to improving performance and equity Authors: Marc J Roberts, William Hsiao, Peter Berman, Michael R Reich. Publisher: Oxford University Press, Oxford; 2003 ISBN: 0-19-516232-3; hardcover, 332 pages; price 29.99 pounds sterling The Director-General of WHO, Dr LEE Jong-wook, identifies comprehensive engagement with, and strengthening of, health systems as necessary starting points for managing global public health challenges. Addressing health systems issues and strengthening the health systems within which health programmes operate, rather than investing in programmes alone, will improve programme effectiveness and the chances of sustainability. This book has a number of strengths. First, it is written by an eminent group of scholars who have hands-on experience of health reforms in a range of settings. Second, it seamlessly links theory and practice and elegantly blends concepts with practical examples to paint a picture of reforms and their associated complexities. Third, it offers a number of analytical frameworks to enable those involved in designing, implementing or evaluating reforms to consider critically the value system within which the reforms take place. Fourth, it describes health system (health system financing, payment, regulation, organization and behaviour) which policy-makers can use to achieve their set goals and objectives. Fifth, it establishes the continuum between outcomes, objectives and interventions (control knobs) to enable policy-makers to consider health reform as a whole rather than separately. The book consists of two parts: Part I concentrates on health system analysis, emphasizing that ethical and political economy considerations are the starting points for reforms; and Part II describes the five control knobs available to policy-makers, with the final chapter linking analysis with execution. The authors argue that a clear understanding of the context, and in particular the value system within a given country, is critical for understanding and shaping the goals and objectives of health reforms. Distinguished are three value systems which shape societal and political preferences in terms of health system goals, objectives and elements: utilitarianism, liberalism and communitarianism. Two variants of each of these value systems are s 2) libertarians, who want minimal interference from the state to pursue their own life (and health) preferences and egalitarians, who eschew positive rights, emphasizing that people should be given the opportunity to realize rights, such as health; and 3) universal communitarians (who share a common value system and espouse this) and relative communitarians (who celebrate diversity). …