Health System Policy and Reform
Health system policy and reform is the study of how societies organise, finance, govern, and deliberately change the institutions that produce health services. It examines the goals a health system is expected to meet, the levers governments and other actors use to steer it, and the processes through which systems are redesigned over time.
Definition
Health policy refers to the decisions, plans, and actions undertaken to achieve specific health care goals within a society; health system reform is the purposeful, often structural, change of a system's financing, organisation, governance, or service delivery to better meet those goals.
Scope
This area orients the reader to the policy and reform dimension of health management: the framing of health systems as organised arrangements with defined functions and goals, the design and reform of those arrangements, the pursuit of universal coverage and access, the regulatory and accreditation machinery that governs providers, and the assessment of whole-system performance. It treats these as reference concepts and analytic frameworks, not as endorsements of particular reform programmes.
Sub-topics
Core questions
- What goals should a health system pursue, and how are trade-offs among them resolved?
- Which policy levers - financing, regulation, organisation, behaviour - effectively change system performance?
- How are reforms designed, adopted, implemented, and sustained across political and institutional constraints?
- How can the performance of an entire health system be defined and measured?
Key concepts
- Stewardship and governance
- Health financing functions
- Service delivery arrangements
- Accountability
- Reform implementation and political feasibility
- Goals: health, responsiveness, financial protection
Key theories
- Health system functions and goals framework
- The WHO World Health Report 2000 framed health systems in terms of four functions (stewardship, financing, resource generation, service provision) directed at three intrinsic goals: improving health, responsiveness to expectations, and fairness in financial contribution. It became a widely used reference lens for comparing and reforming systems.
- Building blocks framework
- WHO's 2007 framework characterises a health system through six building blocks - service delivery, health workforce, information, medical products, financing, and leadership/governance - that interact to produce improved health, responsiveness, financial protection, and efficiency.
- Triple Aim
- Berwick and colleagues proposed that systems be designed and reformed to simultaneously improve the individual experience of care, improve the health of populations, and reduce per-capita cost - a goal set widely adopted in reform discourse.
Mechanisms
Health systems are described as configurations of financing, organisation, regulation, and behaviour that convert resources into services and ultimately into health, responsiveness, and financial protection. Reform works by adjusting these levers - changing how money is raised and pooled, how providers are organised and paid, how the sector is governed and regulated, and how populations and professionals behave - so that system goals are better met. Because these levers interact, reform is treated as a systemic rather than piecemeal undertaking, and accountability relationships among patients, providers, payers, and policymakers shape whether intended changes are realised.
Clinical relevance
Health system policy and reform shape the context in which clinical care is financed, organised, and regulated, and thereby influence what services are available and to whom. The area is a reference frame for understanding that wider context; it describes system-level arrangements and does not provide individual diagnostic or treatment guidance.
Evidence & guidelines
Foundational reference frameworks include WHO's World Health Report 2000 and the 2007 building blocks document, which supply the vocabulary used across the field. Comparative analyses of low- and middle-income systems and conceptual work on accountability extend these frameworks to questions of equity, governance, and implementation.
History
Systematic comparison of health systems expanded after the mid-twentieth century with the growth of national health services and insurance schemes. The WHO World Health Report 2000 marked a turning point by proposing explicit functions and goals and ranking systems against them, prompting decades of debate and methodological work. Subsequent frameworks, including the building blocks and the Triple Aim, refined how reform goals and levers are articulated.
Debates
- Can whole health systems be ranked against one another?
- The WHO World Health Report 2000's composite ranking of national systems was influential but contested on methodological and conceptual grounds, raising enduring questions about how, or whether, system performance can be reduced to comparable scores.
Key figures
- Julio Frenk
- Donald Berwick
- Anne Mills
- Derick Brinkerhoff
Related topics
Seminal works
- who-2000-hsr
- who-2007-buildingblocks
- berwick-2008
Frequently asked questions
- What is the difference between health policy and health system reform?
- Health policy is the broader set of decisions and plans aimed at health goals, while health system reform is the deliberate, often structural, change of how a system is financed, organised, governed, or delivers care to better meet those goals.
- What are a health system's main goals?
- Widely cited frameworks describe goals such as improving population health, being responsive to people's expectations, and ensuring fairness or protection in how care is financed.