HEALTH SYSTEMS: THE CASE FOR REFORM

As medical care has gradually become more involved in prevention, and as it has gradually moved into the era of managed care, the gap between public health and clinical medicine has narrowed. As noted above, many countries are engaged in reforms in their health care systems. The motivation is partly derived from the need for cost containment, or to extend health care coverage to underserved parts of the population. Countries without universal health are may still have serious inequities in distribution of or access to services, and may seek reform to reduce those inequities, perhaps under political pressures to improve the provision of services. The incentives, or case-for-reform, center on cost constraint, regional equity, and preserving or developing universal access and quality of care.
In some settings, a health system may fail to keep pace with developments in prevention and in clinical medicine. Some countries have overdeveloped medical and hospital care, neglecting important initiatives to reduce risk of disease. The process of reform requires setting standards to measure health status and the balance of services to optimize health.
A health service set a target of immunizing 95% of infants with a national immunization schedule, but requires a system to monitor performance and incentives for changes. A health system may have failed to adapt to changing needs of the population through lack or misuse of a health information program. As a result, the system may err seriously in its allocation of resources, with excessive emphasis on hospital care and insufficient attention to primary and preventive care. All health services should have mechanisms for correctly gathering and analyzing needed data for monitoring the incidence of disease and other health indicators, such as hospital utilization, ambulatory care, and preventive care patterns. For example, the United Kingdom’s National Health Service periodically goes through a restructuring process of parts of the system to improve the efficiency of service. This involves organizational changes and decentralization by changing the means of regional allocation of resources.
A continuing evolution affect in demographic and epidemiologic patterns, health systems are also influenced by technology, financing, and organizational change. New problems continually emerge and priorities must be reassessed in order to reach effective methods of addressing them. Reforms may create unanticipated problems, such as professional or public dissatisfaction, which must be evaluated, monitored, and addressed as part of the evolution of public health.