Review of Getting Health Reform Right

I was excited to read Getting Health Reform Right because it approached the problem of health care reform from an international, public policy perspective. The authors all have deep experience working internationally to address health care, and it shows throughout their analysis in the many real world examples of reforms gone right and wrong drawn from across the globe.

The book is meant as a hands on guide for those involved in reform on the ground, so it’s very much a practical, almost how-to guide. I say almost because, as they remind the reader throughout, there is no easy solution to the problem of health care reform, no one size fits all prescription. In every case, in every country, reformers need to take the specifics of the particular national situation into account if they want to have a chance to succeed.

The authors slice up the formidable challenge of health care reform into manageable chunks using the idea of control knobs, i.e., the big bucket categories of health care elements that reformers can address to affect change in the overall system.

They identify the following five control knobs (pp. 27-28):

  • Financing – all mechanisms, such as taxes, insurance premiums, and direct payments by patients, for raising the money that pays for activities in the health sector.
  • Payment – methods for transferring money to health care providers (doctors, hospitals, and public health care workers), such as fees, capitation, and budgets.
  • Organization – the mechanisms, such as measures affecting competition, decentralization, and direct control of government providers, that reformers use to affect the mix of providers in the health-care markets, their roles and functions, and how the providers operate internally.
  • Regulation – the use of coercion by the state to alter the behavior of actors in the health system.
  • Behavior – includes efforts to influence how individuals act in relation to health and health care.

The lion’s share of the book is spent addressing these five control knobs, and the authors do a solid job explaining them fully as well as illustrating how they affect a nation’s overall system of health care.

But as, if not more, valuable is the first section of the book that sets up their discussion of the control knobs with an analysis of health systems in general. Here they tackle the health reform cycle, how ethical theory intersects health care reform, political strategies for reformers, and strategies for selecting appropriate goals and performance measures for health system reform.

These chapters should be mandatory reading for anyone who wants to better understand the current debates on health care reform in the U.S. The generalized, international (or better yet, multinational) perspective allows the authors to set health care reform in a larger context, one that I think makes it easier to see the contours of the U.S. debate than the noise coming from all sides through the media.

And as those of you who visit here regularly know, the book is also chock full of insights for leadership generally: the problem of health care reform is so large and so complex that what leaders need to do to address it will have wide applicability to more narrow corporate challenges.

As usual, would love to hear from folks out there who’ve read the work or who have thoughts about my take on it—jump in and let’s get the conversation started!

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