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This chapter examines archetypes of health care systems, from various European national health systems to the centrally planned model of the former Soviet Union and the market-driven US model. The chapter then analyzes two key health care policy approaches: primary health care and universal health coverage. It provides illustrations of recent and ongoing health system reforms across all world regions (covering China, Thailand, the Middle East, Brazil, Mexico, South Africa, South Korea, and India) that address—to varying degrees—questions of regulation, financing, resource allocation, the nature of service provision, and principles of universality, access, affordability, quality, and equity within the politics of their context. In addition, it provides an overview of the building blocks of health care systems including facilities, different types of health care personnel, problems around health workforce migration, technology, and the powerful role of the pharmaceutical industry.

This chapter focuses on supply-side innovations in delivering health services, and their impact. It begins with an overview of incentives in organizations, located in the conceptual framework of principal-agent theory. It then examines four major types of reform, framing them in terms of a principal agent model which interprets these reforms as measures designed to align more closely the incentives of government and providers; and reviewing the current evidence about their effectiveness. The conclusions highlight the challenges of introducing stronger incentives for health care provider performance in the context of information problems, and the implications for both broader system performance and for the evaluation of such interventions.

This chapter retraces the 100-year history of reforms to the health system of Puerto Rico, beginning with the U.S. occupation in 1898. It highlights the shifting organizing principles of health planners and regulators, which include sanitation and controlling communicable diseases during the first half of the 20th century, public health goals and ensuring universal access to care during the mid-century, and efficiency and the free market beginning in the 1990s. The U.S. invasion of the islands militarized medicine on the island. Initially, health was a military affair insofar as, through public sanitation and venereal disease campaigns, Puerto Rico was to be made safe for American soldiers and the “civilizing” colonial project. The chapter sheds light on how colonialism has consistently shaped the structure and goals of the nation's health system. In addition, it uses ethnographic interviews to illustrate some of the contradictory assessments of privatization.

The Rethink Health Dynamics Model represents the complex dynamics of a regional health system in the United States and has been calibrated for more than 10 regions using nationwide and local data. When testing single interventions, the simulated improvement in system performance is often less than desired. By experimenting with combinations of interventions, the authors have identified recurring reasons for underperformance or intervention pitfalls. Here they discuss four common pitfalls and possible ways to overcome each with additional intervention. The pitfalls include (a) trying to cut costs without changing payment incentives; (b) depleting available funds without securing sustainable financing; (c) trying to achieve greater equity through service delivery without building capacity to meet greater demand; and (d) missing the opportunity to achieve multiple goals simultaneously through the use of mutually supporting interventions. The chapter illustrates each pitfall and proposed solution with causal feedback diagrams and simulation output graphs.

This chapter positions the debate of technology change in health care in the context of health systems reform. It discusses definitions of technological change and innovation, and their impact in driving health system change and output (expenditures). It summarizes an aspect of the literature and contains important insights that need to be accounted for when examining health care technological change and expenditure trends.

Given that health is a state subject, an independent working group of experts was set up in Maharashtra to evolve a framework for Universal Access to Health Care (UAHC) and it has developed a framework document for restructuring the public healthcare system and its financing that will help facilitate the implementation of a UAHC model. This chapter reviews how, over the years, the health financing strategy failed to develop a robust public health financed system through underinvestment in health and further discusses the financing strategy of the proposed Maharashtra UAHC model to establish universal access to healthcare.