A vision for health system reform in the Americas.

Many such terms as " health sector reform " and " health system reform " are used interchangeably and are perhaps misinterpreted. Therefore, it is well to begin with some definitions and in this way clarify what I mean when I use any of these terms. I understand the health sector to cover all the different kinds of activities within a society that are under-taken purposely in order to protect and promote health, as well as to cure and care for the ill. That part of society that has these activities as its main and principal concern is designated the health sector. Thus, while education has a great deal to contribute to health, those activities carried out there cannot be included under the health sector. The health system we will discuss comprises a set of components within the sector that work together in an articulated manner to provide certain outputs. Those components are the financial, human, physical, organizational, and informational resources that function in an articulated and coordinated manner such that the effect of their actions or contributions is greater than the sum of the individual parts. It is not helpful to consider the contribution of one of these components to some final end without taking account of the interaction with other parts of the system. I therefore think it is rather disingenuous to consider the contribution of human resources, for example, without thinking that the informational and physical resources must interact with them in a substantial manner. I will refer principally to the formal part of the system, thereby omitting all those activities that touch on health and are carried out domestically or through folk practices. Even though the formal part of the system is very much the smallest, accounting for about 20% of the health activities, it is the part that is of most concern to us in this setting, where we are addressing mainly public policy and the reform that may take place. The final point I would make here is that I take the health system and its various subsystems as being essentially social in nature, and they therefore entail commitment to some form of social justice. Because health systems are social systems, they should seek to reduce the inequalities of health outcomes in the populations they cover. Similarly, because they employ societal resources, health systems should also be as efficient as possible. The output or …