What works?. This is a difficult question. And this is exactly the issue that Anne Mills is addressing in her NEJM article. Her review of health systems in low and middle-income countries achieves and inconvenient but true conclusion:
On the basis of the evidence presented above, few clear-cut conclusions can be drawn with regard to the best strategies for strengthening countries' health care systems. An approach that works well in one country may work less well in another, and not all approaches are equally acceptable to all governments or their multiple constituencies. There is no one blueprint for an ideal health care system, nor are there any magic bullets that will automatically elicit improved performance. This is hardly surprising: health care systems are complex social systems,31 and the success of any one approach will depend on the system into which it is intended to fit as well as on its consistency with local values and ideologies.
A recent historical study of the contribution of the health care system to improved health in five countries identified a number of characteristics of successful health care systems Such systems were able to develop the capacity to select promising strategies and to learn from the efforts of other countries as well as from their own experimentation. The strengthening of a health care system requires a focus not only on specific strategies, such as those considered above, but also on the creation of an environment that supports innovation. Health care strengthening must thus be seen as a long-term process that involves complex systems and requires carefully orchestrated action on a number of fronts. The global community can help by supporting country-led processes of reform and by helping to create a stronger evidence base that contributes to cross-country learning.
I believe that such characteristics hold as well for high-income countries. Evidence for health policy is context based. No universal laws for implementation, only some criteria, some characteristics. Food for thought.
PS. " Our research suggests that the economics of vertical integration makes sense for payors in only a minority of markets.". McKinsey guys at HA blog. I agree.
