Making Reform Happen

Lessons from OECD Countries

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OECD countries have made significant reform progress in recent decades, in fields as diverse as competition policy, health care and the environment. How have they done it? And why have reforms advanced in some places and stalled in others? This collection of essays analyses the reform experiences of the 30 OECD countries in nine major policy domains in order to identify lessons, pitfalls and strategies that may help foster policy reform in the future. While taking full account of the tremendous differences in the political and institutional settings in which these reforms were undertaken, the authors highlight a number of common challenges and potential solutions that hold good across both countries and issue areas. They show that the scope for cross-national policy learning is enormous.

The importance of such reform lessons is all the greater in the wake of the global financial and economic crisis. As OECD governments confront the challenge of trying to restore public finances to health without undermining the recovery, they will need to pursue a careful mix of fiscal policies and growth-enhancing structural reforms. Designing, adopting and implementing such a policy mix will require the crafting of effective reforms and effective strategies for implementing them.



Effective ways to realise policy reforms in health systems

This chapter investigates the factors that can help or hinder the reform of health systems in OECD countries. “Reform”, here, refers to changes to health systems which aim to improve their performance in one or more dimensions. The chapter is written mainly from a prescriptive point of view – what should governments do to increase the prospects for successful reforms? It is also written mainly from the perspective of economics, although a few selected references are made to political science literature. The first part of the chapter considers the need for reform in health systems. It goes on to set out a general framework for examining the determinants of success and failure in health reforms and to focus on the governance of reforming health systems, identifying some enabling and disabling factors that are likely to be partly under the control of governments. The second part of the chapter presents five case studies of the factors associated with successful and unsuccessful reforms, based on five recent OECD Reviews of Health Systems – in Finland, Korea, Mexico, Switzerland and Turkey. Two final sections discuss the findings that emerge from the case studies and draw some conclusions.


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