Getting Better? In Search of Convergence
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(chapter 6). Here we will address the “macro issues” that tend to dominate discussions of the reform agenda—how to organize service delivery, how to pay providers, how to raise and pool resources for health, and so on. Specifically, we look at the extent to which a lack of institutional convergence helps explain the slow progress of key outcomes. An important theme here is accountability. In keeping with the title of this report, Getting Better, each chapter is about improving a specific priority or result. At this stage, it is also worth highlighting some cross-cutting themes that will recur throughout the report. These are as follows: (1) a focus on outcomes; (2) benchmarking against the EU-15; (3) a balance between a “systems” and a “disease” focus; and (4) a data-driven approach. Each is discussed briefly here: • Focusing on outcomes. The road map has already hinted at a results focus in the report. We begin with what we want to ultimately achieve, an improvement in overall welfare, and work backward from there. Less abstract than welfare, the major results are better health outcomes, more financial protection, and greater efficiency: hence, the three major chapters devoted to these topics. A renewed focus on results is also currently a prominent theme in development policy more broadly. • Benchmarking against the EU-15. The issue of convergence has already been highlighted. Throughout the report, key indicators for ECA countries will be reported alongside the same metric for the EU-15 wherever possible. While Western European health systems are not perfect, they are among the best performing in the world on many of the goals we care about and thus provide a strong indication of what can be achieved. Besides offering a benchmark of what is possible, their historical experience also provides valuable insights into some of the trends that may lie ahead for ECA. Other regions offer useful lessons and benchmarks as well and will be cited at times too, but we emphasize the EU-15 experience as the natural lodestone for an ECA region in which half or more of the countries are currently members of the EU or aspire to membership, while for many of the others, it is a major trading partner and travel destination. • Balancing a “systems” and “disease” focus. Understanding and overcoming the challenges in health sectors require that attention be given both to “systems” issues (such as financing, organization, and the like) and to specific diseases. A business analyst will study a large corporation with reference to its overall revenues, costs, and profits, as well as its individual product lines; an economist will
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