cross-subsidize certain expenses for people who would otherwise have difficulty affording them. A source of information on the last point is the surveys conducted by WHO and HAI (a Dutch nongovernmental organization, Health Action International). These surveys, in various countries, compare the costs of common medicines to the pay of low-wage public sector workers and document the nontrivial burden that such expenses often impose on large parts of the population (WHO and HAI 2008). These three goals appear as the ultimate performance objectives in our Flagship Framework for a health system, as shown in figure 2.1. The other elements of the framework—the control knobs and the intermediate performance measures—will be discussed in detail farther on in the book. Figure 2.1
The Flagship Framework for Health System Performance
THE HEALTH SYSTEM
TARGET POPULATION
Financing
Efficiency Health Status Payment
Organization
Quality
Customer Satisfaction
Regulation
Access Risk Protection Persuasion
Control Knobs
Intermediate Performance Measures
Performance Goals
Source: Roberts et al. 2004, 27. By permission of Oxford University Press, Inc.
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Pharmaceutical Reform