Comprehensive policy analysis for health system reform

This article presents the results of a comprehensive approach to policy analysis that may serve as an input for health system reform. The comprehensive character of this effort stems from the attempt to combine, in a coherent framework, various analytical tools that have been developed recently, such as measurement of the burden of disease, cost-effectiveness analysis to integrate packages of essential interventions, national health accounts, assessment of system performance, consumer surveys, and political mapping. These tools were all applied in a study that was carried out in Mexico from August 1993 through September 1994. After explaining the logic of the study, the paper summarizes the findings and recommendations under five headings that shape the form of reform: the problems, the principles, the purposes, the proposals, and the protagonists. Rather than describing these various elements in detail, the paper focuses on the strategic aspects, which are most relevant to other countries currently planning or implementing reform initiatives. The article concludes that, under the current wave of international interest in health system reform, it is necessary to establish a mechanism for shared learning at the global level. Only in this way will it be possible to reproduce the analytical skills and accumulate the body of evidence that health systems require for their sustained improvement.