Marc J. Roberts – författare

THE FOUNDATIONAL WORK IN HEALTH REFORM, CELEBRATING 15 YEARS OF INFLUENCEFeaturing a new introduction by the authorsGetting Health Reform Right is the world's leading text for understanding and managing health systems and their reform. Its simple, analytical model allows readers to design their own approach to improve health-system performance based on three outcomes of greatest importance (health status, citizen satisfaction, and financial risk protection), with step-by-step instructions for defining problems, diagnosing causes, devising solutions, and implementing changes. "Rapidly assumed the status of a classic and proved an inspiration to a generation of students and policymakers. It is as relevant today as when it was first published." -Peter C. Smith, Emeritus Professor of Health Policy, Imperial College Business School, London"Has become the mainstay of health-system reform conversations among policymakers in India. Its unique and accessible framing, which goes beyond abstract ideas, has resonated strongly in debates over how to improve health system performance." -Nachiket Mor, former Director, Bill and Melinda Gates Foundation, India

Most public controversies about the effects of chemicals on human health revolve around the risk of cancer—hardly surprising, considering that it is the second leading cause of death in the United States. People are concerned about the dangers of carcinogens in air, water, and food, and they expect their representatives in government to protect them from such hazards. On the other hand, the economic costs of eliminating every suspected carcinogen from the environment would cause tremendous economic hardship. How should policymakers use science to help strike a balance between the benefits of lowering the risk of cancer and the economic costs of regulation?In this important book the authors squarely address the complex interaction of science and regulatory policy. They begin by clarifying the scientific issues that are central to regulatory decisions, then explain how and why scientists can honestly disagree about these issues. They demonstrate with two cogent case studies: the heated debates about formaldehyde and benzene, both useful but potentially toxic chemicals. By examining how scientists evaluated the risks from these chemicals, and what kinds of legislative, administrative, and judicial decisions emerged from the evaluations, the authors furnish insight into the checks and balances of health-risk regulation.They point out that overselling science in this context is harmful to both science and democracy. Their final chapter proposes creative methods for constructing a bridge between the scientist and the regulator that will be invaluable to anyone concerned about health risks.

This book applies an established analytical framework for health sector reform (Getting Health Reform Right, Oxford, 2004) to the performance problems of the pharmaceutical sector. The book is divided into three sections. The first section presents the basic ideas for analysis. It begins by insisting that reform start with a clear understanding of the performance deficiencies of the current system. Like all priority setting in the public sector, this 'definition of the problem' involves both ethical choices and political processes. Early chapters explain the foundations of these ideas and apply them to the pharmaceutical sector. The relationship of ultimate outcomes (like health status or risk protection) to classic health systems concepts like efficiency, access and quality is also explored. The last chapter in the first part is devoted to 'diagnosis' - explaining how to move from the definition of a problem to an understanding of how the functioning of the system produces the undesirable outcomes in question.The second part of the book devotes one chapter to each of five 'control knobs': finance, payment, organization, regulation and persuasion. These are sets of potential interventions that governments can use to improve pharmaceutical sector performance. Each chapter presents basic concepts and discusses examples of reform options. Throughout we provide 'conditional guidance' - avoiding the approach of a 'one size fits all' model of 'best practices' in these five arenas for reform. Instead we stress the need for local knowledge of political systems, administrative capacities, community values and market conditions in order to design pharmaceutical sector policies appropriate to a country’s particular circumstances.The last part of the book is a set of teaching cases. Each is preceded by questions and is followed by a brief note on the lessons to be learned. The goal is to help readers develop the skills they need to deal effectively with pharmaceutical sector reform problems in their own countries.