This introductory chapter discusses health sector reform. It argues that economic, social, and political forces, both inside and outside the health-care system, are causing widespread pressures to spend more on health care. New technologies (including new drugs) as well as changes in population structure and disease patterns are continuing to push up per capita health-care costs. The evolving international economic system often limits the capacity of governments and the private sector to meet these higher costs, especially in poor countries, because of short-term crises and longer-term competitive pressures. Broad shifts in intellectual beliefs about the state and the market have led to widespread promotion of market competition and privatization as solutions for all economic problems, including policies for the health sector.
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