Health care reforms around the world--from Europe and North America to Africa, Latin America and Asia--seem to all be market-oriented reforms driven by international business interests and right wing political parties. There seems to be a sudden and broad concern with the "efficiency" of medical care, with the assertion that democratically or professionally run systems are inherently inefficient. Far less concern is evident for the more traditional values held regarding medical care, "effectiveness" (or quality) and "equity." The fact is that we have little good cross-national research that systematically addresses the reform issue.

This book addresses that problem, and attempts to look at health care reforms in a number of countries, representing as wide a spectrum as possible, and using a common conceptual framework that allows for comparable information to be gathered and presented on each, despite differing levels of socio-economic development. The authors agreed on a set of models that were thought to provide reasonable guidance in answering the questions of the source of pressures for reform, the alternative modes of organization that have been found in the world in recent years, and the direction of change among those alternatives.

After World War II, Sweden led the Western world in social programs. By the 1970s it was considered a model of the successful welfare state, providing a broader and more elaborate system of social programs and security to more people than any other country, the centerpiece of which was its health care system. As Twaddle explains, however, by 1990 there was a significant shift in Sweden's health policy debates.

Instead of speaking about the medical care system in terms of effectiveness, solidarity, and public planning, the discussions grew focused on competition, markets, and privatization, taking on more of the characteristics of the U.S. system. Twaddle explores the nature of the proposed changes in medical care, the context in which those changes were being proposed, and the steps that were taken to implement change. He concludes that the problem of market- oriented reforms in health care seems to be almost universal.