by: Marc J. Roberts, Michael R. Reich
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
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
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
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