a. In Western Europe:
1) Maintenance of public financing as a key element for health systems.
2) A tendency to universalize coverage of the population.
3) A tendency to separate finance and the production of services. The production of services tends to be left in private hands, or in a public-private combination, but based on principles of competitive market management.
4) A tendency towards the integration of various health care systems which are superimposed or coexist in each country into a single harmonized programme, whilst still maintaining differences between countries.
5) A tendency - albeit with different criteria - towards defining and explicitly outlining the risks covered: selective financing, a list of benefits, a basic package-deal, etc.
6) A focus towards a greater role for clinical services and doctors in the management of health services.
b. In Latin America:
1) Refocussing and proposals for redefining the role of the State and the private sector in various areas of social welfare and more specifically in health and medicines.
This refocussing has been encouraged to a large extent by debt problems and consequent fiscal adjustments; an easy reply to this problem is for the State to give up its responsibilities to finance and direct the health system. Such behaviour is dangerous since it could have irreversible consequences.
2) The ongoing reforms follow diverse models and strategies but goals frequently proposed are universal coverage and high quality services.
3) A general model for private financing of health care as a cure for these problems in the long term is questionable, and finds difficult support for social and equity reasons.
4) The importance of maintaining solidarity has led various countries to outline and base their health benefits on Social Security Systems, with complementary public financing for groups not covered.
5) With the cooperation of the World Bank and IDB, and health organizations (such as the WHO and PAHO) and European experiences, broad directives and basic lines could be formulated to serve as a reference point for different countries when they outline and design the future of their social protection and health care systems.
6) It is also desirable to elaborate and integrate national drugs policies as part of a health policy.
c) In Africa and Asia:
In most African countries, present clear tendencies towards the abandoning of responsibilities by the public sector generally respond to external pressures and have been put forward by agencies and countries as a requirement for granting financial aid.
In Asian countries, this tendency towards abandoning responsibilities by the public sector in this field is also noticeable, although for different reasons which are apparently domestic.