This study presents a broad overview of health-system reforms in OECD countries over the past several decades. Reforms are assessed according to their impact on the following policy goals: ensuring access to needed health-care services; improving the quality of health care and its outcomes; allocating an “appropriate” level of pubic sector and economy-wide resources to health care (macroeconomic efficiency); and ensuring that services are provided in a cost-efficient and cost-effective manner (microeconomic efficiency).While nearly all OECD countries have achieved universal coverage of health-care risks, initiatives to address persistent disparities in access are now being undertaken in a number of countries. In light of new evidence of serious problems with health-care quality, many countries have recently introduced reforms intended to improve this, but it is too soon to generalise as to the relative effects of alternative approaches. A variety of instruments aimed at ...