Why Healthcare Reform Should Be Designed from the “To Be” State Rather than the “As Is” State
Introduction Healthcare reform is not merely an exercise in repairing defects in an inherited administrative order. It is, more fundamentally, an exercise in institutional design: deciding what kind of health system a society wants, what outcomes it values, and how governance, financing, service delivery, workforce policy, and information systems should be aligned to achieve those outcomes. Contemporary reform agendas across advanced health systems increasingly converge around stronger primary care, better care integration, digital transformation, affordability, and more people-centred care. That convergence already suggests that reform is guided by a desired future state, not by passive extrapolation from legacy arrangements. For that reason, healthcare reform should begin conceptually from the “ to be ” state. A target-state approach clarifies the normative goals of reform and helps orient institutions toward outcomes that matter: better patient experience, better population health, ...