This volume is essential reading for policy makers and researchers focused on the reform of national health care systems. The most important strengths of the authors' framework are the recognition of system complexity as well as the importance of ethical choices at the foundation of the national will to reform health care. Without successful national consensus-building efforts on the social values guiding reform, there is little prospect of effective institutional change.

While emphasizing ethical theory and political analysis, the authors identify practical perspectives on measurement of health care system performance and the "control knobs" accessible to policy-makers to bring about the desired reforms. These include financing, payment, organization, regulation and individual behavior. Evidence based adjustment of these policy levers requires research, including comprehensive review of current literature,consultation with experts concerning other country experiences in health care reform, rapid situation assessments, and support for rigorous research programs.

The most important weakness of this book (according to the authors' own criteria for making efficient use of available evidence) is the lack of reference to the most recent research. Even though the copyright of the edition reviewed here was updated to 2008, most of the literature cited was published before 2000. For example, there is no evidence-based discussion of health information technology (HIT) and its important contribution to national system performance at the institutional or individual levels of analysis. (The only reference to HIT appears on page 147: "Be skeptical of advice...especially advice that comes from those with something to sell, like a costly computerized information system.") While this astonishing omission significantly limits the immediate usefulness of the volume, the framework provided would serve as a valuable foundation for new interdisciplinary research programs on national health care system reform.