Although they may differ in structure or philosophy, health systems around the world have a common goal: to improve the health of the population they serve by delivering high-quality, accessible, and financially sustainable health care. Given ballooning health care costs and increasingly demanding consumers, achieving this goal is becoming ever more challenging. Quality, access, and sustainability form an elusive triad for most health systems, which struggle with at least one of these dimensions. For example, the United Kingdom has focused heavily on access and has succeeded in reducing wait times significantly, but now, more than ever, it needs to address sustainability as the government begins to squeeze public spending in light of the global financial climate. The United States, too, faces a daunting challenge in sustainability; its health care spending already accounts for more than 15 percent of GDP—yet the country still lacks universal coverage. Australia is focusing on quality and sustainability at the federal level, but in some of its states—Victoria, for one—access remains an important concern.
Effecting the whole-system change necessary to respond to these challenges is a difficult undertaking, but not an impossible one: some health systems are achieving considerable success by focusing on regional approaches to health care delivery. The ultimate impact of a health system redesign should be transformational improvements in the health and well-being of an entire population. In London, we expect significant quality improvements as well as efficiency benefits exceeding £1 billion. Ontario, by improving stroke care, has been able to reduce readmission rates by 16 percent per year and the 30-day mortality rate by 8 percent. By taking a regional approach to strategy development and implementation, health systems worldwide can achieve positive change and make a real difference in the lives of the many people they serve.