Regulation and performance of health systems: a review of analytical frameworks

The private health sector has expanded significantly in recent decades, both in Latin America and other regions. Governments and international organizations have dealt with this process in a heterogeneous manner. A policy approach and, above all, a regulatory framework, are required in order to put health objectives and the right to health above the profit motive that drives private sector participation. This paper reviews frameworks for analyzing the performance of health systems and the regulation of financing and service provision, primarily (but not exclusively) in the private sector. This review covers the output of the main international health agencies (Pan American Health Organization and World Health Organization), international development agencies (World Bank and Organization for Economic Cooperation and Development), and academics involved in international health policy debates. Common aspects of the different frameworks are identified, as well as substantive divergences. The purpose of this article, which is part of a larger project, is to contribute to discussions on the regulation of health systems in the Region of the Americas, consider their particularities, and describe the current context.