Quality, value, accountability and information as transforming strategies for patient-centred care: a commentary from an international perspective.

The reviewed paper describes how one of the largest integrated healthcare systems in the US has successfully transformed itself to provide 21st-century healthcare. Even though there are other examples of successful transformation of public health services, it is difficult for large, bureaucratic systems to change, and a substantial number of ministries of health or social security health systems in the developing world are run under the assumption that change is very difficult if not impossible to achieve. The VA has significant differences and more financial resources compared to most of the developing world public health institutions; but still, change is often not only about money, but also about strategic direction, commitment and leadership.