Expanding the scope of health reform: application in the United States.

Since the demise of the Clinton national health plan in the early 1990s, a number of states in the US have continued to pursue health reform. The reforms reflect the on-going debate in the US and throughout the world over market-minimizing versus market-maximizing strategies to improve healthcare systems. This paper describes the limits of this debate and supports a broader view that focuses on how health policy can improve population health. Performance measures and indicators traditionally used to evaluate market minimizing/maximizing strategies for reforming healthcare are redefined for evaluating strategies to improve health. Differences in the two views are illustrated by describing state reforms in the US using the market-minimizing/maximizing framework and evaluating the reforms based on the health-related framework.