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. We begin this article by discussing three ways to define regional boundaries. We then describe a five-step process for developing a regional health strategy. Finally, we discuss what health systems need to do to implement their strategies successfully. Our thinking on these topics has been developed in part through our work in the United Kingdom but also draws heavily on our colleagues’ experiences in other countries.

What is a ‘regional’ approach?

There are a number of ways health systems can take a regional view. One is simply to follow existing geopolitical boundaries. London, for instance, has 1 regional strategic health authority, under which sit 31 separate payors, each covering an average of 240,000 people. In Sweden, all decisions relating to health care provision are made by the country’s 21 regional health authorities. Canada’s health care system is run by its 13 provinces and territories.