2 Escalating expenditures and lack of universal insurance are the focal points of American health care reform, while in Britain, where expenditures are substantially lower and services are available to all, the length of queues, quality of services, and internal misallocation of medical resources have driven reform efforts. Many Eastern European nations face the dilemma of trying to maintain universal access to health care services in the face of sharp de lines in public sector revenues associated with general economic reforms. The health care systems in these transitional economies often suffer from overstaffing, unnecessanly large physical facilities with inadequate medical equipment, and overutilization of services.<sup>4</sup> Health care reform in the LDCs is focused more cn the fundamental problerns of inadequate medical resources (providers, facilities, equipment and supplies), the geographic distribution of these resources, and the failure of financing mechanisms to instill providers and patients with adequate concern for the cost of care. Between and wit-iin these blocks of countries there clcarly are differences in the urgency, nature, and scope of health care reform efforts. Yet common elements do exist, and lessons learned Di one context may help to solve related problems in other settings. This, of course, is why current U.S. health care reform efforts are being monitored closely by other countries and international agencies such as The World Bank.

In addition to common concerns about how to finance and control rising health ca;e expenditures,<sup>5</sup> many countries face similar problems in encouraging healthier lifestyles that would reduce the need for medical intervention. While some developed countries report significant reductions in per capita consumption of tobacco and distilled spirits,<sup>6</sup> personal health habits remain poor in many areas, including Central and Eastern Euwope. For example, a recent review of Bulgaria's publir sector notes that: "Indicators of the health of the population in Bulgaria show an overall pattern that compares unfavorably with W- 2em Europe but is typical of the countries in anXtral and Eastern Europe." The report further notes that "...the main source of differences in life expectancy between Bulgaria and other countries is in diseases of the circulatory system, with nechanisms for health care, and alternative mechanisms for controlling costs' as a key area of potentially fruitful research.

4. For a detailed discussion of the problems and prospects for health care reform in these countries, see Preker and Feachem (1993).

5. Korea, for example, ' experienced very rapid increases in health expenditures. In the 1980-1985 period, real health expenditure. grew at an annual rate of almost 17 percent, of which 15.4 percent was attributable to rising utilization and intensit , only 1.4 percent of the increase was due to demographic factors. Overutilization appears to be a significant problem in Korea, despite considerable 'out-of-pocket' fmincing (51 percent in 198S). For further details of the Korean experience, see De Geyndt (1991).

6. See, for example, Tables No.201 (p.123) and No.209 (p.127) of the _Statistical Abstract of the United Star_ (1991).