Il règne une croyance prépondérante parmi les tenants de la réforme du système de santé selon laquelle les nouvelles techniques de gestion publique comme la décentralisation et les approches axées sur le marché constituent une panacée aux ennuis qui minent le système de santé. Dans ce premier volet d'un exposé en deux parties, les suppositions et la preuve empirique appuyant ces techniques sont étudiées tandis que l'effet de leur mise en œuvre sur ceux et celles qui sont appelés à gérer le système de santé est évalué. D'autres paradigmes portant sur la prestation de soins de santé seront envisagés et décrits dans un deuxième volet à paraître ultérieurement. Les systèmes de santé du monde entier ont été secoués par l'escalade des coûts, la perception d'un usage inconsidéré des ressources et l'insatisfaction des consommateurs et des fournisseurs de soins quant à la prestation de ces soins et aux résultats obtenus.
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