interdependency of seemingly autonomous actions. Reformers need a comprehensive perspective lest their remedies for one aspect of a health care system generate unintended-and potentially negative and costly-im plications for another part Developing a com prehensive perspective for such a com plex challenge requires a framework to help guide decision making To create an overview of the complicated relationship between the com peting goals common to all health systems, we identified and unbundled the primary elements of supply and demand. (The full report, A Framework to Guide Health Care System Reform, was published in January 2007 and is available free of charge online. In so doing we formulated six principles that apply to a broad spectrum of health care systems. Two of these principles relate to demand, three to supply and one to intermediation between supply and demand we then derived a seventh principle concerning the organizational and operational framework necessary to im plement these concepts(Exhibit 1). Despite the unique characteristics of health care, our findings should refute the notion that it is fundamentally beyond the possibility of structured, logical, economically rational reforminterdependency of seemingly autonomous actions. Reformers need a comprehensive perspective lest their remedies for one aspect of a health care system generate unintended—and potentially negative and costly—implications for another part. Developing a comprehensive perspective for such a complex challenge requires a framework to help guide decision making. To create an overview of the complicated relationship between the competing goals common to all health systems, we identified and unbundled the primary elements of supply and demand. (The full report, A Framework to Guide Health Care System Reform, was published in January 2007 and is available free of charge online.) In so doing, we formulated six principles that apply to a broad spectrum of health care systems. Two of these principles relate to demand, three to supply, and one to intermediation between supply and demand. We then derived a seventh principle, concerning the organizational and operational framework necessary to implement these concepts (Exhibit 1). Despite the unique characteristics of health care, our findings should refute the notion that it is fundamentally beyond the possibility of structured, logical, economically rational reform