Each of these ways to organize health services has its strengths and weaknesses in various
contexts and when applied to different types of population-based and clinical services.
When a strongly coordinated approach is needed, as was the case for example during the
postwar (late 1990s) reconstruction of the health service in Bosnia and Herzegovina or
during an outbreak of cholera, hierarchical controls are better. Largely inspired by experiences
such as the British National Health Service and the difficulty of addressing health
problems through markets alone, many low and middle income countries have, over the
past 50 years, established state-funded health care systems with services produced by a
vertically integrated public bureaucracy. This has led to improved access to health care for
millions of people and underpinned many successful public health programmes.