Hospitals are a critical component of the health care provided to many Brazilians. Hospitals which absorb nearly 70 percent of public spending on health are also a critical component of the government s budget, and are thus at the forefront of policy discussions. Why hospitals are important in Brazil is easy to understand. What makes hospitals deliver quality care efficiently or not is much harder to grasp. Drawing on an eclectic array of research and evaluative studies selected from a mix of sources, Hospital Performance in The Search for Excellence analyzes Brazilian hospital performance along several policy dimensions, including resource allocation and use, payment mechanisms, organizational and governance arrangements, management practices, and regulation and quality. Although a few Brazilian hospitals are world-class centers of excellence, many hospitals, including those who serve Brazil s poorest people, are low performers. Yet the Brazilian hospital system is both dynamic and pluralistic, and herein lies is strength. As is shown throughout the book, the foundations for change approaches, ideas, innovations, and initiatives for addressing the shortcoming of underperforming facilities are already present throughout the country s hospital system. Building on these strengths, the authors propose a policy- and practice-based hospital reform agenda that should assist policy makers and practitioners in their search for excellence .