Most health systems continue to be restructured and modified without much thought to underlying public policy. Patient safety, quality and innovation are monitored through a range of agencies while performance measures are regularly measured and the results published. Primary healthcare in many systems remains fragmented. To achieve value of the whole health system as well as its component parts, the development of an outcomes-based approach to performance measurement is required to guide teh delivery of constantly improving health services. This is a critical issue in health systems management.