the breadth of policy reforms has varied dramatically across countries in a few there has been rapid structural change whereas in a greater number of countries changes have been limited to parametric change reductions in salaries pharmaceutical prices increases in copayments the most common changes have been to reform pharmaceuticals both to pay less at a national level and to encourage more use of generics increase copayments and to centralise purchasing or provision of health goods and services that said a number of reforms have attracted considerable critique and political unrest among workers industry and the general population