In Australia, health care spending accounts for more than 9% of GDP and is expected to rise. The health system is perceived as complex, uncoordinated, unwieldy and nonresponsive to individuals. An additional issue is that the health system is viewed as a drain on economic resources rather than a contribution. Many observers of the system conclude that things as they are cannot go on, and that some major surgery is required writes Jane Hall. However, health system reform, though much prescribed, is rarely underpinned by research or evaluation. The question I want to pose in this lecture is whether major surgery is warranted, or would conservative treatment be more appropriate?