Health spending continues to rise inexorably, growing faster than the economy in most OECD countries. Most of this spending comes from the public purse. Given the recent economic downturn, countries are looking for ways to improve the efficiency of health spending. This publication examines current efforts to improve health care efficiency, including tools that show promise in helping health systems provide the best care for their money, such as pay for performance, co-ordination of care, health technology assessment and clinical guidelines, pharmaceutical re-imbursement and risk-sharing agreements, and information and communication technology.