Abstract
There are enormous financial, demographic, epidemiological and clinical safety pressures on health care systems around the world. Thesepressures are well known and are increasing every day.This perspective paper describes one possible way forward to meeting these pressures undertaken through the system-wide transformationof the health care system in the Basque Country to a population of over 2.3 million people. The overall goal has been to turn the health caresystem to become more proactive than reactive and more collaborative than fragmented. This ambitious plan started in 2009.