A blueprint for the future of the Welsh NHS has called for the service to modernise or face being overwhelmed.
The review was announced by the finance minister in 2002
It calls for people to take better care of their own health and warns the current position is not sustainable.
Derek Wanless, who compiled the report on behalf of the Welsh assembly, said the situation in the Welsh NHS was worse than in the rest of the UK, but shared the same problems.
Health minister Jane Hutt - who announced an extra £4m to cut so-called bed-blockers - said: "We know it is not business as usual - there are tough messages coming in from this report."
She said the cash would help to "unblock barriers betweeen authorities and the health service" which led to people staying in hospital longer than they needed.
Demand for health and social care services could overwhelm the system and workforce
Health and social care organisations need to improve performance and modernise
Citizens and communities need to take greater responsibilty for their own health
More emphasis put on prevention
It also warned that demands for health and social care could swamp the system and stressed the need for greater integration.
Addressing the Welsh assembly, Ms Hutt said the Wanless report endorsed the reforms she had brought in over the past four years, in particular, the aim of encouraging a health service led by family doctors.
"We are a small nation, we should be able to apply the best practice," she added.
"It's about making sure we have a 21st Century health workforce.
"The people of Wales have got to take responsibility as well for their own health and well being."
The report was compiled by Derek Wanless
Ms Hutt added she would return to the assembly in the autumn with a more detailed implementation plan following the report.
Richard Thomas, the director of the Welsh NHS confederation, supported the findings of the report.
"New ways of providing services and modernisation are absolutely essential to transform the NHS into a service that will meet the needs of Welsh patients in the 21st century", he said.
The report took evidence from the NHS, local governments, patient groups, the voluntary sector, social care, professional bodies and academics.
Derek Wanless, the former chief executive of NatWest bank, was asked to compile the report after finishing a health review on the NHS for the UK government.