The Health Care Dilemma: A Comparison of Health Care Systems in Three European Countries and the US

Studies of comparative health systems have taken a well-entrenched place in health policy research and analysis. The natural instinct to look elsewhere for solutions, or at least coping mechanisms, relating to difficult problems is, of course, facilitated by relatively easy access to literature and databases, such as those provided by the Organization for Economic Cooperation and Development and the World Health Organization. Such databases, at least ostensibly, are standardized to enable cross-country comparison. A comparative health system language has evolved over recent decades, enabling researchers to compare economic parameters (eg, percentage of gross domestic product spent on health, per-capita health expenditure), structural dimensions (eg, single-payer, regulated competition, primary care gate-keeping, capitation) and outcomes (eg, disability-adjusted life-years, patient satisfaction, trust in the health system). True, the methodological challenges are great, and the authors often express doubts about the external validity of various measurements across countries. Nonetheless, researchers of comparative health systems seem to manage to adjust for these deficiencies, so the data, even if often tentative, can be used judiciously and can serve as a basis for comparative work and learning of lessons.