What is the Usefulness of Comparing Health Systems?

It is important to examine health care systems (HCS) from a comparative perspective because it helps us to understand how the characteristics of health care systems in different countries impact health outcomes. It also provides useful clues pertaining to improving the quality of the health care system and reducing health care costs. International comparisons are usually made based on health care expenditure that is, percentage of GDP/GNP and on established performance indicators and health care system attributes (Birn et. al, 2009).
The United States presently, does not guarantee universal health insurance to a large segment of its population and many have faced bankruptcy as a result of high health care costs. These are perplexing facts, given that the US has the most technologically advanced medicine internationally and spends a large proportion of its GDP (16%) on health care (Schoen et. al, 2006). This clearly points to one of the reasons why health care expenditure per capita (one of the methods used in comparing health care systems) ought not to be used as a key performance indicator when ranking countries. High health care expenditure does not translate into high quality and equitable health care for the population. It is noteworthy that citizen satisfaction is not always high, even within countries that are deemed to have “great” health care systems. For example, there may be long wait lists for persons who need to have surgeries and some services like home health care may not be publicly funded. Several of the indicators used to measure performance of health care systems are derived form the ideological perspective (free market economics – privatization and competition) of the sponsors of comparative analysis studies. Market-based priorities result in biased reports right from the outset, and do not augur well for valid international comparisons.
Large numbers of comparative studies have been conducted, detailing the advantages of adopting features of health care systems deemed to be “ideal” such as those in the UK, Canada, Australia and France. Obviously, these comparative studies have had negligible impact on influencing health policy reforms in the US and several other countries. This may be attributable to the fact that each country is unique with respect to how its health care system evolved. The value system, the historical, political, and economic contexts of each country influence the structure of the health care system it possesses.
International comparative studies rely heavily on data collection. However, one has to be cognizant of the fact that the availability of quality data, which is valid, reliable and unbiased, is not commonplace as a result of the data collection methods (statistical modeling instead of using actual data) and the ideologies adopted by the researchers and donors.
In my opinion, whilst there is usefulness in comparing health systems, it is limited in scope. The quality of data for example, needs to be improved by correcting data collection biases. The indicators of successful health care performance must be more broad-based that is, they must rely on appropriate qualitative data in addition to quantitative data (Birn et. al, 2009). The changing developmental contexts of values, history, politics and economics from which health care systems emerge must also be carefully considered in making comparisons.


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