1. Introduction to Comparative Health Care Systems
Lecture 3
Tracey Lynn Koehlmoos, PhD, MHA
HSCI 609 Comparative International Health Systems

2. Overview Define Health Define Health Services System
How can we compare?
Why should we compare?

3. Defining Health
WHO:
Health is not merely the absence of disease, but the state of physical, mental and social well-being.
Fundamental conditions for health:
Peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice, equity

4. Determinants of Health

5. The Iron Triangle or the Holy Grail?
All nations struggle to
balance access to healthcare
with quality and cost efficiency.
Is there one perfect solution for all nations?

6. Health Care in General Health status is central to quality of life
In every advanced country, healthcare is the largest economic activity—consuming between 5% and 16% of the GDP.
Health services workforce >10 % of all workers in most OECD nations.
All countries are engaging major healthcare reform with an emphasis on cost efficiency.

7. Common Challenges of Developed Nations
Aging population—Europe, USA, Japan
30-40% of consumption in some countries
Need for long term care
Indigent citizens—how to include everyone
Incorporating technology
Rationing expensive procedures
Overuse in some countries
Rising costs—What GDP % is too high?

8. Defining a Healthcare System
The combination of health care institutions, supporting human resources, financing mechanisms, information systems, organizational structures that link institutions and resources, and management structures that collectively culminate in the delivery of health services to patients. (Anderson, 1989a)

9. Roemer Model Our definition of a healthcare system lends
itself to the use of
the Roemer Model
DELIVERY OF
SERVICES
ORGANIZATION OF
PROGRAMS
MANAGEMENT
ECONOMIC
SUPPORT
RESOURCE
PRODUCTION

10. Components to Compare Organization of the Program
Management of Health Services System
Economic Support of Health Services
Production of Health Services Resources
Delivery of Health Services
Not in the Roemer Model—but look for the use of Information Systems and advanced technology!

11. Paradigms for Comparison
National Health Service Model (Beveridge):
Universal coverage, tax-based financing
National ownership of production
Social Insurance Model: (Bismarck Model)
Universal social security (employer, employee taxes)
Public/Private ownership of production
Private Insurance Model:
Employment-based private insurance
Private ownership of production
NO ABSOLUTES, VARIATIONS IN ALL APPLICATIONS!

12. Major Influences on Systems
Environmental Influences
Historical Record
Demographic Influences
Economic Influences
More: Cultural, Political, Social Influences
Public Health and Disease Prevention—What makes the population need health services? (Lifestyle, pollution, unsafe?)

13. Health Outcomes to Compare
Infant Mortality
Life Expect
Male
Female
Canada
5.3
76.3
81.7
Japan
3.6
77.6
84.6 UK
5.8
75.0
79.8 US
7.2
73.9
79.4
( )

14. Value of International Comparison
Understand and appreciate common healthcare problems
Understand how characteristics of the delivery system impact population outcomes
Impact of mental illness on culture
Comparative strategies for reform and increasing quality and containing costs

15. Conclusion
There is no “Gold Standard” for health services systems just the ability to adapt, reform and learn.
Werner Christie (Norwegian MoH) said, “The whole healthcare system is futile, as the average death rate is still 100%”
This course should teach you about the range of possibilities and give you tools to apply in your own life and work.