The following objectives should be met by the end of this first module:
- Understand conceptual and methodological issues in comparative healthcare analysis
- List and define the three basic ideas involved in analysis and the goals for learning from each
- Review and understand the basic healthcare systems concepts in France, Canada, and Britain as well as their specific allocation issues
- List and define the three areas that the United States healthcare system differs from Western Europe and Canada
These notes are intended only to supplement your readings. The best way to ensure each module is absorbed is to complete all the readings prior to reviewing these lecture notes. I will try to highlight what I believe to be the most important topics from your module readings. If you have any questions or concerns or there is something you do not understand, please ask me. You can either post on the webboard the question you have (that way others can benefit from the response), or you can e-mail me if you want a more private response. Either way it is extremely important that you have a complete and thorough understanding of the material for the module. Good luck and have a great semester!
This module will focus on comparative health systems, the study of health care systems from different countries. This chapter will center around analyzing countries from a policy perspective. It is useful to study other countries health care system when trying to better understand our own. I think it is very interesting to see where other countries have been, what programs they have tried and why they did or didn't work. Things that do not work well here in the United States have the potential to work well in others. The field of health care administration does not have to strictly stay in the United States. Health care administration consultants work for many countries in helping to redesign or improve their existing health care systems.Comparative health system analysis has both conceptual and methodological problems that researchers are struggling with. The definition of a health system is fluid and changes from country to country. We developed a model in the first portion of this class that we will stick with (the HSO management model) that included both internal and external environments. These internal and external environments change greatly when comparing one country to another. For example, if we are investigating access to birth control in the United States compared to Puerto Rico, religion would play very different roles in the external environment for this process. Methodologically, to compare countries both systems must be identical except for the portion under investigation.... obviously this is impossible. Different approaches have been developed to try to deal with this issue in study design.
Our text discusses three ways that studies of other countries' health care system can be used for learning and adapting to our country. These include evolutionary progress of health systems, with the view that all health care systems develop similarly. Table 17.1 on page 461 reviews the 5 types of health care systems with the trend of moving from type 1 to 5. Public policy learning and understanding determinants and effects of health care policy are the two other methods of comparative health care learning. Evolutionary progress suggests knowledge that can be gained from policy issues in other countries that are more advanced and applied to our future policy plans. Policy learning helps to bring other solutions to American problems in health care. Lastly, understanding determinants and effects of policies abroad can assist in evaluating policies at home.
Another method involves looking at other countries with similar problems and then using the three ideas to focus on solutions. Some issues of importance include inefficiency in the allocation of health care resources (financial and access), lack of continuity of care, and no control over healthcare policy decisions for stakeholders (consumers, healthcare personnel, insurance companies, etc.) The issues of resource allocation are discussed in our text as an example of a comparative study using the problem based approach and focusing on France, Canada, and Britain.
When evaluating how the United States compares to these countries on issues such as resource allocation, we must first understand the major differences between the countries. The United States has three basic differences:
- American values and popular opinion
- Structure of health care financing and organization
- Policy responses to health sector problems
Once these differences are understood we can begin to experiment with solutions and different ideas for our specific health care problems.
It is now time to look at the table on page 480 comparing health expenditures, life expectancy and infant mortality. (There is a reason, this table is put at the end of the chapter). Our country spends the most on health care as a percentage of the GDP, but does not do as well as other countries in life expectancy and infant mortality rates. Now that you know these cannot be directly compared (due to differences in measurement, etc), they still are provocative when suggesting changes to our health care system. What do you think?
That is it for notes for module #8! Let me know if you have any questions.