Editorial: International Health Care Systems

Stephen Morrissey, Ph.D., David Blumenthal, M.D., M.P.P., Robin Osborn, M.B.A., Gregory D. Curfman, M.D., and Debra Malina, Ph.D.

N Engl J Med 2015; 372:75-76. January 1, 2015
DOI: 10.1056/NEJMe1415036

Abstract / Resumen:
All countries want to meet the health and medical needs of their populations, preferably without bankrupting themselves or draining resources that serve other important human needs and purposes. In the face of varied economic, political, cultural, environmental, epidemiologic, and demographic forces, each country tries to tailor its health care system to the specific characteristics and needs of its population. Yet the building blocks are largely the same: every country requires a basic public health infrastructure, which in developing countries may rely heavily on community health workers. Developed countries require physicians, nurses, and other health care professionals, hospitals and clinics, and some way to pay both for clinical services and for drugs, medical devices, and other interventions. Countries need ways to measure the effectiveness of the care provided, in order to improve and regulate it and to ensure the care is meeting the demand. They need ways to evaluate treatments and health care interventions and ways to disseminate them. They need ways to educate clinicians about health and medicine, as well as ways to educate everyone else, to help their populations lead healthy lives, make wise health care decisions, and participate in their own care. And with health care costs ranging from about 2% to more than 17% of GDP, they need ways to pay for it all. During the U.S. health care reform debate leading up to the passage of the Affordable Care Act, health policy approaches used in other high-income countries were sometimes cited either as models to be emulated or as cautionary tales – and occasionally both. In truth, most effective national health care systems have had both successes and failures and have continued to shift and change, whether through reasoned evolution or owing to the swing of a political or economic pendulum. In many cases, lessons can be drawn from failures and setbacks as well as from advances and successes.

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