High Income Comparisons
Head-to-head numbers on health system performance inspire competition, drive reform and promote accountability by encouraging better monitoring. But, to move from measurement to improvement, aggregate numbers should be accompanied by a deeper understanding of what they actually mean. If one country does better at treating asthma, it could be because they have a less complex patient population, or because their primary care infrastructure catches patients earlier. The reasons behind success (or failure) have significant implications for policy and systems.
A common refrain in U.S. health policy conversations is that every other high income nation has figured out how to provide accessible, high-quality care to all of its citizens – so why can’t the U.S.? The team at the Harvard Global Health Institute have learned that the reality is rarely so simple, though far more interesting. Since no country or plan can cover everyone for everything all the time, designing a healthcare system requires making difficult choices — yet we all know very little about how these choices are made, and how they affect patients and caregivers. Our research examines how a diverse set of high-income nations comparable to the United States choose to care for their people, and what the outcomes created by those decisions feel like for both patients and providers of care.
Alongside our work to quantify how systems are doing, we are producing a series of pieces that outline and explore considerations necessary to interpret this information. These pieces are aimed at improving the field, but also providing practical guidance for policymakers who want to make sense of, and respond to, results from international comparisons. The first piece, entitled Challenges in International Comparison of Health Care Systems was published in JAMA. It provides a practical breakdown of challenges and states that “Without understanding and addressing these challenges, cross-national comparisons will fail to improve health policy and may lead to misinterpretations and poor policy making.”