ABSTRACT
Prologue: Many European countries are years, decades,ahead of the United States in reforming their health care systems. At first glance, many of the nations appear to have followed similar paths. The three countries examined here all areconsidered leaders among their peer nations and have gone beyond initial reforms aimed at curbing spending growth to focus on responsiveness to patients and efficiency in use of resources, among other things. However, a closer examination illuminates some key differences, not the least of which is the pace of reform. Also, as the authors of this comparative essay note, “although the vocabulary of reform may be international, terms such as ‘managed market,’ ‘budgetary incentives,’ ‘purchasers,’ and ‘providers’ are interpreted differently in the three countries.” The experiences of the three countries offer lessons for U.S. policymakers, specifically on the role of government in health care, the importance of primary care, and the need to hold providers accountable to patients. These issues are central to the ongoing reform debate in the United States. Chris Ham is director and professor of health policy and management at the Health Services Management Centre, University of Birmingham, in England. He holds degrees from the University of Kent and the University of Bristol and has previously worked at the King’s Fund College and the King’s Fund Institute. He is the author of several key books on the British National Health Service and on comparative health systems. Mats Brommels is professor and director of the Programme in Health Services Management, University of Helsinki Medical School, in Finland. An internist, Brommels previously was a professor at the Nordic School of Public Health in Gothenburg, Sweden. He is an expert on health systems in the Nordic countries and has been involved in supervising the management training of physicians in Finland.
122The experiences of three European countries that are actively engaged in reforming their health care systems—the Netherlands, Sweden, and the United Kingdom—point to a degree of convergence in the types of reforms being pursued. European experiences also offer a number of lessons for the United States. These include the importance of government intervention in the health care market to ensure universal coverage, the key role of primary care in ensuring access to basic health services and in containing costs, and the need to create a strong purchasing or insurance function to hold providers accountable on behalf of patients. The pace and scope of reform are affected significantly by the political process in each country.
