This paper takes a macro perspective on quality and safety in elderly care, focusing on the role of the macro level context in two European countries; Norway and the Netherlands. The aim is to conduct a comparison of the healthcare systems as a foundation to understand quality and patient safety improvement efforts in elderly care across the two countries. Our methodological approach is to conduct a review of macro level factors as suggested by previous studies such as governance and financing structure, role of different actors, and types of initiatives taken. Data was collected from open sources such as national statistics, governmental reports, and web pages of key actors at the macro level. The similarities and differences are discussed to highlight the main areas where improvement efforts need to take country-specific factors into account when learning across countries.