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Health care systems: Germany and Britain compared/ Health care delivery - towards an agenda for policy learning between Britain and Germany

Busse R

London: Anglo-German Foundation for the Study of Industrial Society





1.1 Purpose

This paper proposes a framework for analysing health care systems, which it then applies to a comparative review of the British and German systems. The aim is to identify areas where further comparative research will be scientifically rewarding as well as politically relevant for decision-making about future reforms. Examples of best practice are identified.

The paper describes in some detail those areas where current research data exist, while highlighting the many areas where such information is lacking and which are therefore priorities for further research.

1.2 Methodological framework

Health systems research has developed considerably in the past few years. While it used to be mostly descriptive, comparing different countries or regions, it has become apparent that for meaningful analysis the objectives of health care systems need to be clear, so that actual performance can be compared against these objectives. Although this may seem obvious, it is still far from usual that explicit objectives are stated. Yet a degree of consensus has emerged around certain objectives, for example:

• Access to health care for the whole population

• Effectiveness in terms of producing health gain

• Equitable financing.

Once objectives are set, health system research can assess whether these are met. In the simplest case this will be a longitudinal analysis in a single country, using pre- and postreform data. Another approach is to take a comparative perspective, analysing two or more countries. Here the focus might be the on the relative strengths and weaknesses of the two systems, rather than on the extent to which they meet their objectives...

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