These river systems, running west to east, have shaped agricultural development and population growth throughout China's history Theme 1. The Chinese coastline and the Grand Canal first constructed in C.
Identifying the conditions under which health-care systems function most effectively has become a vital, albeit elusive, goal. One point is certain: It is impossible to fully understand the dynamics of health-care systems without comparative health-care research.
Knowledge of systems other than one's own provides the observer with multiple vantage points from which to gain a fresh perspective on strengths and weaknesses at home.
Studying other systems, including their successful as well as failed health-reform efforts, provides a global laboratory for health-systems development. While some countries have been quick to draw upon the health-care innovations of their neighbors, the United States has been relatively slow to look internationally for health-reform ideas.
Fortunately, the proliferation of comparative health-care studies promises that such insularity will be much less likely in the future. The comparative study of health-care systems focuses on two broad types of issues. The first involves describing the range of health-care services in populations or societies, particularly their organization and functioning.
By far the most common type of research, descriptive studies, brings together statistical indicators and factual explanations about how various national systems operate van Atteveld et al.
Some of this work incorporates an analytical dimension by categorizing systems in terms of conceptual schemes or typologies. Less attention has been paid to the second type of research, which looks more closely at the dynamics of how health-care systems behave.
The intent in this type of research is to analyze the patterns among system characteristics, especially with the idea of anticipating the outcomes that are likely with specific types of system arrangements.
Still in its infancy, this work promises an in-depth yet practical understanding of how health-care can be organized and financed to achieve desirable levels of both quality and access.
Interest in cross-national studies of health-care systems increased dramatically in the early s as a result of national debates over reorganizing American health-care.
Rapidly aging populations in many advanced, capitalistic countries, in combination with the expanding scope of high technology medicine, resulted in increased public demand for health-care. At the same time, poverty and other forms of social inequality as well as ineffective societal institutions created major public health problems in many developing countries, such as hazardous water, inadequate or harmful food supplies, poor air quality, unsafe homes and workplaces, and the swift spread of infectious diseases.
In both cases, health-care systems have been severely challenged and often cannot meet the needs of citizens. Because of these problems and also due to enhanced global cooperation, social scientists and policy makers are increasingly turning their attention to the experience of other countries.
Within this broad framework, the methodology for comparing health-care systems can vary widely. A standard approach would include some or all of the dimensions outlined below. The most fundamental comparative dimension is the organization, financing, and control of a health-care system.
This involves comparing which health services are provided; how they are paid for; how they are configured, planned, and regulated; and how citizens gain access to them. Among countries with advanced economies, health-care services today look much the same to the casual observer; however, the financing arrangements and policy-making mechanisms that underlie them vary widely.
The role of government is perhaps the most significant organizational variable in international health-care. All governments, with the notable exception of the U.
Some governments take it upon themselves to actually provide health services and, therefore, own their own clinics and hospitals and hire their own physicians and staff—examples are Sweden and Denmark.
In a variation of this model, the government acts as the purchaser but not the owner of health-care services, obtaining services from private providers on behalf of patients, such as in Canada or the reformed health-care system in Britain.
In Finland, local governments can purchase from either public or private providers. In another model, illustrated by Germany and Japan, the government avoids acting as the major payer, and instead takes the role of an overseer, setting mandates for health coverage, including the type and level of coverage, and regulating the terms of what is largely a private system.
Due to economic pressures, national governments in both Germany and Japan provided increasing subsidies to support their systems in the s. It is important also to compare health-care systems in terms of physician characteristics and provider arrangements for primary care and prevention.
The supply of medical personnel e. Interestingly, there is significant variation in the number of physicians in advanced economy nations, ranging per 10, population from fifty-five in Italy to thirty-four in Germany to twenty-six in the United Stateswhich is more typical, to seventeen in the United Kingdom Anderson and Poullier Equally interesting is that there is no apparent corresponding variation in the health status of these populations.
A more complex issue is how different systems organize and divide medical work between various professions and occupations. In some countries, such as Sweden, Finland, and the Netherlands, midwives or nurse midwives have primary responsibility for normal prenatal care and childbirth; in others, such as the United States, physicians have responsibility for these tasks and midwives are relatively rare.
Practice arrangements between generalist and specialist physicians are another point of comparison. The United States is unique among its peers because primary care physicians working in ambulatory settings also have hospital privileges, and, therefore, have the right to admit patients and to treat hospitalized patients.
In Britain, Sweden, Germany, and many other countries, on the other hand, only specialists comprise the hospital medical staff and only they can treat patients there. Hospitals and long-term care arrangements constitute another dimension in comparing health-care systems.
Countries vary widely in how they use hospitals, as well as in how and where citizens with chronic illnesses and other debilitating conditions receive ongoing, nonacute care.
Many Western countries today are in the process of shifting from institutional to community-based care.In the early s, Beijing faced one of its toughest tests of popular support as it attempted to recover from a series of political challenges to the Chinese Communist Party (CCP) during the tumultuous s.
Since the late s and s, the Communist Party of China (CPC) has made attempts to improve access to health services and rectify the problems that emerged from the initial phase of reforms in the s. China’s health service systems face several challenges today which have implications for .
The need to provide retirement pensions, health care for the old and other support services for the ageing has long been a major challenge for public policy and social security systems in .
Mar 17, · The “four beams” comprise: public health care; medical care; health insurance; and essential drugs.
Public health system reform is designed to achieve the equitable provision of basic public health programs to all residents. The reform of the medical system will focus on improving health care quality and efficiency. Victor G. Rodwin is Professor of Health Policy and Management, at the Wagner School of Public Service, New York University and Co-Director (with Michael K.
Gusmano) of the World Cities Project, a joint venture of Wagner/NYU, the Hastings Center, and the Butler Columbia Aging Center. When China began its economic reforms in the early s, the old system ended as the country attempted to switch to a market-oriented healthcare system.
After 30 years of economic reforms, China has achieved an economic miracle.