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A Cross-National Comparison

Barbara Starfield, MD, MPH

JAMA. 1991;266(16):2268-2271.

Abstract
Ten Western industrialized nations were compared on the basis of three characteristics: the extent of their primary health service, their levels of 12 health indicators (eg, infant mortality, life expectancy, and age-adjusted death rates), and the satisfaction of their populations in relation to overall costs of the systems. Information was derived primarily from published sources. Indices were developed to characterize the extent of primary care in each country and the standing of each country relative to the others on the health indicators. There was general concordance for primary care, the health indicators, and the satisfaction-expense ratio in nine of the 10 countries. Ratings for the United States were low on all three measures. West Germany also had low ratings. In contrast, Canada, Sweden, and the Netherlands had generally high ratings for all three measures. The lack of concordance in the ratings in the United Kingdom may be a result of relatively low expenditures for other social services and public education in that country. The findings may add to the debate and deliberations concerning modifications in organization and financing of care that are currently being considered in the United States.

(JAMA. 1991;266:2268-2271)

Author Affiliations
From the Division of Health Policy, Department of Health Policy Management, The Johns Hopkins University School of Hygiene and Public Health, and the Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md.

Footnotes
Reprint requests to the Division of Health Policy, The Johns Hopkins University School of Hygiene and Public Health, 624 N Broadway, Room 452, Baltimore, MD 21205 (Dr Starfield).

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