Comparative healthcare system analysis: economics, data, history and attitudes

Comparative political economy studies interactions between the state, markets and society, both national and international. It can be useful to look at other (comparable) countries when considering different options to moving towards universal health coverage (UHC; see Section 2.2) in a particular country. Such a comparative analysis includes two key activities: the selection of a relevant peer group and a condensed qualitative analysis of selected countries in this peer group.

Each country's experience is unique, and no system can simply be taken and implemented in another country. Evidence-based health policy research points to the fact that it is useful to assess carefully the processes in individual countries and to identify specific initiatives, patterns and mechanisms that have probably contributed to successful reforms and sustainable financing arrangements that support UHC (Jamieson 2013). Pooled funds can be used to extend coverage to those individuals who were previously not covered, to provide services that were previously not covered or to reduce the direct payments needed for each service. WHO developed the concept of the “health financing cube”, which reflects these three dimensions of population, services and direct costs.1William Savedoff et al. (2012)

identified key common features that support the move towards UHC: political processes that are driven by a variety of social forces to create public programmes or regulations that expand access to care, improve equity and pool financial risks; income growth and a concomitant rise in health spending, which buys more health services for more people; and increased pooled health spending as opposed to funds paid out-of-pocket by households. The authors point to pooled healthcare spending as a necessary condition, but as insufficient, for achieving universal health coverage. Beyond this macro-view, concrete country experiences might also be useful. Positive outcomes can be found if health reforms are:

Situated within a wider social justice framework (a package of pro-poor policy reforms extending beyond the health sector). Such a framework creates an enabling context for pro-poor health reform and can create lasting momentum for the process even when challenges occur.