Organizing Health Care

Research has not satisfactorily answered the question of whether institutions are becoming more similar across countries despite the existence of nationally distinctive social, cultural, political and economic factors. This study presents an institutional account for the process of change in national institutions over time, and specifically examines one of the most important national institutions, health care systems (HCSs). Longitudinal data on national health care systems and population health in the OECD countries show that there has been increasing convergence in the general characteristics of national HCSs since 1960, mainly in the expenditure on health and the level of public coverage of medical costs. At the same time, the composition and utilization of such HCSs have diverged, particularly concerning the national availability and utilization of health care resources. Despite these differences in national HCSs due to variations in national cultural traits like the degree of individualism, countries have healthier populations, and improvements in health appear to converge all over the industrialized world. Results from this study indicate that population health is ultimately affected by social variables such as the level of socioeconomic inequality rather than by the way countries organize health care.