HEALTH-CARE SYSTEMS IN 24 COUNTRIES

Changes in the way health care systems finance services are often driven by some combination of data, public pressure, payer receptivity, and the expressed views of the medical profession and allied disciplines. In this paper, two of the most seasoned observers of comparative health system research and a colleague provide the latest data and some commentary upon them for the health care enterprises of the twenty-four countries that are members of the Organization for Economic Cooperation and Development (OECD). George Schieber is director of the Office of Research at the U.S. Health Care Financing Administration (HCFA). Jean-Pierre Poullier is principal administrator, Directorate for Social Affairs, Manpower, and Education for the OECD in Paris. Leslie Greenwald is a health policy analyst in the HCFA Office of Research and also a doctoral candidate in public policy at the University of Virginia. The OECD's health database provides the most current road map available to compare the status of the health systems of its member states. Given that these twenty-four member countries spend on average almost 8 percent of their gross domestic product on financing health care services, it seems remarkable that the OECD devotes so few of its resources to tracking trends in these health systems. Poullier is an incredibly valuable resource in the collection and analysis of these data, given that he essentially works alone keeping tabs on how twenty-four countries are allocating their health resources. While the OECD's effort in tracking health financing data is far from sufficient, it exceeds comparable pursuits at the World Health Organization and the European Community, where health financing issues enjoy even less standing.