suing major health care reform; how the reform movements in Europe have affected technologic innovation and diffusion; the role and infrastructure of primary care in the United Kingdom and its implications for strengthening primary care in the United States; and lessons on global budgeting from countries such as Canada and Germany and, closer to home, Rochester, New York, and its experiment with regional caps on hospital income.

Jan E. Blanpain, the first 1992–1993 Rosenthal lecturer provides a highly informative overview of the three major “waves” of health care reform in Europe, beginning with the introduction and expansion of cradle-to-grave coverage through the 1940s; rising concerns over health care costs, inappropriate utilization, and excess capacity in the 1970s; and a number of reforms focused on encouraging better management tools and more efficiency in the 1980s. While America may be opting for a greater role for government under health care reform, countries like the United Kingdom and The Netherlands are moving to a greater reliance on market forces and competition. Dr. Blanpain's remarks underscore the many similar problems that both Europe and the United States face in their attempts to make health care more affordable and efficient—the impact of rising health care costs on national economies and budget deficits, an unbalanced supply of health care workers on both a functional and geographic basis, and growing concerns about the impact of cost containment on quality and access. Although Dr. Blanpain speaks to the value of international comparisons, he urges that analysts take into account the fact that foreign health care systems “are, on average, not well documented, extremely complex, and driven by unique local cultural and socioeconomic dynamics.”

In a discussion on the development and diffusion of medical technology, Annetine C. Gelijns and Kathleen N. Lohr compare the European tradition of macromanaging the allocation of medical technology and other health care resources through public planning and regulatory tools to the United States' more micromanaged approach through financial incentives, utilization review, and other protocols for clinical decisions. Similar to Blanpain, Gelijns and Lohr point out that a nation's medical traditions, as well as its social and cultural variables, are important determinants of how technology and other medical resources are used and managed. In the current climate of seeking more cost effective approaches to health care delivery, almost all European nations have begun to invest more heavily in technology assessment and outcomes research. The authors suggest that a great deal of productive cross-fertilization could take place between the United States and the 44 states of Europe in the area of technology innovation and diffusion because they offer a wide



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