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Changing the Health Care System: Models from Here and Abroad
implies that other countries have some of the answers. As far back as the 1970s, U.S. interest in foreign health care systems had been as intense as it is now. During that period, the scope of countries and the kind of issues selected for study were rather biased. A common language with the United States led to an overrepresentation of Australia, Canada, and the United Kingdom in whatever study was mounted. The features or policy choices of a particular foreign health care system were not infrequently misrepresented. Usually, it was due to sloppy study design or conclusions that were based on superficial information. Occasionally, the ideological prejudices of the investigators prevailed, and they were often compounded by deliberate disinformation handed down by the system(s) being studied.
The current interest in the United States in foreign health care systems receives extra impetus and focus from the political momentum that health care gained during the 1992 presidential election campaign. This was also the case in previous elections.3
Health care systems in the member states of the Organization for Economic Cooperation and Development (OECD) present interesting case studies for the United States, but analysts must take into account the facts that foreign health care systems are, on average, not well documented, extremely complex, and driven by local cultural and socioeconomic dynamics. Moreover, a majority of OECD countries present “moving targets” while their health care systems are in the grips of important reforms.4
U.S. visitors are discovering that European health care systems are in a state of flux. Health care issues in Europe are very controversial, and health care reforms tend to become bogged down in compromises. Health care is even more in the forefront of the political debate and election campaigns in Europe than it is in the United States. 5
There is a certain irony in the fact that health policy options copied from the United States are under severe attack in The Netherlands, Spain, Poland, and in particular the United Kingdom.
EUROPEAN HEALTH REFORMS IN REVIEW
The first wave of major health reforms since the introduction of compulsory health insurance in Imperial Germany by Otto von Bismarck in 1883 and in the United Kingdom by Winston Churchill and Lloyd George in 1911 occurred in Europe toward the end of World War II.
The reforms of the mid-1940s were an integral part—and, indeed, were the cornerstone—of the cradle-to-grave welfare state. The main goal was to provide universal, equitable, and free access to all health care resources. Two models prevailed: (1) the gradual merging of existing health