In this top group, national health care systems cover a large majority or the whole of the population, delivering high-quality services.
Sweden has relied increasingly on privatized elements of delivery, while rationalization of high costs is a focus in Canada. Rising costs are a particular concern in New Zealand and in Denmark, where a move to a demand-driven system has few cost containment components.
Belgium and Finland have controlled costs by limiting health-care sector wages, leading to staffing shortages. Switzerland’s mandatory coverage system is expensive, with little progressivity in its funding mechanisms.
In this group, high-quality care is typically available to most of the population, but is often expensive or somewhat inefficient.
Perverse incentives or inefficiencies in delivery are a concern in Australia, Austria, Norway and the Netherlands. This last country saw a clear decline relative to the SGI 2009, associated with market-based reforms that have left costs rising and public satisfaction low.
German reforms have made coverage mandatory, and have shifted future cost increases from employers to employees, along with implementing larger government subsidies. Luxembourg’s organizational reforms have failed to contain growing deficits, while South Korea’s low-expenditure system offers good service but requires patients to pay high fees.
Iceland’s high-quality care has been somewhat undermined by cutbacks associated with the country’s financial collapse.
Chile’s highly subsidized public system has been slowly expanded, but wealthy individuals use private services. The USA passed landmark health reform legislation, but even this will not achieve universal coverage, and remains deeply controversial. Today’s US system ranks last in the OECD in terms of life expectancy compared to overall spending.
Infant mortality rates are high in cross-OECD comparison in Chile and the USA. Preventative care receives relatively poor ratings in the UK, France, Portugal and Italy.
In this bottom group, serious flaws in national health care delivery systems make equity a concern, with outcomes significantly poorer for some sectors of the population.
State-run health care services in Greece, Poland and Hungary are inefficient, offering low or unpredictable quality. Planned reforms in Poland and Hungary were blocked, while Slovakia’s government barred private companies from making a profit, and eliminated even symbolic, sub-€1 fees for service.
Mexico’s health delivery service is fragmented by class and region, with upper- and middle-class citizens choosing expensive private services, and a government program aimed at reaching universal coverage in the coming years. Turkey’s doctor shortage has led to mandatory service in state hospitals for new doctors.