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August 19, 1992

The Best Health Care System in the World?

Author Affiliations

From Stanford University and the National Bureau of Economic Research, Stanford, Calif.

JAMA. 1992;268(7):916-917. doi:10.1001/jama.1992.03490070098051

"AMERICANS enjoy the best health care system in the world." So says President Bush, and many physicians agree with this claim. But frequent repetition doesn't make it true. What kind of evidence would an objective observer examine to evaluate different systems of health care? Is it possible to determine the best system unambiguously, or does the choice depend on the criteria used? The "best" health care system may be like the "best" spouse—it all depends on what one is looking for. Physicians, for instance, may assign values to system characteristics that differ markedly from those assigned by the public. Even within the profession, each specialty may have a different point of view and reach different conclusions about the system, eg, radiologists vs family physicians.

Naoki Ikegami, a Japanese psychiatrist, has suggested three criteria for assessing "best medical practice": (1) maintenance of technical standards in diagnosis and treatment; (2) preventive measures