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Cross-national comparisons in health care and social care may offer insight into quality and cost.1 For example, the US spends more on health care and less on social services nationally than other high-income Organisation for Economic Co-operation and Development (OECD) countries and has poorer outcomes in several key health indicators, including life expectancy and infant mortality.2 In comparison, the Netherlands spends a similar percentage of total gross domestic product on combined social and health care services, but has a higher ratio of social to health care expenditures and better health outcomes than the US.2
Although a higher ratio of social to health care spending is an attractive explanation of variable health outcomes at a population level, it is not known whether and how these differences matter at the individual level. A proposed approach to evaluate this hypothesis involved comparing social and health care use and costs at sites in the Netherlands and the US using existing databases with individual-level data.3 However, fragmented care and disparate, nonanalogous databases restricted quantitative comparative efforts and led to identification of 5 domains that limited cross-national comparisons. This Viewpoint describes these 5 limitations and proposes a framework with factors that could be considered in studies that compare data from cross-national databases.
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Carlson MD, Roy B, Groenewoud AS. Assessing Quantitative Comparisons of Health and Social Care Between Countries. JAMA. 2020;324(5):449–450. doi:10.1001/jama.2020.3813
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