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Viewpoint
July 15, 2020

Assessing Quantitative Comparisons of Health and Social Care Between Countries

Author Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota
  • 2University of Minnesota Medical School, Minneapolis
  • 3Department of Internal Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 4Radboud University Medical Center, Scientific Institute for Quality in Health Care, Nijmegen, the Netherlands
JAMA. 2020;324(5):449-450. doi:10.1001/jama.2020.3813

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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    1 Comment for this article
    EXPAND ALL
    International Comparisons of Health and Social Care
    Michael McAleer, PhD (Econometrics), Queen's | Asia University, Taiwan
    The compelling Viewpoint on quantitative comparisons of cross-national health and social care indicators with individual-level data by three international medical experts is highly informative in terms of the quality of care, its effectiveness in terms of health and medical outcomes, and associated costs that are not independent of the quality of health, medical and social care that are dispensed.

    The domains of potential incommenurability the authors identify affect the extent of use, and the quality and costs of medical, health and social care in terms of in-patient and out-patient services, hospitalization, formal and informal care giving services, tracking of discharged
    patients, and intensive and extensive home and palliative care.

    In order to conduct meaningful meta-analysis, the health and social care databases must be accurate, complete, clear, consistent, confidential, accountable, storable, reproducible, conservable, retainable, accessible, comparable, integratable, saveable, protected, quarantined, retrievable, statistically interpretable, computable, and downloadable to widely-used data software processors.    

    Numerous other issues related to hospital, medical and social care include obesity, exercise versus sedentary lifestyles, active versus passive participation in sport, heart disease, various cancers, alcohol intake, tobacco use, comorbidities and multimorbidities, ethnicity, socio-economic factors, poverty, immigration and language barriers that affect incomes and access to health and life insurance, family coverage, and company versus private health insurance plans, affect mortality and morbidity.

    The Viewpoint has established a convincing platform for conducting important international meta-analytic comparisons of health, medical and social care services that should prove essential for global public policy considerations.
    CONFLICT OF INTEREST: None Reported
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