The Performance of National Health Care Systems: A “Good News, Bad News” Finding for Reform Possibilities

This paper seeks to contribute to an understanding of how macro health systems work by comparing three possible sets of influences on national health care outcomes: 1) health care facilities and their presumed link to national affluence, 2) social characteristics which are assumed to promote healthy behavior, and 3) political variables in the form of welfare state development. Our findings bear both optimistic and pessimistic connotations. On the one hand, the somewhat limited importance of the first set of factors shows that good health in a country is not simply the function of high spending levels. However, the surprisingly strong role of “social development” in determining health care outcomes that emerges implies that much more than the direct provision of health care must be manipulated to ensure optimal health for a nation's population.