Are health systems of different countries and their cities truly comparable? Health policymakers and organizations such as the World Health Organization (WHO) are concerned both with the average level of population health and related inequalities within the population. According to WHO, health systems across the globe have varying performance measures. The WHO has provided a framework for assessing the performance of health systems. A key finding is that health system performance variation is tied to education, levels of income, and health expenditure. Seeking to understand health systems better, I read Health Care in World Cities: New York, Paris, and London. Gusmano and colleagues compare the health systems of different cities: Paris, France; London, United Kingdom (U.K.); and New York, NY; France, the U.K., and the U.S. are developed countries with similar economic infrastructures. The authors hope that the comparisons will provoke some discussion of how health care might be improved in both developed and developing nations.
The book's chapter titles are: A New Approach to Comparing Health Systems; Comparable Cities within Contrasting Health Systems; Overall Performance of the Health Systems; Avoidable Mortality, Access to Primary Care; Avoidable Hospital Conditions, Access to Specialty Care; The Treatment of Heart Disease; and Conclusions. Each chapter ends with a summary reinforcing the main points discussed by the authors.
The authors begin by boldly making the case that comparing different health systems is essential, drawing the reader's attention to potential opportunities to improve and maintain health around the world. Programs that provide financial incentives to physicians in training to increase the availability of specialty care are only one example. This chapter lays the foundation for the comparisons presented in the subsequent five chapters. While there are many indicators to health system performance, the authors focus on access to timely, effective health. First, in New York, Paris, and London there is a broad support for the notion that people who need health care should receive it. Second, comparable measures at the neighborhood level in each city exist, allowing the authors to evaluate access to health care within and among the cities. Examples of comparable measures of health care performance are avoidable mortality, access to primary care, and access to revascularization.
The comparisons presented in chapters three to five show that each city performs well in some areas and poorly in other areas. Overall, the inequality of access to timely and effective health care appeared to be greater in New York than in Paris and London where there is universal access to health care. This is mostly due to the financial constraints experienced by the people in New York, especially those of the lowest incomes. In the final chapter, a succinct summary of research findings and comparisons is provided.
Overall, the book has multiple strengths. The summary at the end of each chapter is useful as it refreshes the mind and reinforces the objective of the chapter. Two, the authors are able to compare the three cities' health systems without showing their preference for one particular health system. The authors effectively compare the challenges, successes, and strengths of each city's health care system. Three, the use of research data and results from previous published works ensures that appropriate variables are being addressed and relates the comparisons to the relevant trends observed across the globe.
I found the book easy to read. Gusmano and colleagues certainly achieved their goal to provoke some deliberation about how health care might improve in both developed and developing nations. I would recommend this book to students (undergraduate and graduate levels) of public health. Additionally, it is a great reference tool for policymakers looking for models on how to organize public health infrastructures. Health systems of cities and their respective nations are comparable as long as the countries supporting them have similar economic infrastructures.
1. Murray C, Frank J. A framework for assessing the performance of health systems. Bulletin of the World Health Organization. 2000;78(6).