The Healthcare Systems: Models for Comparative Analysis

The epidemiological approach

Application of the epidemiological approach to the analysis of health care systems works with several dimensions. It involves four subsystems, which are the individual, the institutional, the societal, and the larger system. The societal subsystem covers the political, socio-cultural, demographic, and economic elements. This dimensional analysis assigns casual effects to a collection of factors, and it is mostly used to study the interrelationships between a number of effects and what causes them (Ellenzweig 2002).

This model has its benefits when it comes to multilevel analysis and the historical point of view, but one cannot ignore the know problems associated with it. For instance, it would be difficult to ascertain casual links directly between different political and economic orientations and the arrangements of the institutions involved in the health care systems. In addition, it would also be challenging to establish the connections between the individual and institutional level (Maria, 2000).

Comparative analysis of cross sectional multidimensional nature requires a modular approach. This modular approach consists of a number of separate modules that can be combined according to requirements. In this manner, one can make several comparisons significant on a narrower perspective, and solve problems of various sizes. The use of the epidemiological approach in comparative analysis can experience difficulties when it comes to linking the results coming from several modules (Maria, 2000). This approach permits different levels of comparison that do not depend merely on the absence of disease. It suggests the inclusion of the analogical association and the establishment of casual links depending on the available evidence.

The health services approach

The health services approach develops a method to group national health systems based on cross-sectional assessment of each of their constituents (Ellenzweig, 2002). According to Light (2007), this approach presents a dynamic model of elements that are common and base on availability of resources, economic support, good management, and delivery of proper services. As a result, one can identify the different types of health systems with as free market, welfare state, socialist, underdeveloped, and transition systems with regards to delivery systems. The complexity and performance of the system of health care are a contributing factor to the delivery of health services and financing of medical care.

According to Maria (2000), the free market health care system cuts off any involvement of the government in terms of regulation, licensing, approval, and oversight. Welfare state health system involves complete participation of the government in all the aspects involved in delivering health care. The socialist health care system involves a government providing health care and financial support to everyone, thus, overseeing the health needs of all individuals of the society thus improving access to health care, financial stability, and maintaining a healthy society. The underdeveloped health care system is characterized by unequal distribution of health personnel, poor health infrastructure, understaffed health facilities, and poorly organized health expenditure. Health care systems in transition often show signs of improvements in all aspects from economic stability to delivery patters, thus, are more prone to manipulation than any other system (Arrow, 2010).

A comparative analysis of a countries’ health care system is done with regards to its capacity to incorporate either institutions or populations. The main weakness of this approach is its inherent effort to reduce the explanation of a multifaceted health care system to one or two variables. It seeks to simplify comparison unidirectionally, thus, increasing the error margin. Another weakness is that it does not regard the trends that occur over time. This is according to Morrison (2005), who stipulates that it only gives a static representation and does not reflect longitudinal changes in systems.

The health policy approach

This approach includes the politico-economic policy-oriented model used to distinguish between national health systems based on the assumption that these systems present clear-cut ideologies (Ellencweig, 2002). Some systems have conservative ideologies such that they believe in the fact that equality makes law; while others are of a more liberal orientation whereby they believe that opportunities are equal for all people. There are also other systems that have a radical orientation, thus, believe in equality of results regardless of the methods used. An organization can choose any of these three systems to apply to its health care policies.

The health policy approach encompasses political, historical, and economic processes. It focuses on achieving goals of a system with regards to the politico-economic ideologies of a government enacted to ensure proper planning and delivery of health services to all its citizens. However, this approach fails to provide solid tools for provisions on the availability of clear-cut government ideologies (Porter & Olmsted, 2004).

The health system just like any other system is made up of various components that facilitate their functioning and service delivery. The components include input, process, and outcome. Input involves the resources used in making the whole system function well. There are the human resources, which include the healthcare providers, the patients, and the payers. The physical resources mostly consist of the healthcare infrastructure, and the financial resources are what enable the establishment of the health care system (Feldstein, 2004). The processes of the healthcare system include the services provided by the input that transform into care giving. The outcome is the result of the process of care giving that determines the present and the coming future health status of the system.

The significance of why nurses need to understand these models.

A comparative study on the health care system may avoid problems related to care giving, reform and definition. However, other comparative issues still come up because health systems comprise several complex interactions that may permit unknown variations in policy making and delivery and control measures. This complexity calls for the attention of all the parties involved, especially, the care givers, in this case, the nurses. Proper functioning of the health care system depends on the relationship between consumers, health care providers (nurses), and the governing system. Consumers depend on the nurses for care while the nurses depend on the governing system for they pay and legal frameworks (Porter & Olmsted, 2004).

This design puts the nurses as caregivers in the middle of the system thus they need to understand how these models for comparative analysis of health care systems work. It is, therefore, essential that healthcare professionals, especially nurses, learn how these models function so that they get the opportunity to make or suggest any changes to improve the systems as time passes (Ellencweig, 2002). Without the understanding of these models, nurses would not have the capability of providing the care needed to their patients mostly because of the different dynamics. It is extremely hard to provide services to clients if the involved personnel do not understand the trends of the system.

Nurses need to understand the models for comparative analysis of health care systems so as to facilitate the core strategy of quality system improvement. They will also be able to develop organizational skills and abilities required to support the dynamic system improvement. This will significantly improve the performance of the system because there will be room for better performance. It is clear that nurses are at the centre of the delivery system and; therefore, they will be better positioned to engage patients in the process of care delivery and educate them of the care system. Nurses will also be able to come up with ways of integrating seamless health care transitions that promote the effective functioning of the system (Maria, 2000).

When nurses understand the functioning of these models, they will be able to engage in leadership activities that promote the achievement of common goals of the system. These activities provide opportunities for aligning all the goals set for the organization. In addition, they will be able to come up with effective learning approaches and ways to test and add on the improvements. In any system, it is clear that the flow of information is a significant contributor to its success (Morrison, 2005). Nurses with access to information about comparative analysis models in the health care system will be able to provide a platform with guidelines on system improvement. As result, informed nurses mean that the system will have high chances of overcoming short-term, as well as long-term factors that undermine successful operation (Light, 2007).


Arrow, K. (2010). Uncertainty and the welfare economics of medical care. American Economic Review , 245(56), 941-973.

Ellencweig, A. (2002). Analyzing health systems: a modular approach. New York: Oxford University Press.

Feldstein, P. (2004). Health policy issues: an economic perspective. Chicago: Administration Press.

Light, D. (2007). The rhetorics and realities of community health care: the limits of countervailing powers to meet the healthcare needs of the twenty first century. Journal of Health Politics, Policy and Law, 22(1), 105-145.

Maria, S. (2000). Reshaping health care in Latin America: a comparative analysis of health care reform in Argentina, Brazil, and Mexico. Ottawa: IDRC.

Morrison, G. (2005). Mortgaging our future :the cost of medical education. The New England Journal of Medicine, 12(5), 117-119.

Porter, M., & Olmsted, E. (2004). Redefining competition in health care. Harvard Business Review, 7(5), 1-13.

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