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Lessons for (and from) America.

Rudolf Klein1

  • 1University of Bath, London School of Economics, and London School of Hygiene and Tropical Medicine, England.

American Journal of Public Health
|January 4, 2003
PubMed
Summary

The US excels at exporting health policy ideas but struggles to implement effective domestic healthcare systems. Importing foreign healthcare systems is challenging due to differing histories and institutions.

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Area of Science:

  • Health Policy
  • Comparative Health Systems
  • International Health

Background:

  • The United States faces challenges in healthcare reform, despite its global influence on health policy.
  • International experience offers valuable lessons but must be balanced with domestic realities.

Purpose of the Study:

  • To analyze the paradox of the US exporting health policy while failing to build an effective domestic system.
  • To explore the transferability of health policy ideas, instruments, and systems across borders.

Main Methods:

  • Qualitative analysis of international health policy.
  • Examination of the adaptability of health policy ideas and instruments.
  • Assessment of institutional and historical factors influencing system import.

Main Results:

  • General health policy ideas and specific micro-instruments (e.g., diagnosis-related groups) are more transferable than entire healthcare systems.
  • Adaptability of ideas and instruments to local contexts facilitates their international adoption.
  • Importing comprehensive healthcare systems requires significant political and institutional transformation.

Conclusions:

  • The US's success in exporting health policy contrasts with its domestic system challenges.
  • Barriers to importing foreign healthcare systems are deeply rooted in American history and political structures.
  • Future US healthcare reform may benefit more from adapting adaptable ideas and instruments than from wholesale system importation.

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