COMPARATIVE HEALTH-CARE SYSTEMSeastern European systems), capitalist dependen-
cies in the periphery and semi-periphery (e.g.,
Brazil and India), and socialist-oriented, quasi-
independent of the world system (e.g., China
and Cuba).
In 1990, Esping-Andersen (1990) contributed
an important theoretical framework to the field of
comparative welfare states research, that can also
be useful in distinguishing among health-care sys-
tems in advanced capitalist nations. Esping-Ander-
sen conceptualizes all welfare activities, including
health-care, as a product of a state-market-family
nexus. His typology organizes ‘‘welfare regimes’’
around this nexus, specifically as it results in the
decommodification of workers in a country; that
is, the degree to which a citizen can obtain basic
health and social welfare services outside of the
market. In terms of health-care, this would mean
a citizen’s ability to access health-care services
without having to purchase them ‘‘out-of-pock-
et.’’ Esping-Andersen identifies three types of sys-
tems: conservative or corporatist, liberal, and
socialist or social democratic. In The Three Worlds
of Welfare Capitalism, he constructs measures of
decommodification that he applies to data from
eighteen nations in order to assess where each
nation’s welfare regime ranks according to the
three types. Under Esping-Andersen’s scheme, so-
cial democratic systems include the Nordic coun-
tries and the Netherlands; liberal systems include
Canada, Japan, and the United States; and the
conservative or corporatist welfare states include
France, Germany, and Italy. These placements
appear similar to what Graig proposed using a
much simpler public-private dimension; however,
Esping-Andersen’s methodology is unique in its
theoretical approach and because it can be
operationalized quantitatively to allow precise dis-
tinctions among a large number of nations.
Reviewing various health-care system frame-
works shows a wide variety of approaches and
scholarly emphases. Comparative research is in
the process of moving beyond simple typologies to
focus on the conditions under which different
types of systems emerge and under which they
change. This work demonstrates the value of a
broad approach, integrating the key aspects that
affect the development of health-care systems,
including historical, cultural, political, and eco-
nomic factors.
REVIEW OF SELECTED HEALTH-CARE
SYSTEMSComparative international research on health-care
systems requires information that is both detailed
and current. Obtaining data is complicated by the
fact that health-systems throughout the world op-
erate in a state of constant flux. These summaries
present the most recent information available for
the health-care systems of selected countries.
Among countries with advanced economies, Swe-
den and the United States often occupy opposite
extremes when it comes to health-care organiza-
tion and financing. For this reason, Sweden is the
first country discussed along with three countries
that have similar systems—Finland, the United
Kingdom, and Canada—followed next by Germa-
ny, Japan, Russia, and China, with additional dis-
cussions of France, Mexico, Argentina, Chile, Co-
lombia, and Ghana.Swedish health-care reflects three basic princi-
ples: equality among citizens in access to health-
care; universality in the nature of services (the idea
that everyone should receive the same quality of
services); and solidarity, the concept of one social
group sacrificing for another group in the interest
of the whole society (Zimmerman and Halpert
1997). Solidarity in this context refers to taxing
those who use fewer services at the same rate as
those who use more—for example, similar health-
care taxation for younger persons or affluent per-
sons versus the elderly or the poor). The Swedish
health-care system is predominantly a publicly
owned and funded system; thus, approximately 85
percent of Swedish health-care is publicly funded,
whereas in the United States the public portion is
just under 50 percent (Lassey, Lassey, and Jinks
1997). The differences between the two systems
are more startling in terms of the growth of overall
spending. In the early 1980s, both countries were
spending approximately 9.5 percent of their Gross
Domestic Product on health-care. By the end of
the century, the situation had changed dramatical-
ly; in 1999, Sweden was spending 8.6 percent
($1728 per capita) compared to 13.5 percent ($3924
per capita) in the United States (Anderson and
Poullier 1999). Populations in the two nations also
differ markedly on several basic health status indi-
cators. Infant mortality Sweden is four deaths per
thousand live births compared to 7.8 in the United
States. Swedish men live nearly four years longer