Six Worlds of Healthcare Systems

In this paper, we build on the variety of healthcare system typologies that contribute to our understanding of the similarities and differences how healthcare is organized in advanced, industrialized countries. The majority ofexisting classifications are based on three key dimensions: funding, provision, and regulation. Recent debates have asked to what extent these typologies can help us explain the cross-national variation in population health and health inequalities. We argue that in order to make healthcare system classifications fruitful for this question, it is necessary to go beyond structural indicators of funding and provision. In particular, we argue that it is important to consider the relative importance of different healthcare functions (provision, primary care, curative care, etc.) as well as the quality of the care provided as additional dimensions. Moreover, recent reforms have substantially changed healthcare systems in the OECD and require an update of existing classifications. Based on quantitative and qualitative indicators from various international comparative data sources and an expert survey, we develop a healthcare system typology including 30 OECD countries. Using cluster and latent-class analysis, we present distinct types of healthcare provision and the relative fit of individual countries to these types. The results is compared to earlier classifications and based on this comparison, we assess convergence and divergence processes among OECD countries.