Definition of a health system (HS) is a subject of academic and policy debate. According to Hsiao (2003), the debates on health system reform and health system comparisons have both been hampered by a lack of accurate definition of health system to the extent that people compare “apples to oranges”. However, the author (ibd) sees HS as “a set of relationships in which the structural components [means] and their interactions are associated and connected to the goals the system desires to achieve [ends]”. In this context therefore, HS on one hand comprises supply of health care and consumption of health care with access as intermediary. On the other hand, HS comprises the private providers, public providers, health care itself, purchasers and consumers where each of these too have their own components.
However, World Health Organisation (WHO) in the World Health Report 2000 defines HS in terms of functions and performance. According to WHO (2000), there are three basic goals of any health system: to keep people healthy, treat the sick and the injured, and to protect families from catastrophic spending for healthcare. Therefore all health systems in the world aim at achieving these goals, but some have better results than other. The question is why these differences in country health systems?
That brings in the next point. What is a national health system? This is more complex that health system itself. For the purpose of this article, a national health system is one with strong (not necessarily absolute) control/regulation at the center. Key question then is which one is better to have between a national health system and a disintegrated health system?
Out of the six countries (USA, Germany, Canada, France, Australia, and UK) reported in the study by Davis et al (2007), only USA has no definable national health system, yet it has the most expensive and worst performing health system among them all being ranked last in three consecutive assessments conducted in 2004, 2006 and 2007.