All the countries covered in this book have dynamic health care systems. They are frequently—even constantly—modifying their health care systems. Occasionally this is by a major piece of legislation, but more frequently it is by new regulations or other arrangements. Furthermore, many of the nongovernmental actors in a country—the insurance companies, the physicians, the hospitals, and others—are taking action. For instance, insurance companies merge or cease functioning.
In addition, the countries studied in this book tabulate and report data in substantially different ways. For instance, official statistics regarding drug costs vary widely. In some cases, validated drug spending is reported only as retail pharmacy sales. In other cases, official drug spending statistics include drugs administered in hospitals. Other governments only report the cost of drugs the government subsidizes.
Finally, some of my sources disagreed about how some aspects of the health care system operate or should be described. For instance, there is disagreement about whether to consider long-term care financing as part of the health care budget. These differences are a function of both professional judgment and the particular history of each country’s health care system.
The consequence of these issues is that accuracy is a matter of direction and degree. I have done my best to report all facts using 2017 data and to make the data as comparable as possible, so that the overall picture conveyed is as close to reality as it can be. I apologize if I have missed any changes in these health care systems since the writing of this book. Nevertheless, the overall structures and tendencies I report are valid and, I hope, helpful to the reader.