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January 2003, Vol 93, No. 1 | American Journal of Public Health 61-63
© 2003 American Public Health Association

HEALTH POLICY AND ETHICS FORUM

Lessons for (and From) America

Rudolf Klein, MA

Rudolf Klein is with the University of Bath, the London School of Economics, and the London School of Hygiene and Tropical Medicine.

Correspondence: Requests for reprints should be sent to Rudolf Klein, L 12A Laurier Road, London NW5 1SG, England.

Drawing lessons from international experience for health care reform in the United States requires striking a difficult balance between historical determinism and free will, between cynical pessimism and naïve optimism. The key to this puzzle may lie in a paradox: the United States is the most successful exporter of public health policy ideas and instruments yet has failed to build an effective health care system.

General ideas (like notions about the role of competition) and microinstruments (like diagnosis-related groups) travel better than do health care systems. Ideas can be adapted to local circumstances, and instruments may easily fit into preexisting systems.

Importing systems from countries with different histories and institutions would require a tectonic shift in the American political landscape.




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