After a late evening flight I arrived at Zurich and took advantage of the wonderfully integrated Swiss transport system, with a comfortable train whisking me to Bern. I had been asked to speak at the conference of the Swiss Health Economics Association. The question they posed was “what is the best health system in the world?”. Not easy. So much depends on what each system wants to achieve. After reviewing the various approaches that had been taken to rating health systems, and showing how the results you get are sensitive to how you ask the question, I decided that, in my view, the best system is one that can anticipate how the world is changing and respond effectively to it.
One way that health care is changing is that it is becoming much more complex. Chronic diseases, such as diabetes, require inputs from a broad range of professionals and from informed patients. This requires organisation – it does not happen on its own. Consequently, we can look at the outcome of diabetes (here, the death rate among young people) as a measure of how systems adapt to this complexity. Some much criticised systems, such as the UK NHS, do very well, whereas others, most notably the US system, perform disastrously. Then there are other challenges, such as preventing the spread of antibiotic resistant bacteria or retaining health professionals. This provides a different way of looking at health systems but maybe wone that we should be adopting more widely.