International Comparative Analysis of Health Systems


Course Objective

Students acquire knowledge and insight into:
- Different ways in which health systems in different countries are
- Underlying reasons for reforming systems and different models for
reforming health systems
- The relationship between system innovation and transdisciplinary
- Different conceptual frameworks for carrying out a comparative
- Benchmarking the cost effectiveness of different health systems

The student learns:
- To design and carry out a comparative analysis and to reflect on the
scope of application, to make use of the framework for comparative
- To make a clear and structured presentation in the form of a lecture
and present it in a lecture session; and in the form of a poster and
present it in a poster presentation session

Course Content

Recent demographic and epidemiological developments occurring in health
systems worldwide necessitate re-evaluation of the health care systems.

Applicability, appropriateness and effectiveness of existing
organizational structures, goals and frameworks will be critically
analyzed. For this, this course aims to equip you with the knowledge and
skills related to concepts, theory and methods on the following key
• What a health system is (and different ways of describing it)
• What goals and functions health systems have
• Why and how health systems and their performance can be analyzed and
• Why and how health systems evolve and are reformed

In this course, the students gain insight into the complex world of
‘health systems comparison’. In lectures, quantitative and qualitative
aspects of ‘health systems comparison’ are discussed and critiqued.
Furthermore, the complexity and culturally determined nature of health
system design and health system reform are presented through a series of
lectures form VU-lecturers and experts from a variety of institutions
such as the Royal Tropical Institute and OECD.

Small group work for the assignments provides opportunities to practice
relevant skills by analyzing, first, the health system of two selected
high-income countries according to a defined theme (health finance,
primary care, mental health, and maternal care & family planning).
Groups will present their findings with a lecture. Subsequently, health
systems of two middle or low income countries with comparable financial
resources (e.g. GDP per capita, per capita health expenditure, etc.) but
different health outputs and outcomes are analyzed to find out why two
countries are performing in such different ways. The findings will be
presented in a poster format. By repeating the analysis on the same
theme but with different countries, the students are challenged to
constantly improve their own analysis process.

Teaching Methods

Lectures, workgroups for assignments, problem-driven learning,

Attendance to the workgroup sessions for assignments is compulsory.

Method of Assessment

Written exam (50%), assignments (50%). All parts need to be passed (min


1. Murray CJ, Frenk J. A framework for assessing the performance of
health systems. B World Health Organ. 2000;78(6):717-31.
2. World Health Report 2000: Health Systems: Improving Performance.
(Message form the director, Chapter 1, Chapter 2 and the Statistical
3. Yin RK. Case Study Research: Design and Methods. Fourth edition, Sage
publications 2009, London. (Chapters 1 and 2)
4. Bunders JFG, Broerse JEW. The urgency for change. In: Broerse JEW,
Bunders JFG, eds. Transitions in Health Systems: Dealing with Persistent
Problems. Amsterdam: VU University Press, 2010. (pages 3-15)
5. Roberts M, Hsiao W, Berman P, Reich M. Getting Health Reform Right: A
Guide to Improving Performance and Equity: Oxford University Press;
2004. (Chapter 1)
6. Plsek PE, Greenhalgh T. Complexity science: The challenge of
complexity in health care. Brit Med J. 2001;323(7313):625-8.
7. Health System Reviews (HiT reports) of the countries selected for the
assignments (European Observatory on Health Systems and Policies), as
well as other relevant articles students find.

Target Audience

First-year students MSc Global Health

Additional Information

Compulsory course for Global Health students

General Information

Course Code AM_1025
Credits 6 EC
Period P2
Course Level 500
Language of Tuition English
Faculty Faculty of Science
Course Coordinator dr. T. Cesuroglu
Examiner dr. T. Cesuroglu
Teaching Staff dr. T. Cesuroglu

Practical Information

You need to register for this course yourself

Last-minute registration is available for this course.

Teaching Methods Study Group*, Lecture

*You cannot select a group yourself for this teaching method, you will be placed in a group.

Target audiences

This course is also available as: