International Comparative Analyses of Health Care Systems


Course Objective

• To understand and recognize the different components of a health
system and different models of health system organization using various
frameworks for health system analysis
• To understand and analyze outcomes of health systems with respect to
equity, fair financial contribution and health status
• To understand the complex adaptive nature of health systems and its
• To understand different methods in analyzing and comparing health
systems: health system performance assessment (benchmarking), case study
analysis, cost effectiveness analysis
• To understand the underlying reasons for health system reform and to
recognize different health care reform strategies;
• To understand cases study methodology regarding comparison of
components of health systems
• To apply the acquired knowledge in the context of high, middle and low
income countries;
• To design, carry out and reflect on a (comparative) analysis of high,
middle and low income countries, making use of the framework for
comparative analysis;
• To be able to link the characteristics of policy recommendations,
strategies on health system reform and public opinions on certain
aspects of care to the specific determinants of the country/region at
• To give a well-structured and academically solid lecture on the
comparison of countries, including its the handouts;
• To make a well-structured, academic poster on the comparison of
countries, including its the handouts.

Course Content

Given the fact that health systems worldwide are confronted with
demographical and epidemiological changes, health systems are currently
experiencing a period in which they have to re-assess their set-up,
framework and goals. In this course you will obtain an overview of the
complex nature of health systems and its different components, both with
respect to conceptual components (service delivery, resource creation,
stewardship, financing) and content components (primary care, mental
health care, maternal care, etc.), and you will acquire skills to
analyze and compare these components. In various lectures, both the
quantitative aspects, and the critique there-upon, and the qualitative
aspects of health system comparison is discussed. Furthermore, you will
gain insight in the complexity and culturally determined nature of
health system design and health system reform, through a series of
lectures form VU-lecturers and experts from a variety of institutions
such as the Royal Tropical Institute and OECD.

Through two assignments, you learn and reflect on the topics that are
discussed throughout the course. First, you will carry out a comparative
case study of two high income countries for a specific aspect of its
health system. You will present your findings in the form of a lecture.
Second, you will make a comparative analysis of the 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. You will present the findings in
a poster format at a poster session. In both assignments you will have
regular feedback sessions with health researchers in small groups.

Teaching Methods

'International Comparative Analyses of Health Care Systems’ is a
fulltime course of four weeks (6 ECTS). The total study time is 160
hours. Tuition methods include lectures, workgroups for assignments,
problem-driven learning, self-study.

The different elements have the following study time:
- lectures: 28 hours
- workgroups for assignments and presentations of assignments: 20 hours
- (project) self-study remaining hours
- exam 2,5 hours

Attendance to the workgroups for assignments is compulsory.

Method of Assessment

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


A selection of literature will be made on the basis of lectures and
state of the art research. A selection of last year’s literature is
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

Compulsory course within the Master specialization International Public
Health, optional course within the Master specialization Infectious
Diseases (master programme Biomedical Sciences). In any other
circumstances admission should be requested from the course coordinator.

Additional Information


Recommended background knowledge

It is recommended that students have knowledge on public health and/or
public policy in the context of healthcare.

General Information

Course Code AM_470820
Credits 6 EC
Period P3
Course Level 500
Language of Tuition English
Faculty Faculty of Science
Course Coordinator dr. T. Cesuroglu
Examiner dr. T. Cesuroglu
Teaching Staff prof. dr. J.E.W. Broerse
dr. D.R. Essink
dr. T.J. Schuitmaker-Warnaar MSc

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

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