The “perfect” health system

20 Oct
Joan MV Pons
Joan MV Pons

Mark Britnell is an international expert in health systems having held several senior positions in the NHS and currently provides consulting services for several countries. With this wealth of experience, Britnell wrote a book in 2015 with the inspiring title of, In search of the perfect health care system (1). In it, Britnell examines the dilemmas facing governments, the global challenges such as demographic, epidemiological, technological and economic transitions, as well as the more specific cases facing each country.

A significant portion of the book, more than half, is dedicated to examining individual countries grouped by continent: the Asian region including Australia (with large countries from Japan, China and India, to small densely populated enclaves such as Singapore and Hong Kong) Africa and the Middle East (just three very different examples such as Qatar, Israel and South Africa), Europe (from Portugal to Russia via the Nordic countries, Germany, Italy, France and the English) and the Americas (from the north; Canada, USA and Mexico and the south, such as Brazil). Too bad that the section on the Iberian Peninsula only speaks of our western neighbours (the eastern side but a general walk through).

There is no questioning that Britnells’ knowledge has been acquired first hand, given his worldwide expertise in conferences and consultancy. As the author mentions, he is often asked which country has the best health care system? Since the WHO report, Health systems: Improving performance (2), published in 2000, several country rankings have been published according to the assessment of their health systems using a variety of methodologies and outcomes. The table below serves as an example.


Nowadays, rankings proliferate as can be seen in universities and research institutions/centres. The indicators may be different, but it seems that one may always end up finding the most favourable ranking for them. Catalan public universities are a good example, given that centre advertises their position – besides that of excellence in comparison to other universities which are not necessarily British –  in the ranking system which makes it stand out to a greater degree that other Catalan universities.

Britnell, getting back to our point, after so many rankings, lectures and consulting, make a proposal on what the best health system might be by taking the best areas from the different countries. If the world could have a perfect health system, it would have to possess the following characteristics:

–    Universal healthcare values (UK)
–    Primary health care (Israel)
–    Community services (Brazil)
–    Mental health and welfare (Australia)
–    Promoting health (Scandinavian countries)
–    Empowerment of patients and communities (certain African nations)
–    Research and development (USA)
–    Innovation and new ways of doing things (India)
–    IT and Communication technologies (Singapore)
–    The capacity of choice (France)
–    Funding (Switzerland)
–    Care for the elderly (Japan)


(1) Britnell M. In Search of the Perfect Health System. London (United Kingdom): Palgrave Macmillan Education; 2015.

(2) The World Health Report 2000. Health systems: improving performance. Geneva (Switzerland): World Health Organization (WHO); 2000.

(3) Where do you get the most for your health care dollar?. Bloomberg Visual Data; 2014.

(4) Davis K, Stremikis K, Squires D, Schoen C. 2014 Update. Mirror, mirror on the wall. How the performance of the U.S. Health Care System Compares Internationally. New York, NY (US): The Commonwealth Fund; 2014.

(5) Health outcomes and cost: A 166-country comparison. Intelligence Unit. The Economist; 2014.

Post written by Joan MV Pons.