Welcome to comparative health systems. In this course, you will learn a lot and say a lot as you visit healthcare systems in the United States, England, Germany, Brazil, and China. It is customary to begin of course by identifying the things that you will learn that will add to your stock of knowledge. In this course, I want you to start at a different point. I want you to begin by marshaling all that you know about your healthcare system. Some of you are managers, some of you are healthcare providers, all of you have engaged with the healthcare system as patients either directly or indirectly through the experiences of friends and family. I want you to marshal all that knowledge, because that is the starting point. That is the most significant building block for developing and understanding and making use of comparative analysis of healthcare systems. It's important to note that some of the possibilities and limits of comparative analysis. As Professor Marmot indicates, comparative analysis is useful as a way of gaining a better understanding of one's own circumstances. It is also useful is why I'm challenging standard national accounts of health systems. It's less useful as a guide for policy making. Comparative analysis is less useful if the goal is to search for policies that will achieve a particular outcome in a particular system. It's less useful if you search in other systems to find policies that worked in those systems with the goal of transplanting them and having them work in your own system. So take for example a gradual expansion of social health insurance in Germany as a pathway towards the development of universal health coverage. An understanding of how social health insurance formed the pathway for universal health coverage in Germany is really important in raising questions about how a system can emerge in this way. It's really important for challenging some of the standard accounts of why health system, for example, the United States hasn't achieved universal health coverage. But it's not useful as a way of imagining that in the United States, you can use employer-based health insurance as a way of achieving the goal of universal health coverage. An understanding of the process of achieving universal health coverage in Germany will trigger questions, and will lead to a better understanding of why hands-on system, but it's not a God to policy-making. Healthcare systems are complex, but they're comprehensible. Later in the lecture, we will go through some of the techniques and some of the tools and methodologies we'll use to compare healthcare systems. As part of that, you'll learn a lot of details about similarities and differences between health systems. But the motive for learning, the driving force for learning in this course is not one of just cataloging similarities and differences as important as that will be, rather the mode of learning is engaging in an act of imagination. It starts with imagining how healthcare systems in other countries, with other patents of relationships between stakeholders in different parts of the healthcare system, can produce a given set of outcomes. In that act of imagination, there'll be many questions throwing up about how your own healthcare system has developed, how it has moved or not moved towards universal health coverage, and what the limits of that movement are. Developing a more nuanced and complex understanding of your own healthcare system is a really significant goal in this course, but it's not the only one. The act of imagination in understanding dynamic patterns of interaction between elements of the healthcare system is important, but this active imagination is significant for a second reason. It changes the way you imagine your own relationship to the healthcare system, the way in which your activities as a manager, or as a healthcare provider, or as a patient affect the capacity of a system to move towards a given set of goals. Importantly, a better understanding of one's own relationship with this system enables you to gain a better understanding of the relationships between stakeholders in that system. Out of an understanding of those relationships, you will develop a more effective way of working with others to engage in activities that aim to improve health outcomes produced by your healthcare system. This system can be a micro system in which you work, or the macro system, the system of healthcare in the country as a whole. These introductory remarks have been primarily concerned with the comparative part of comparative health systems. That is, I have focused on what we're seeking to achieve when we compare health systems. In the remaining parts of the lecture, we'll focus on the tools and methodology that will allow us to engage in learning about the similarities and differences in other health care systems, and then about a managing the ways in which the elements of those healthcare systems interact to produce those outcomes. As part of this, we're to address the following questions: What are health systems and how do you engage in a comparative analysis of those health systems? What is population health and how do we measure population health? Along the way, we'll outline some of the tools we'll use to describe and analyze health systems. In particular, we'll review the World Health Organization Building Blocks framework. This is very important because it allows us to categorize the inputs in the system, and by breaking the inputs into categories, we'll then be able to analyze how the building blocks dynamically interact to produce outcomes, and different patents of interaction between the building blocks can produce a given set of outcomes. Finally, we'll look at some of the characteristics of complex systems. This is useful because it will give you some of the tools to imagine different ways in which building blocks might interact, different ways in which patterns of interaction may produce different outcomes, and importantly, ways in which those patterns of interaction may be influenced in order to produce different outcomes. In the next part of the lecture, I'm going to ask you to follow up on my earlier comments. I'm going to ask you to bring to mind your expertise in health systems, I'm going to ask you to identify the problems that you must want to think about and analyze. This act of self-assessment is independent of the formal assessment in the course. It will challenge you to test your capacity to engage in comparative analysis, and also to measure how far your thinking has developed by the time that you complete the course.