Convergence versus social embeddedness: Debating the future direction of health care systems

Abstract

The question of whether health care systems in developed countries are coming to resemble each other more is attracting increasing attention. A number of recent papers have argued that the current crop of health reforms is creating convergence in health systems structure and organization. This paper suggests a 3-part framework with which to analyse competing claims about convergence versus what can be termed social embeddedness (as reflected in divergence between different health systems). The available evidence on social, political/health policy and technical/mechanical categories is reviewed. The paper concludes that both convergence and divergence can be seen in subsectors of developed countries' health systems. It might be useful to consider the convergence/divergence mix between countries in order to reflect better the current situation as well as to retain a broader range of options for national policy makers.