This chapter presents the book's conclusions, including the key findings from each previous chapter. It also presents the solutions for low performance in relation to social determinants, health funding and health expenditure which were not included in previous chapters, to consider what they can add to our findings. It includes a further discussion of the role of the Australian healthcare system, which has been found to be unusual in its patterns of causal factors and outcomes in previous chapters, as well as a consideration of what the US and UK can learn in terms of health system change. It concludes with a discussion of some general lessons that the book offers and, finally, the strengths and limitations of the book as a whole.
Chapter 2 was concerned with the social determinants of health. It found that countries with high health outcomes have ∼GINI as a necessary condition, and there are two sufficient solution pathways to that outcome, ∼GINI*EDUC, or BEHAV*∼GINI*HEALTHEXP, but with the former having higher coverage of countries, which were France, the Netherlands, Norway and Sweden. For high health equity, ∼GINI was again a necessary condition, and the solution with by far the largest coverage and unique coverage was ∼GINI*HEALTHEXP, which covered Germany, the Netherlands, Norway, Sweden and Switzerland.
For both high health outcomes and high health equity, ∼GINI*HEALTHEXP was a necessary condition, with ∼GINI*EDUC*HEALTHEXP forming the sufficient condition for the Netherlands, Norway and Sweden, but with Switzerland deviant for coverage, so also having high health outcomes and high health equity, but not forming a part of the solution set.
As such, for high health outcomes and health equity, low income inequality and high health expenditure were necessary conditions, and the root of the dominant sufficient solution. These two causal factors were therefore carried forward to Chapter 6, which explores the relationship between the most important factors, as well as widening the sample of countries to 31.
Chapter 3 was concerned with health funding and found GOV*∼VOL to be a necessary condition for high access, with that combination forming the core of the two sufficient solution pathways (GOV*HEALTHEXP*∼VOL and GOV*∼OOP*∼VOL), and the former covering Germany, the Netherlands, Norway and Sweden, and the latter Germany and the Netherlands (in common with the first pathway), along with New Zealand and the UK.