In this third article on the role of international comparative practices in the formation of national health care systems I discuss a familiar group of systems-builders--medical professional organisations--and so focus on some early comparisons undertaken by organised groups of doctors. So far in this series I have argued that any attempt to make international comparisons--whether in the 19th-century or today--is bound to be based on a 'characteristically national' understanding. Not infrequently such an understanding finds its clearest expression in the very (...) act of undertaking practical tasks like 'comparing'. Dependent on whether comparisons are carried out by individuals privately, collectively by larger groups within the medical profession, or by government agencies the descriptions of 'national characteristics' (of medical organisation, institutional formation, clinical practice, research, public health and education) will differ in emphasis. -/- The examination of collective professional attempts at international comparison can enhance our understanding of the cultural distinctions that were incorporated by emerging national medical professions. This process can show which aspects of foreign medical systems were deemed pertinent, and also reveals methodology. What did such collective endeavours add to the more biographically coloured comparisons undertaken by the individual mid-century authors I discussed in part II of this series? (shrink)

This study presents a first assessment of the challenges faced by Dutch health care providers dealing with the increasing cultural diversity in Dutch society. Qualitative interviews with 24 Dutch caregivers and policy-makers point to a number of important difficulties encountered when confronted with the growing diversity of patient populations. The study focuses explicitly on the challenges health care providers perceive in their direct interactions with patients. On the basis of the observations of the 24 respondents five strategies were formulated to (...) improve the delivery of care in a multicultural environment. Their findings were further evaluated by confronting the empirical data with care-ethical notions (attentiveness, responsibility, competence, and responsiveness) and intercultural communication-theory. (shrink)

The accounts of Wunderlich and Lee, which have been presented in the second part of this brief series, are two representative examples of a well-respected 19th-century genre of international comparison of medical systems. Since these early comparative accounts consist of observations on medical systems by doctor-travellers at a time when intense medical reform debates about the national significance of medicine were taking place, the focus of attention is often intra-professional. In texts such as those by Wunderlich and Lee, creating coherence (...) within a national health care system was primarily understood as constructing national coherence within the medical profession. The comparisons which derived from international travellers of the period were on the whole cast in a literary, narrative form, and were based on personal observation and occasional hands-on experience in foreign practice. The relevance of this type of publication for national policy at this early stage of national system development was defined in terms of the perceived advantages which a more detailed explication of differences between the medical educational structures, medical philosophies and practical professional roles in different nations might bring. (shrink)