Our health care system, take three

Having taught a course on comparative health care systems for more than 25 years, I have become increasingly uncomfortable with the use of the word “system” in regard to the numerous ways different societies make health care available to their people. System may imply a carefully thought out plan, and appropriately coordinated sets of arrangements, whereby people get access to high-quality health care in an efficient and effective manner. This is universally not the reality when one examines health services throughout the world. If, however, one interprets system as a set of interdependent parts, regardless of how well they function, then it is appropriate to talk about a health system.