International comparisons of health care systems: Conceptual and methodological developments over half a century

This paper builds on the health care systems comparisons undertaken by Ragnar Berfenstam and his colleagues in the 1960’s. It describes the original health systems model guiding that early work and a developed health systems model that we have constructed based on more recent international comparative health systems work. We provide examples to elucidate the orig-inal model and the developed model. Using a selective literature review we note changes and developments in comparative studies over the past 40 or 50 years. We conclude by suggesting the major advances in the field and continuing major challenges to doing international health systems comparisons.