Introduction

Any comparison between the UK and US healthcare systems as a whole will inevitably conclude that the high costs and the lack of universal coverage in the United States make it extremely unattractive from any European perspective. Indeed, the United States can learn a great deal from the United Kingdom about the provision of universal access to health services at a much lower cost by reforming its health financing system. In the other direction, much has been gained in recent years from examining parts of the US experience and exploring how they might, with appropriate adaptation, be of benefit in the United Kingdom. Some of the lessons could be taken further.

Lessons from managed care

Our comparison between the US managed care organisation Kaiser Permanente and the NHS generated interest, debate, and subsequent studies.1 Several visits by ministers, managers, and clinicians have followed to see what might be learnt from US healthcare organisations. Interestingly, the increased international interest in Kaiser and similar systems has also stimulated debate about the possibilities of extending this model more broadly within the United States.2

We identified several factors that might explain performance differences between Kaiser and the NHS, and other researchers have investigated these in more detail.3 The most important of these, in our view, was achieving true integration, a view subsequently supported by Light and Dixon among others.3^–5 This integration has several components, including:

• Integration of …