Comparative Health Care Systems (2026-2027)

Background

Health systems play a fundamental role in improving population well-being, yet countries differ dramatically in how they finance, organize and deliver care. The United States spends more per person on health care than any other country, but many people still struggle to afford necessary services. Insurance coverage is often tied to employment, and navigating fragmented programs can be confusing, contributing to preventable illness — especially among individuals with chronic disease or those facing social or economic disadvantage.

The Netherlands offers an instructive contrast. All adults are required to have health insurance, which is provided by private organizations but regulated by the government to ensure universal access. Dutch policies emphasize prevention, primary care and coordinated mental health services.

Comparing these two systems provides an opportunity to understand how design choices related to financing, regulation and benefits influence cost, equity and outcomes. These insights can help identify policies that support more efficient, equitable and people-centered care in both settings.

Project Description

This project will engage team members in a comparative analysis of health care delivery and financing in the United States and the Netherlands. The goal is to examine how each country balances cost, access and quality — and what lessons can be drawn to inform U.S. reform debates and international collaboration.

The project will unfold across the academic year:

Foundational learning and research design
Team members will receive training in comparative health systems, research ethics and cross-national study design. They will conduct literature reviews, develop background briefs and begin early data collection. Initial interviews with stakeholders from Duke, Leiden University and Erasmus University Medical Center will help refine research questions.

Analysis, synthesis and dissemination
The team will compare financing structures, insurance design, provider incentives and workforce models in both countries. They will examine how each system addresses chronic disease, preventive care and mental health, especially for marginalized populations. Team members will draft comparative policy briefs, produce infographics and prepare a student-led symposium at Duke. A manuscript submission (optional) will be developed for journals such as Health Affairs or BMJ Global Health.

Short-term immersion in the Netherlands
A small number of team members will travel to Leiden and Rotterdam to conduct stakeholder interviews, observe care delivery and present findings with Dutch partners.

Anticipated Outputs

• Comparative policy briefs on financing, access, outcomes and equity
• Infographics and communication materials for Duke, Leiden and Erasmus partners
• Student-led symposium or poster session
• Optional academic manuscript with student co-authorship

Student Opportunities

The team will include 3 graduate or professional students and 4 undergraduate students from fields such as public policy, global health, population health sciences, economics and sociology.

Students will:

• Conduct literature reviews and gather comparative policy data
• Analyze system-level indicators related to financing, delivery, equity and outcomes
• Participate in interviews with U.S. and Dutch experts
• Produce policy briefs, presentations and visualizations
• Present research at a symposium and potentially co-author a manuscript

Graduate students will mentor undergraduates, support analytic planning and lead interactions with policy partners. Undergraduates will gain training in both qualitative and quantitative research methods, evidence translation and cross-cultural communication.

In Fall 2026, the team will meet on Tuesdays from 3-4:30 p.m.

Timing

Fall 2026 – Summer 2027

Fall 2026:

• Comparative systems training
• Literature review and background briefs
• Initial stakeholder interviews

Spring 2027:

• Thematic analysis and synthesis
• Policy brief drafting and infographic creation
• Student-led symposium at Duke
• Manuscript preparation

Summer 2027 (optional):

• Field interviews and site visits in the Netherlands
• Presentation of project findings to Dutch partners

Crediting

Academic credit available for fall and spring semesters