RT Journal A1 Reinhardt UE T1 The swiss health system: Regulated competition without managed care JF JAMA JO JAMA YR 2004 FD September 8 VO 292 IS 10 SP 1227 OP 1231 DO 10.1001/jama.292.10.1227 UL http://dx.doi.org/10.1001/jama.292.10.1227 AB Health services researchers around the globe have known for decades that the United States, with a comparatively young population, spends much more on health care than do other nations1- 2 (Table 1). As US annual health spending continues to exceed that in comparable nations by ever wider margins, and as US health policymakers begin to run out of ideas for how to constrain that growth, interest in the performance of health systems abroad has increased in recent years. One need not import another country's political system or social ethic to learn from the techniques they use to seek cost-effective health care. Cost-effective health care delivers the maximum attainable benefit for a given sacrifice of resources or, alternatively viewed, minimizes the sacrifice in resources for a given level of benefits. While economic circumstance and a preferred social ethic may lead some nations to spend more on health care to achieve higher levels of benefits than others, in principle, all nations should strive for cost-effective health care at whatever level of health spending they have chosen.