The cross-country patterns of utilization, expenditures, and health outcomes can be better understood by returning to the two fundamental questions posed at the beginning of the paper. First, does the production function embodied in the U.S. healthcare system lie below that for other countries? That is, if the United States spent no more per capita on health care than Canada or France, would its health system deliver more or less in quality-adjusted health? If we were to value improvements in health equally for those with high and low demand, the answer seems to be that productivity is indeed inferior in the United States.
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