Table 1.

Summary of national policy-level characteristics in each country related to funding and quality of health care at the time of the research in 2011.

Year: 2011	England	Netherlands	Norway	Portugal	Sweden
Population	61.3 m	16.5 m	4.8 m	10.6 m	9.3 m
Austerity measures in financial years 2010 and 2011	Budget cuts 0.2% and 2.2%	Limited to 2.5% growth	Budget cuts 0.8% and 0.2%	Budget cuts 13% and 7%	Costs limited to 9.5% GDP leading to growth of approx 1–3%
Funding (see note below)	Tax-based. Mainly publicly funded	Mix of taxation and insurance	Tax based	Tax based	Tax based
Remuneration related to quality of care	Hospitals remunerated through contracts with commissioners for volume and quality	Insurance companies different quality requirements in contracts. Hospitals manage multiple demands	Main hospital funding from government through regions not linked to quality but waiting times guarantee with financial penalties	Hospitals remunerated in block funds from government with activity targets. 4% budget incentivized for delivering national quality and efficiency targets	Financing through County Councils – volume and some quality measures/incentives. Recent schemes of payment from government in relation to access
Regulatory framework for quality	Explicit focus on quality, targets and use of financial rewards and penalties. Hospital licensing in place through the national Care Quality Commission	Explicit focus on quality, targets and use of financial rewards and penalties. Hospital accreditation is in place. Many bodies involved in QI	Regional with some oversight. Requirement to have systems in place to control quality with discretion about how to do this. No accreditation system	Regional with some oversight. Requirement to have systems in place to control quality with discretion about how to do this within boundaries. Hospital accreditation is in place	Autonomous County Councils/Regions – decision making. Guidelines developed centrally but few requirements and targets. No accreditation system
Reforms underway (2012)	Major structural changes in purchasing to devolve responsibilities to GPs	Minor reforms to payment for performance to strengthen competition, requirement for hospitals to have a safety system, insurers to use care quality in purchasing decisions	Major structural reform involving patient pathways, roles of municipalities, funding, administrative, service development	Major structural reforms to primary and ambulatory care, long-term care and hospital management and inpatient care	Major reforms to increase diversity of providers change in ownership of primary care centres and pharmacies
Public access to information about quality of care	Large amount of information available to the public	Large amount of information available to the public	Growing amount	Very little	Growing amount

GDP: gross domestic product; QI: quality improvement; GPs: general practitioner.

None of the hospitals in the study used private treatment income to supplement or take the place of publicly funded care.