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Institute of Biomedical Ethics and History of Medicine (IBME)

New article by Joelle Robertson-Preidler, Nikola Biller-Andorno, Matthew Anstey, and Alexandra Norrish on approaches to appropriate care policy in Australia, England, and Switzerland


Appropriateness is a conceptual way for health systems to balance Triple Aim priorities for improving population health, containing per capita cost, and improving the patient experience of care. A framework for comparing appropriate care policy can help establish system priorities and facilitate appropriate care practices.


We developed a framework for conceptualizing appropriate care policy based on the Triple Aim that identifies policy goals and consequent trade-offs for public health, financing, clinical practice, and the individual patient. We used secondary data sources to compare the appropriate care approaches of Australia, England, and Switzerland according to our framework.


Health system approaches to appropriate care delivery varied. England prioritizes public health, equity and efficiency at the expense of individual choice, while Switzerland focuses on individual patient preferences, but has higher per capita and out of pocket costs. Australia provides equity in public care access and private health care options that allows for more patient choice, with health care costs falling between the two.


Integrating the Triple Aim into health system design and policy can facilitate appropriate care delivery at the societal, financial, clinical, and individual levels. Approaches will vary and require countries to negotiate and justify priorities and trade-offs within the context of the health system.