Diseconomies of Scale in Health Care

The PBS News Hour has been running a series comparing international health care systems. In the series, the US system is being compared against the Netherlands, Canada, Japan and Mexico. The Swiss model for health care has also been favorably reviewed as has the French model.

One thing that doesn't seem to come up is diseconomies of scale. The Netherlands has a population of 16M, Canada 33M, Japan 127M, Mexico 109M, Switzerland 7.5M, France 61.5M and the US 304M. Just for comparison, New York State has a population of 19.5M, Wisconsin 5.6M and Massachusetts 6.5M.

Since the delivery of health care is dependent on the interaction between a patient and a health care provider, some of the European models might scale better to the States rather than to the US. Europe has a population of 731M and has somewhat different health care systems in each country. Is there a way to have a national health care system in the US but still allow some room for innovation at the State level? The problem would be to write a minimum set of standards that all States would have to meet. In this respect, the Canadian model provides the most interesting comparison (the national government wrote a brief set of standards for the delivery of health care at the provincial level).