Differences in healthcare structures, processes and outcomes of neighbouring European countries: the example of Germany and the Netherlands.

Although healthcare systems across Europe face rather similar challenges, their organization varies widely. Even neighbouring countries substantially differ with respect to healthcare structures, processes, and resulting outcomes. Focusing on Germany and the Netherlands as examples of such neighbouring countries, this paper will first identify and discuss similarities and major differences between both systems on the macro-level of healthcare. It further argues that it is often unknown how these differences trickle down to individual healthcare organizations, providers, patients or citizens, i.e., to the meso- and micro-level of healthcare. Hence, in a second step, potential implications of macro-level differences are described by considering the examples of total hip arthroplasty, antibiotic prescription practices and resistance, and nursing home care in Germany and the Netherlands. The paper concludes with an outlook on how these differences can be studied using the example of the project "Comparison of healthcare structures, processes and outcomes in the Northern German and Dutch cross-border region" (CHARE-GD). It further discusses potential prospects and challenges of corresponding cross-national research.