Learning from others: shall the last be the first?

The cross-national exchange of ideas and experience in health care reform has, in recent years, reached epidemic proportions. Taking stock of this suggests the need for critical caution. The various participants in the process have different motives; models may be exported before they have been fully tested; information may be sought chiefly as political ammunition; and selective perception often distorts the evidence. A more helpful approach might be to concentrate on evaluating the experience of countries over time, rather than concentrating on the latest fashionable panacea, and to focus more on the process of introducing change.