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  ichard Saltman has to be ready at a moment’s notice to pack a bag, hop a plane, and take his health policy expertise on the road. At WHO’s bidding, he has whisked off to Kazakhstan to encourage the government to reverse a sudden decision to privatize the health care system. On a recent request from Tony Blair’s government, he attended a vetting seminar for a new white paper on primary care in England. In fact, in the past few months, he’s been to England, Bosnia, and Russia to offer policy analyses of health systems in those countries.
     Saltman now has been exploring health policy questions for 25 years through two Fulbright fellowships, as a research director of the European Observatory on Health Systems and Policies, and through appointments at Harvard and the London School of Economics and Political Science and as professor of health policy at the Rollins School of Public Health (RSPH). His experiences have led to a firm belief that although people of diverse countries “imagine the world differently,” they still can learn from each other in making good health policies. He sees a clear connection between culture and health decisions.
     “Despite globalization, the societal norms that drive the process of health care decision-making are not converging,” says Saltman. While many countries have adopted health care tools that function similarly, such as diagnosis-related groups (DRGs), that similarity exists only at a mechanical level. By contrast, countries remain broadly fixed in the value systems that ultimately influence health care decisions. The intersection of these cultural norms and health care decisions raises interesting questions for Saltman.
     For example, national policy makers across Europe agree in principle that primary care should be the linchpin of a well-designed health care system. However, those principles fail to carry over into the organizational mechanisms best suited to achieving that common objective. Across Western, Central, and Eastern Europe, primary care is delivered through widely ranging institutional, financial, professional, and clinical configurations. Primary Care in the Driver’s Seat?, edited by Saltman, Ana Rico, and Wienke Boerma, studies the reforms of primary care in Europe and their impact on the broader coordination mechanisms of European health care systems.
       The book is part of a series produced by the European Observatory on Health Systems and Policies, a project that promotes evidence-based health policy-making through comprehensive and rigorous analysis of health care systems in Europe. Saltman describes the Observatory—with its partners of WHO, the World Bank, seven European governments, and others—as a bridge between academe and government. “An academic might spend three years on one narrow topic and have the research perfected before publishing,” he says, “whereas a policy maker doesn’t care about perfect. He or she wants three good options to introduce to a cabinet now.”
     The Observatory grew out of a 1996 conference that gathered ministers of health from across Europe to discuss health sector reform. Saltman and co-author Josep Figueres published the conference findings in two critical books: European Health Care Reform, which remains a best-selling volume published by WHO, and Critical Challenges for Health Care Reform in Europe, which was named the best book for health care analysis in 1999 by the European Healthcare Management Association.
With a current staff of 25 and a $5 million operating budget, the Observatory synthesizes lessons from current literature and develops policy options for decision makers. “Our job is not to recommend,” Saltman says. “We stop at the policy lessons and options. We do the research and thinking, but we don’t get mixed up with the political side. Implementation is an important ingredient, but that’s not our job.”
     The Observatory disseminates information through publication of book series, country profiles, and policy briefs and also hosts workshops and seminars to provide a forum for policy makers to share experiences and discuss potential reforms. The Health in Transition series provides comparative information on health care systems and reform initiatives in countries throughout Europe. (A former Humphrey Fellow at the RSPH, Vaida Bankavskaite, is currently updating books on health systems in Spain, Sweden, and Denmark.) Recent titles from another series have examined social health insurance, pharmaceutical costs, and European Union enlargement. The policy briefs highlight policy lessons that are easily accessible to health care ministers and other policy makers.
     Despite the many trips to Europe and multiple publications in process, Saltman has never missed a scheduled class at the RSPH in Atlanta. In the fall, he teaches the capstone course for the health policy track, and each spring he teaches a course on comparative health systems. Students get a syllabus at the beginning of the semester with 13 sessions but flexible dates. In return for their flexibility, students gain by having instruction from someone at the epicenter of evaluating the very latest in health policy decisions throughout the world.


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