The Covid-19 crisis that led to the loss of thousands of lives and initiated one of the most complex social and economic upheavals has also a created a window of reflection for health systems researchers to revisit our major concepts, frameworks, and underlying assumptions. This commentary reviews two literatures that remain rather separate: comparative health policy and global health. First, I examine whether convergence in circumstances brought about by the spread of Covid-19 creates opportunities for learning “about” as well as unpacking the motivations of policy actors and how they use the cross-national information. However, given the emphasis on national policy actors and processes, this literature may overlook the importance of global actors, institutions and ideas. Second, global health differentiates itself with an emphasis on multilateralism as a political positioning and its multidisciplinary and multi-sectoral approach. However, the global health field is also challenged to consider its mission, political standing on multilateralism, changing relationships between North and South and its commitment to multidisciplinary approach. I argue that health systems scholars should use the window of opportunity created by Covid-19 pandemic to reexamine their methodologies and rearticulate their positioning by acknowledging the voice and agency of the Global South.

Health technology assessments (HTAs) are used as a policy tool to appraise the clinical value, or cost effectiveness, of new medicines to inform reimbursement decisions in health care. As HTA organisations have been established in different countries, it has become clear that the outcomes of medicine appraisals can vary from country to country, even though the same scientific evidence in the form of randomised controlled trials is available. The extant literature explains such variations with reference to institutional variables and administrative rules. However, little research has been conducted to advance the theoretical understanding of how variations in HTA outcomes might be explained. This paper compares cases of HTA in England and Germany using insights from Kuhn (1962, The Structure of Scientific Revolutions, 2nd edn. Chicago: The University of Chicago Press) and Hall (1993, Policy paradigms, social learning, and the state: the case of economic policymaking in Britain. Comparative Politics 25, 275–296) to demonstrate how policy paradigms can explain the outcomes of HTA processes. The paper finds that HTA outcomes are influenced by a combination of logical issues that require reasoning within a paradigm, and institutional and political issues that speak to the interaction between ideational and interest-based variables. It sets out an approach that advances the theoretical explanation of divergent HTA outcomes, and offers an analytical basis on which to assess current and future policy changes in HTA.

The 2010 Affordable Health Care Act (ACA) treats abortion differently than any other health service, precluding public funding for abortion and imposing other restrictions on American states. To determine whether the ACA’s abortion restrictions are uniquely American or have counterparts in other national health systems, this study employs a cross-sectional design comparing abortion restrictions in the ACA with those in 17 Western European countries. Using a six-item scale, the intensity of abortion restrictions is compared across Western European nations. A similar scale is employed for a five-state sample of state-level abortion restrictions. Although the United States is not alone in having abortion restrictions, how abortion is proscribed in the ACA has no counterpart in Western Europe. Unlike many Western European countries, the ACA’s restrictions focus on abortion funding, not the length of gestation or the health of the pregnant woman.