1 Introduction

Healthcare system performance must be measured and reported to ensure accountability, and transparency and to help identify areas that need to be improved [1]. The age-old normative query of determining which nation has the best health system has become less relevant in cross-national research on health services. Instead, many countries have become increasingly interested in the lessons they might learn from one another’s experiences related to the management, resources, and clinical indicators of healthcare systems [2].

In recent years, several studies have been conducted to compare the health systems of a country and contrast them with other member nations of the Organization for Economic Cooperation and Development (OECD) [1]. For many years, the OECD has collected and shared annual data on the availability of healthcare resources, national spending on healthcare, various health issues, and status indicators. Currently, the most comprehensive source of comparable statistics on health and health systems across OECD countries is the OECD Health Database [3].

Back in 1960, around 20 nations initially ratified the Convention on the Organization for Economic Cooperation and Development, including Italy and Spain, where both countries still own a great record of involvement within the OECD [4]. Recently, in 2021, Costa Rica officially joined this organization as its 38th member, successfully completing an accession process that started back in 2015 [4, 5].

1.1 Chile

Chilean public health originated in the twentieth century with the creation of the National Health Service (NHS) in 1952, including systematic public policies for the promotion of health. In 1981, a parallel private healthcare system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80% [6]. This went hand in hand with an improvement in economic and social indexes; per capita income at purchasing power parity increased from US$ 3827 to US$ 20,894 and poverty decreased from 60 to 14.4% of the population. Related indexes such as illiteracy, average schooling, and years of primary school education, were significantly improved as well [7].

During the last years in Chile, health spending reached approximately 8.5% of GDP, below the average of OECD countries, out-of-pocket spending is one of the highest in the OECD, at approximately 35% of total financing contributions of the Health System, and includes financing of copayments for health benefits, outpatient medications, dental benefits. Among others, Chile and the United States of America are two of the OECD countries with the lowest public investment in health [7]

1.2 Costa Rica

Costa Rica, Italy, and Spain have health systems based on principles of universality that intend to provide care to their entire population. The Costa Rican Public Healthcare Institution called Costa Rican Social Security Fund (CCSS, by its acronym in Spanish) was created in 1941, aimed at implementing compulsory social insurance that contemplated covering the risks of illness, premature disability, old age, death, and involuntary unemployment [8]. Costa Rica has a health system that seeks to achieve universal coverage which, by 2019, had 91% of the population covered [3].

According to a 2017 OECD analysis, the Costa Rican health system is characterized by its institutional stability, which has allowed the country to have health and performance indicators similar to the OECD. However, in the same report, it is mentioned that one of the elements that affects the most to Costa Rica’s health system is public sector salaries, which in general are equivalent to 13% of gross domestic product (GDP); the same level as countries such as Norway (13.6%), and easily exceeding the average of 10.6%. of the OECD [9]

1.3 Italy

The Italian National Health Service was established in 1978 to provide universal access to a uniform level of care across the nation, free of charge for the population, and supported by general taxation. Italy’s healthcare system is based on the principles of universality, equity, and solidarity; therefore, every citizen is entitled to the same level of care, regardless of their socio-economic status or geographic location. The system is funded through taxes and provides comprehensive care, including preventive and primary care, hospital services, and prescription drugs [10, 11].

However, the system faces challenges such as an aging population and rising healthcare costs. To address these challenges, Italy is focusing on digitalization, innovation, and preventative care to improve efficiency and quality of care. The government is also promoting public–private partnerships and investing in research and development to advance healthcare technologies. These efforts are aimed at ensuring that the healthcare system remains sustainable and continues to provide high-quality care to all citizens [10, 11].

1.4 Spain

The origins of Spain’s National Health System date back to the nineteenth century, with the creation of the Commission for Social Reforms to study the situation of the working class concerning its social welfare. Currently, it is organized in two levels, national and regional, and funded by general taxation. The Spanish health system is divided into autonomous communities, ranking it more accurately described as a decentralized system, rather than a national one [12, 13]. Spain currently ranks second among OECD countries in terms of life expectancy at birth and at 65 years old, but factors such as a high share of out-of-pocket spending and a relatively low level of health professionals continue to interfere with higher health system performance [14].

According to the World Bank, Costa Rica and Chile are classified as upper-middle-income countries that had a GDP per capita between $12,472–16,265 in 2021 respectively, with an annual GDP growth between 7.6 and 8.5%. Compared to Italy and Spain, both are ranked as high-income countries, with GDPs per capita of $35,657 and $30,103, with annual growths of 6.7% and 5.5%, respectively [15]. Another fact is that Costa Rica, Chile, Italy, and Spain share similar positions within the Human Development Index (HDI) [16]. This index reflects aspects of human development such as living a long and healthy life, having access to knowledge, and having a decent standard of living. According to the 2021 Human Development Report of the United Nations Development Program (UNDP) Costa Rica is classified as a very high-ranking country with an HDI of 0.809, placing Costa Rica in 58th place with an HDI value of 0.819, while Chile ranks 40th. Like Italy and Spain, which ranked 30th with an HDI of 0.895, and Spain which ranked 27th with an HDI of 0.905, out of 191 countries and territories worldwide [16].

Currently, in the scientific literature, there are no studies that analyze and compare Costa Rican, Chilean, Italian, and Spanish healthcare systems. This study aims to make a health systems performance comparison using the data reported by these countries on the OECD Health Statistics database, to determine whether the differences or gaps between them and the OCED average have been maintained, increased, or decreased over time.

2 Materials and methods

In this study, the performance of Chile, Costa Rica, Italy, and Spain’s healthcare systems are evaluated using a value-for-money approach, which is intended to provide an overview of the amount that these countries spend on their healthcare compared to the OCDE average, while also measuring the value they receive for those spendings. The comparison between the three countries and the OECD average is made using reported values for each indicator in a year near the beginning of the last decade (year 1) compared with data reported around 2020 (year 2) to determine differences over time, which is indicated in “Results” section as “Δ”.

This method has been frequently used in several reports that compare the performances of other universal healthcare countries, most recently by Barua and Moir [1] who based their indicators choice primarily on those presented in Nadeem and Walker [17] and Rovere and Skinner [18], and were categorized using the framework presented in Barua and Moir [1] The performance of the healthcare systems in the selected countries is evaluated using indicators that measure healthcare expenditure and healthcare provision. The cost of health care is measured using two indicators, whereas healthcare provision is measured using more than 40 indicators representing seven broad categories: availability of resources, use of resources, access to resources, quality and clinical performance, health status, non-medical determinants of health, and population coverage for healthcare (Fig. 1).

Fig. 1
figure 1

(Adapted from Barua [21])

Framework for analysis of healthcare systems

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In addition, the Pharmaceutical Consumption per ATC code in defined daily dose (DDD) per 1000 inhabitants reported to the OCDE has been included. Pharmaceutical consumption is being added to the Framework for the analysis of healthcare because several pharmacoeconomic studies relate the consumption of medicines with the health status of a given population, such as Miller and Frech [19] who concluded that an increased pharmaceutical consumption helps improve mortality outcomes, and in 2004 these same authors determined that an increased pharmaceutical consumption helps improve quality of life, as well as life expectancy [20].

All indicators used in this report are either publicly available or derived from publicly available data from the OECD, which was updated on July 3, 2023.

During the preparation of this work, the author(s) used ChatGPT to improve the readability of translated sentences. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.

3 Results

An analysis of thirty-nine indicators and their subcategories within each country's healthcare system and the average of all OECD countries was conducted. The summarized findings are presented in Table 1, showing the fluctuations of each indicator over the years established; whether they demonstrated improvement, decline, or remained the same.

Table 1 OECD indicators used for the performance analysis of Chile, Costa Rican, Italian, and Spanish Healthcare Systems and their trends in the established periods [3]
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Additional file 1: Table S1 illustrates healthcare expenditure between 2010 and 2020 in the four countries. Costa Rica (0.2), Chile (1.3), Italy (0.6) and Spain’s (1.6) increase its share of GDP dedicated to healthcare expenditure, and the four countries reports an increase in spending per capital (US PPP) in line with the OECD average; Italy being the one that reports the highest per capita spending of the four countries.

Among the four countries analyzed, Chile and Costa Rica reported the lowest population health coverage for a core set of services in 2019. On the contrary, Spain and Italy report 100% coverage, a value above the OECD average. In terms of satisfaction with the quality of care received, in 2020 the four countries performed below the OECD average (71%). In terms of the perception of the health status among the population, Costa Rica, Italy, and Spain report values above the OECD average (69%), while Chile is the only country that presents a low value over the average of the OECD countries.

Additional file 1: Table S1 also compares health status and non-medical factors across the three regions. Costa Rica shows health improvements, with reduced infant and maternal mortality, increased life expectancy, and the lowest tobacco and alcohol consumption rates among the analyzed countries. Chile reports the biggest reduction in tobacco use, while both Italy and Spain reported an increase in alcohol consumption. All countries have lower tobacco consumption rates compared to the OECD average.

Table 2 provides information about healthcare resources, specifically focusing on the employment and active healthcare professionals like physicians, nurses, and pharmacists in Costa Rica, Chile, Italy, and Spain. Overall, all countries have increased or maintained the hiring of healthcare professionals, which is in line with the average trend seen in other OECD countries. Notably, Chile shows the highest variation in this regard, followed by Spain, Italy, and Costa Rica. Additionally, Table 2 shows that the number of hospitals decreases slightly in Costa Rica and Spain, whereas in Italy and Chile, there is a reduction higher than the OECD average. Similarly, the number of hospital beds also decreased slightly in Italy, Spain, and the OECD average, while it remained the same for Chile and Costa Rica.

Table 2 OECD indicators of healthcare resources for Chile, Costa Rica, Italy, Spain, and the OECD average in the established year range [3]
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Additional file 1: Table S2 shows indicators regarding healthcare utilization, immunizations, hospital discharges, and hospital average length of stay by diagnostic categories. Regarding healthcare utilization, the trends in physician consultations and inpatient care discharges exhibit a consistent pattern across Costa Rica, Chile, Italy, Spain, and the OECD average, all of which decreased. On the other hand, inpatient care average length of stay indicates an overall rise, except in Spain and the OECD average where a slight decrease of 0.2 and 0.1 is noted, respectively.

In terms of immunizations, Costa Rica emerges as the only studied region with a rise across all indicators within this category. Specifically, about DPT immunization, Costa Rica reports a notable increase in the proportion of immunized children against DPT (+ 5.7%); in contrast to Italy, Spain, and the OECD average, all of which experienced declines. Similarly, Chile has the biggest improvement in the percentage of individuals aged 65 and older who were immunized against influenza (+ 27%), while Spain and Italy reported a significant decrease of 11%. The trends in immunization against measles and hepatitis B varied among the examined regions.

Regarding hospital discharges by diagnostic categories, Italy, Costa Rica, Chile, and the OECD average noted a decline in all the indicators within this classification, while Spain exhibited an increase in infectious and parasitic diseases (+ 26.3%), diseases of the nervous system (+ 0.3%), and diseases of the respiratory system (+ 27.6%). Lastly, considering hospital average length of stay classified by diagnostic categories, Costa Rica emerges with the fewest indicators displaying an increasing trajectory (infectious and parasitic diseases and endocrine, nutritional, and metabolic diseases). In contrast, Chile, Italy, Spain, and the OECD average collectively report an increase in at least 5 indicators within this category.

Table 3 presents data on waiting times from specialist assessment to treatment as access to resources indicators, as well as healthcare quality indicators such as cancer care, primary care, and acute care. In terms of resource accessibility, the only indicators that exhibited an increase in waiting times from specialist assessment to treatment across Chile, Italy, Spain, and the OECD average were coronary bypass, and hip replacement procedures showed an increase in all four countries. Meanwhile, other indicators demonstrated diverse trends within each of the analyzed regions.

Table 3 OECD indicators of access to resources and healthcare quality and clinical performance for Chile, Costa Rica, Italy, Spain, and the OECD average in the established year range [3]
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When considering cancer care as an indicator of healthcare quality, none of the four studied countries reported similar outcomes as compared to the OECD average, which reports an improvement in the 5-year net survival rates for all evaluated cancer types. Breast and rectal cancer were the only cancer types to exhibit an enhanced five-year net survival rate across Italy, Costa Rica, and Spain, while Chile showed improvement in breast cancer, but not rectal cancer.

As for primary care indicators, all three countries and the OECD average displayed a decline across all categories. Costa Rica exhibited the most significant decreases in diabetes hospital admissions (− 50.6) and admissions for asthma and chronic obstructive pulmonary disease (− 88.6), while Italy showed the biggest decline in congestive heart failure and hypertension-related hospital admissions (− 112.8). Lastly, regarding acute care, the indicator for 30-day mortality due to acute myocardial infarction (AMI) showed a decrease across all four regions and the OECD average, whereas the remaining indicators exhibited variables for each indicator.

Table 4 illustrates pharmaceutical consumption between 2011 and 2020 in the four countries, expressed by DDD per 1000 inhabitants. Drugs are classified according to the ATC categories [22]. Pharmaceutical consumption follows similar patterns across all the examined regions. For instance, the most widely consumed category within the four countries under study, as well as across the OECD average, are agents acting on the Renin-Angiotensin system. Similarly, in Italy, Spain, and the OECD average, the next two most prevalent categories are drugs for peptic ulcers and gastro-esophageal reflux diseases (GORD) and lipid modifying agents. Costa Rica and Chile differ from this trend by having a distinct category, specifically drugs used in diabetes and lipid modifying agents and diuretics for Chile.

Table 4 OECD indicators of pharmaceutical consumption for Chile, Costa Rica, Italy, Spain, and the OECD average in the established year range [3]
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On the other hand, in three out of the four analyzed regions exhibit decreases in the consumption of cardiac glycosides, antibacterials for systemic use, and non-steroidal anti-inflammatory and antirheumatic products, which goes hand in hand with the OECD trends. In contrast, Chile exhibits a significant increase in the consumption of medication included in these ATC categories. Regarding the use of anxiolytics, while the OECD average and Chile report a decrease in the use of these medications, Costa Rica, Italy, and Spain recount an increase, with Spain displaying the most prominent rise (+ 6.4 DDD/1000 inhabitants). In the context of Costa Rica, apart from being the second most frequently used category, there has been a significant increase in the consumption of drugs used in diabetes (+ 30.8 DDD/1000 inhabitants), same as Chile that its increase is higher (+ 39.7 DDD/1000 inhabitants). Similarly, the category of lipid modifying agents has also seen substantial increases in consumption in Costa Rica (+ 21.9 DDD/1000 inhabitants), Spain (+ 39.2 DDD/1000 inhabitants), and Italy (+ 35.1 DDD/1000 inhabitants), but Chile leads the incremental average (+ 74.1 DDD/1000 inhabitants).

4 Discussion

The determinants of health are shaped and impacted by a multitude of elements, including human biology, environmental conditions, lifestyle decisions, and the healthcare systems and infrastructure. These components collectively contribute to a holistic comprehension of health, with the healthcare system serving as an indispensable component of optimal national functioning, and the quality and availability of medical services depend on how the system is funded [23, 24]. The OECD Health Care Quality Indicator (HCQI) Project, launched in 2001, aims to create a set of measures that can accurately show the quality of healthcare across different countries using data that can be compared reliably [25].

4.1 Healthcare expenditure, coverage, status, and non-medical determinants

The GDP share change for the average OECD nations has gone up, and Chile, Italy, Spain, and Costa Rica are following this trend, but Costa Rica experienced the lowest improvement (+ 0.2) compared to the other regions. This tendency is not uncommon in the Latin American context, where economic conditions often are not favorable and only a few countries in this region consistently increase the share of GDP allocated to healthcare over time [26, 27]. Examining health spending per capita, all three countries have seen an increase in expenditure, and notably, Spain has seen the most significant rise (+ $ 696.5). This lines up with the results seen in the average OECD data.

This emphasizes the need to improve healthcare for citizens across low, middle, and high-income countries since investing more in health is crucial as it can lead to fairer access to health services in different regions [28]. However, it is crucial to emphasize that a larger allocation of resources or budget for healthcare investment does not automatically ensure favorable health outcomes for a nation. Several factors come into play, including how the investment is allocated, including infrastructure, pharmaceuticals, and primary care, among other aspects. Additionally, non-medical determinants, such as population habits and lifestyles, exert a substantial influence on health outcomes [29].

Multiple studies have indicated that health spending should be effectively utilized, and there is room for enhancing health policies to boost investments in health technology. These measures should go hand in hand with environmental reforms and quality-of-life improvements, aiming to achieve enduring health outcomes. Therefore, it is not solely about increasing healthcare investments but also ensuring their appropriate and strategic allocation [29, 30].

In terms of population coverage, both Spain and Italy offer healthcare services coverage to 100% of their citizens, exceeding the OECD average and adhering to the foundational principles of their respective national healthcare systems. In contrast, Costa Rica reports a lower statistic for population health coverage. This aspect, while signifying a substantial area for improvement within its healthcare system since Costa Rica is also striving for universal coverage, is important to highlight that this region maintains relatively high coverage levels within the Latin American context [31]. In the context of Chile, the highest coverage is attained by combining the private sector, which constitutes 18%, with the public sector, which makes up 82%. This collaborative approach prioritizes certain severe medical conditions, ensuring 100% coverage for them [6, 32].

These statistics are mirrored in terms of satisfaction with the quality of care in 2020, where Costa Rica, Spain, and Italy score below the OECD average. Nevertheless, it's widely recognized that the population anticipates the highest standards of care and treatment, suggesting that this figure might be somewhat subjective. This perception is further influenced by the fact that when assessing the population's perception of good or very good health status, these three countries report values above the OECD average in 2018.

Spain also reports the highest life expectancy among the countries studied; it not only surpasses Costa Rica, Italy, and Chile but also outperforms the OECD average. In terms of mortality, whether it is infant, maternal, or avoidable mortality, Italy demonstrates the lowest rates, which is primarily attributed to its proactive healthcare culture [33]. On the other hand, Costa Rica and Chile exhibit the highest rates in these indicators, suggesting a significant opportunity for substantial improvement, which underscores the need for the healthcare system to shift towards a preventive approach.

Lastly, in the examination of non-medical determinants impacting health, Costa Rica stands out as the country with the least prevalent tobacco and alcohol usage among its citizens. Although Chile, Italy, and Spain report higher rates of tobacco and alcohol consumption than Costa Rica, it is crucial to emphasize that consumption rates in Chile and Italy remain lower than the OECD average. Furthermore, these countries have also recorded the most substantial reductions in tobacco consumption indicators. Within each of these nations, a noticeable decline in tobacco consumption became apparent after the introduction of legal regulations designed to oversee public consumption in various regions. This highlights the profound influence that government regulations and proactive promotion and advertising campaigns can exert, particularly within developed nations [34].

4.2 Healthcare resources

Upon analyzing the data concerning the resources allocated to general healthcare, all four countries as well as the OECD average demonstrate an uptick in the number of healthcare workers throughout the studied period. This trend, however, contrasts with a general decline in the quantity of infrastructure resources and hospital beds available for patient admission. Once again, collectively, these nations fall in line with the overall OECD country data. In the context of Italy, it could be inferred that the decrease in available hospital beds is associated with the growing establishment of private healthcare facilities. On the other hand, the rise in healthcare workforce recruitment is likely influenced, at least in part, by policies implemented to mitigate the aftermath of the recent pandemic, thereby giving heightened importance to public health priorities [35, 36].

4.3 Healthcare utilization

Regarding the use of the health system, the trend of the countries under study is a reduction in medical consultations and hospital discharges, and except for Spain, an increase in the average number of days of hospital stay in the study periods. Highlighting the immunization coverage among the Costa Rican population is of utmost importance. This nation leads with the highest proportion of individuals immunized against DPT and hepatitis B, and what further distinguishes it is the fact that it is the only country studied that reported an increase across all indicators in the count of immunized individuals. This achievement directly stems from the country’s well-organized policies, encompassing a mandatory vaccination program for all residents, and the ongoing vaccination campaigns meticulously carried out by the public sector [37]. On the contrary, both Spain and Italy demonstrate a significant decrease in the percentage of the population aged 65 years and older who received influenza vaccinations. This highlights a substantial area for improvement and presents an opportunity for a call to action to enhance policies related to influenza vaccination.

4.4 Access to resources

Although consistently reporting the highest number of waiting days for procedure evaluations across medical specialties, Costa Rica has shown significant relative reductions during the study period compared to Chile, Spain, Italy, and the OECD average. Prolonged waiting times for treatments can potentially lead to a decline in patients' health conditions and diminish the efficacy of treatments, ultimately creating a barrier to accessing healthcare services. Given that achieving equitable access and treatment based on need is a fundamental objective of national health systems, patients' waiting periods should solely correspond to their health requirements. This implies that individuals with the same health needs should experience equal waiting times, regardless of other factors [38].

In the case of Italy, a study highlighted considerable disparities in waiting times for specialist consultations and diagnostic assessments that need to be addressed, among different regions within the country [38], and Italy is also the nation under examination that demonstrated the least variation in the periods studied, indicating minimal deterioration or improvement. To address this, amendments were made to Italy’s national legislation governing essential levels of care, stipulating timely services. An agreement between the state and regional authorities set maximum guaranteed waiting times for outpatient care, including 60 days for five major diagnostic imaging procedures and 30 days for eye and cardiology appointments, along with similar limits for three elective hospital procedures [10]. This offers a potential solution to this issue in Chile and Spain, as it only recorded a reduction in waiting times for Percutaneous Transluminal Coronary Angioplasty and knee replacement. In contrast, the remaining specialties exhibited a noticeable increase.

4.5 Healthcare quality

The quality of healthcare services constitutes an essential factor within the healthcare domain and directly impacts the operations of all interconnected sectors. The World Health Organization actively promotes the adoption of national policies and strategies to enhance the quality of health systems and elevate the standard of healthcare services, as outlined in its various guidelines and manuals on best practices across nations [35].

In terms of cancer care, diverse patterns emerged within the four examined nations. However, none mirrored the trajectory of the OECD average, which reflects an upward shift in the 5-year net survival rates across all cancer types. Notably, Costa Rica stands out by exhibiting the most substantial enhancements in 5-year net survival rates for colon cancer, rectal cancer, and stomach cancer, values even surpassing the OECD average. This could potentially be attributed to improved healthcare accessibility and increased health coverage within the country. Additionally, increased investments in cancer treatment and management might contribute to this positive trend in Costa Rica, as well as the establishment of guidelines for its management across the public sector [39]. Furthermore, childhood cancer survival rates in Chile have consistently exceeded 80% from 2018 to 2022, thanks to the implementation of a nationwide treatment protocol known as the “Children’s Antineoplastic Drug Program” (PINDA, in Spanish). This approach has significantly enhanced the safety and efficacy of therapies. Additionally, the presence of a healthcare statistics system contributes to ongoing advancements in these health indicators [40, 41].

Within Italy, the National Outcomes Evaluation Program (PNE) analyzes a range of health metrics across the nation. It was observed that the 30-day mortality rate for Acute Myocardial Infarction (AMI) experienced a reduction of 2.1%. Additionally, hip-fracture surgeries initiated within 2 days of hospital admission registered an increase during the study period, and the proportion of medical interventions conducted within this two-day timeframe determined by the PNE increased from 31.3% in 2010 to 64.6% in 2020 [42]. Spain also decreased healthcare quality indicators for acute care, except for hip-fracture surgeries initiated within 2 days of hospital admission, which represents a big area of opportunity to improve the quality of care provided.

Highlighting the significance of primary care outcomes, it is important to showcase that all four studied regions reported reductions in hospital admissions for the three indicators. These reductions exceeded the OECD average, particularly evident for the admissions for congestive heart failure and hypertension, as well as the ones for asthma and chronic obstructive pulmonary disease. This achievement accentuates effective disease management and outpatient monitoring within these regions, contributing to a lower occurrence of hospitalizations originating from decompensation in these chronic conditions.

4.6 Pharmaceutical consumption

Collectively, the data concerning drug consumption in these countries reveal a gradual and consistent rise in pharmaceutical usage among individuals. Studies have demonstrated that elevated pharmaceutical intake not only contributes to improved mortality outcomes but also enhances overall quality of life and life expectancy [19, 20]. Notably, the most prevalent class of drugs consumed by the population across the OECD average belongs to agents targeting the renin-angiotensin system, which aligns with expectations, given that cardiovascular diseases stand as the primary global cause of death [31].

This pharmaceutical consumption trajectory is in line with the rise in life expectancy and the commitment to healthcare in Costa Rica, Chile, Italy, and Spain. Projections anticipate that as the elderly population continues to grow, the prescription and utilization of drugs for chronic conditions will exert a greater impact on pharmaceutical expenditure. This demographic shift is attributed to both declining fertility rates and advancements in longevity [43]. It's worth highlighting that between 2011 and 2020, the consumption of antibacterial agents for systemic use declined in Costa Rica, Italy, and Spain. This trend is notable despite the escalating concern of antimicrobial resistance in recent years, signifying an emerging health challenge. This data potentially indicates a commendable adherence to international guidelines regarding the prudent use of antibiotic agents.

A comparative analysis of healthcare resource allocation and public health outcomes across diverse nations reveals the inherent difficulty in crowning one country as definitively superior. Each population presents unique characteristics and challenges, necessitating tailored approaches and policy decisions by their leaders. While Chile, within the Latin American context, stands out for exceeding the average share of GDP dedicated to healthcare per capita, neighboring Costa Rica exhibits significantly less growth in this area. However, Costa Rica surpasses its peers in the crucial domain of population immunization, reflecting a distinct strategic focus.

The cases of Italy and Spain represent noteworthy examples of universal healthcare coverage, encompassing 100% of their respective populations. This policy choice demonstrably impacts life expectancy, with both countries boasting averages exceeding the organization's overall benchmark. However, it is crucial to acknowledge that such blanket generalizations risk overlooking contextual nuances and potential trade-offs.

These analyses serve a dual purpose: firstly, providing crucial insights into healthcare systems across diverse nations, and secondly, fostering the identification and promotion of evidence-based policy solutions. One specific example lies in the potential application of telemedicine interventions to address the challenge of long waiting lists and specialist consultations. Research demonstrates that strategically implemented telemedicine projects can effectively mitigate this issue while upholding service excellence [44].

Prolonged length of hospitalization for patients could present an additional challenge. To alleviate pressure on tertiary hospitals, investments should bolster primary care infrastructure and expand access to long-term care facilities [45]. Internally, hospitals can identify and rectify inefficient processes contributing to extended stays. Predictive models, leveraging artificial intelligence, can personalize care plans for high-risk patients, facilitating timely discharge [46]. Ultimately, this analysis serves as a springboard for further exploration, empowering policymakers to craft nuanced and effective healthcare strategies that are responsive to the unique needs of their populations.

4.7 Limitations

Several limitations should be acknowledged in this study. We acknowledge that this present investigation while illuminating, represents but a preliminary foray into this multifaceted domain. Hence, we advocate for further research along several critical vectors, which aim to empower policymakers with even more robust data for informed decision-making. The lack of available data for certain indicators across the countries under investigation (Costa Rica, Spain, and Italy) further limits the comprehensiveness of the analysis, since these indicators had to be excluded: expenditure by disease, age, and gender under the System of Health Accounts (SHA) Framework for both inpatient/hospital and outpatient/ambulatory spending by disease (ICD), perceived health status, hospital employment data, breast cancer or cervix cancer screening, prescribing in primary care, patient experience and mental health. It is important to recognize that data collection methods might have differed among the countries, potentially introducing variations in the results obtained. Another pertinent limitation lies in the temporal scope of the study, as the cancer care evaluation primarily focused on periods ranging from 2005 to 2014, thus potentially not capturing more recent developments. Lastly, the study's descriptive nature should be noted, indicating that the presented results pertain to entire populations, obviating the necessity for statistical testing to discern disparities between the indicators.

5 Conclusions

Comparing healthcare indicators across different countries serves as a crucial effort with numerous advantages. This analysis helps reveal the workings of diverse health systems, allowing us to pinpoint areas for potential improvement within each region. By examining the achievements and obstacles faced by other nations, policymakers and healthcare stakeholders acquire a valuable foundation on which to enact reforms. This comparison paves the way for broader discussions about vital healthcare issues, initiating an ongoing process of gradual enhancement. This, in turn, fosters the development of healthcare structures that can adapt to the changing demands of populations. Through the insights from these cross-country comparisons, the healthcare landscape has the potential to transform into one that promises equitable access, enhances care standards, and consistently delivers services for all individuals and empowers policymakers to craft nuanced, effective, and population-specific healthcare strategies. By embracing evidence and tackling diverse challenges, we can build a more accessible, efficient, and equitable healthcare system for all.