costs are comparable to other countries with institutionally similar health care systems market mechanisms in regulating both insurance coverage and health care provision such as germany and switzerland but relatively high in comparison to most other oecd countries with different systems joumard et al more specifically hospital care exhibits mixed efficiency scores while quality is high in preventive and outpatient care findings that predate the effects of recent health care reforms other studies have emphasized the high equity and access in the dutch health care system davis et al