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Objective To compare countries' health care needs by segmenting populations into a set of needs‐based health states. Data sources We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data. Study design We developed the Cross‐Country Simple Segmentation Tool (CCSST), a validated clinician‐administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self‐reported physician diagnosis of chronic disease, and performance‐based tests conducted during the survey interview, individuals were assigned to 1–5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross‐sectionally to assess cross‐country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death. Data collection/extraction methods We segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories. Principal findings The CCSST is a valid tool for segmenting populations into needs‐based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country‐specific areas for analysis of ecological and cultural risk factors. Conclusions The CCSST is an innovative tool for aggregate cross‐country comparisons of both health needs and transitions between them. A cross‐country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high‐need, high‐cost patients.

How to improve service provision in the health care sector is a question of high economic and social relevance, as the health service industry represents a major part of developed nations' economy and health care is a service virtually everyone is touched by in their life. The topic embraces different perspectives or levers, including the (re)organization of service provision, a stronger focus on the patient in the service delivery process, and the crucial role of employees in health service provision. We invited a group of well-renown scholars from different academic fields to share with us personal observations, empirical evidence, and interpretations of how to improve service provision in health care in the form of individual commentaries that cover the different perspectives. The resulting special research article includes motivations on why changes in the health care sector make service management research (smr) more relevant, it depicts implications (of smr) for health care organizations, and it outlines suggestions for future research. This article is designed to offer avenues for further service research on different perspectives for the improvement and professionalization of health care -a discipline in which joint efforts of service and health care researchers can have great societal impact.Health services are similar to other services in that they are characterized by intangibility, inseparability, perishability, and credence service. Yet health care also has uncommon characteristics that merit attention in service research, highlighted in the following.Customers are sick: Health care customers are usually ill and under stress. Under those circumstances, medical customers can be far more emotional, demanding, sensitive, and/or dependent than they would normally be as consumers. The combination of illness, pain, uncertainty, and fear and the one hand and relief, jubilation and thankfulness on the other influences their ability to make choices. Hence, decision-making is likely to be incomparable to other service situations. Customers are reluctant:In contrast to most other services, health care is a service that people need but do not necessarily want. Customer reluctance may affect quality of care, due to customer unwillingness to perform the coproducer role necessary for successful service provision, as well as service quality perceptions as customers might evaluate desired and dreaded services differently.Customers relinquish privacy: Health care services are inherently personal but not private. To receive the best possible care, patients may not only have to disrobe, but they may also have to discuss highly personal matters such as psychosocial issues, even with staff they are meeting for the first time.Customers need "whole person" service: Health care services need to be customized to fit not only a patient's medical condition but also the patient's age, mental condition, personal traits, preferences, family circumstances, and financial capacity/insurance status. Additionally, health care customers...

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