Based on the fiscal incentives inherent in a nation's hospital reimbursement methodology, it is highly predictable how the nation's healthcare executives will manage their organization's resources. The hospital data presented herein suggest that prospective reimbursement such as with DRGs in Germany and the United States encourages preadmission testing, more ambulatory care procedures, shorter average lengths of stay, and a greater number of employee hours per discharge. Payment on the basis of total patient days, such as in Canada, results in more acute care beds and more total days per 1000 persons, longer average lengths of stay, and less intensive use of personnel. But even when nations provide universal access, for various reasons those with mental illness and those who are indigent, poorly educated, and nonwhite use less healthcare services.