The "States of Health" series has looked at the experiences of people as they seek investigation and treatment in the health services in Northern Ireland and the Republic. While comparisons have been anecdotal by design, they have given a real flavour of what it is like to be a patient.
With the exception of hip replacement, waiting times in the Republic's public system have exceeded those of the NHS in the North. Within Northern Ireland, practices which purchase services from hospitals (fund-holding practices) are able to provide quicker treatment. And, of course, the private sector in the Republic beats the public system every time.
Measuring performance is hugely complex, and health economists will immediately point to the dangers of analysing performance based on a single criterion such as waiting times.
However, it has been shown that even by combining various indicators, it is difficult to distinguish between good and bad performance. So a valid case can be made that it is the public who use the service who should decide which aspects of the health system matter most.
The Institute of Public Health, an all-island body set up under the Good Friday agreement, will publish the first All-Ireland Mortality Study later this year. It will show that mortality rates for many conditions are worse in the Republic compared with the North. While mortality rates are a crude measure of outcome, it is reasonable to ask whether they would improve if waiting times were reduced.
The report will also show the island as a whole compares unfavourably with 15 other EU states. Health systems North and South will have to look towards these countries to learn what improvements will enhance patient outcome.
What are the obvious differences between the health services? Per capita there are more consultants in the Republic and more GPs in the North. The primary healthcare system, and in particular a team-based approach, are more developed in the North. There are more nursing homes and respite beds in the Northern health service.
And yet the two systems face the same problems: not enough acute hospital beds; a shortage of nursing staff; problems at the interface between primary and secondary care; excessive non-consultant hospital doctor working hours; and a high level of waiting lists, exacerbated in both by a shortage of facilities for long-term care of the elderly.
The health service in the Republic will be largely shaped by the outcome of the Health Strategy review, which has just begun. In the North, the Acute Hospitals Review Group, chaired by Senator Maurice Hayes, is due to complete its research next month.
A reduction in the number of acute hospitals is forecast for the North's NHS. Units in Downpatrick and Dungannon are under threat, although there is speculation that a new acute hospital will be built to service the south-western area of Tyrone and Fermanagh.
In the Republic, there is support within the Department of Health for a proposal to separate elective hospital services from those providing accident and emergency cover.
Instead of having most public hospitals battling to stem the tide of emergency admissions in order to keep beds free for planned surgery, we are likely to see each region with one accident and emergency hospital which will not be under pressure to perform elective work.
All other hospitals in the area will carry out planned investigations and procedures only, allowing them to plan an uninterrupted throughput of patients from waiting lists. The internal working of the health service must change. Medical hierarchical structures will have to develop into a team approach, in which nurses and paramedics take a greater leadership role.
Nor is it acceptable that 70 per cent of operations are performed by doctors in training grades. The Medical Manpower Report makes it clear that a large increase in consultants is needed to create a consultant-provided service.
Probably the biggest change for both health services will be cross-Border co-operation. Already, patients from Letterkenny travel to Belfast City Hospital for cancer treatment. The Co-Operation and Working Together initiative involves close liaison between Border health boards in the Republic and the North.
Next month the Centre for Cross Border Studies will issue its report, Cross Border Co-operation in Health Services in Ire- land. It will make recommendations on how co-operation can be made more effective on an all-island basis.
The ultimate goal for health services North and South must be, in the words of Dr Jane Wilde, director of the Institute of Public Health, "to change how decisions about healthcare are made by providing more accessible information to people in the community".
Series concluded