This chapter presents a comparison of liability/compensation systems across countries, which can be challenging because of substantial differences in tort doctrine, judicial systems, and administrative compensation mechanisms. It approaches the problem of patient injury in a healthcare system from the dual (and dueling) perspectives of system responsibility and provider culpability. The basic question that the chapter asks is this: Who should bear the economic costs of medical adverse events? The US system remains solidly anchored in the tort liability system, with its emphasis on negligence-based culpability in medical malpractice cases—but with timid moves toward enterprise liability and statutory communication and resolution programs. By contrast, the Scandinavian systems have publicly funded patient compensation funds.