Health sector reforms in Central and Eastern Europe
AbstractThe political and economic transition of the 1990s in the countries of central and eastern Europe has been accompanied by wide ranging health care reform. The initial Soviet model has given way to a variety of forms of health insurance. Yet, as this paper argues, reform has too often been preoccupied with ideological imperatives, such as provider autonomy and the creation of funds separate from government, and has given much less thought to the contribution that health care can make to population health. The paper begins by examining the changing nature of health care. It recalls how the Soviet model was able to provide basic care to dispersed populations at low cost but notes how this is no longer sufficient in the face of an increasingly complex health care environment. This complexity reflects several factors, such as the growth in chronic disease, the emergence of new forms of infectious disease, and the introduction of new treatments requiring integrated delivery systems. It reviews evidence on how the former communist countries failed to keep up with developments in the west from the 1970s onwards, at a time when the complexity of health care was becoming apparent. It continues by setting out a framework for the organisation of health care based on the goal of health gain. This involves a series of activities that can be summarised as active purchasing, and which include assessment of health needs, designing effective packages of care, and monitoring outcomes. It concludes by arguing that a new relationship is needed between the state and the organisations involved in funding and delivering health care, to design a system that will tackle the considerable health needs of the people who live in this region.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoArticle provided by Max Planck Institute for Demographic Research, Rostock, Germany in its journal Demographic Research Special Collections.
Volume (Year): 2 (2004)
Issue (Month): 7 (April)
Contact details of provider:
Web page: http://www.demogr.mpg.de/
Central and Eastern Europe; Europe; health; health care reform; population health;
Find related papers by JEL classification:
- J1 - Labor and Demographic Economics - - Demographic Economics
- Z0 - Other Special Topics - - General
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Chervyakov, Valeriy V. & Shkolnikov, Vladimir M. & Pridemore, William Alex & McKee, Martin, 2002. "The changing nature of murder in Russia," Social Science & Medicine, Elsevier, vol. 55(10), pages 1713-1724, November.
- Koupilová, Ilona & Epstein, Helen & Holcík, Jan & Hajioff, Steve & McKee, Martin, 2001. "Health needs of the Roma population in the Czech and Slovak Republics," Social Science & Medicine, Elsevier, vol. 53(9), pages 1191-1204, November.
- Delcheva, Evgenia & Balabanova, Dina & McKee, Martin, 1997. "Under-the-counter payments for health care: Evidence from Bulgaria," Health Policy, Elsevier, vol. 42(2), pages 89-100, November.
- Mackenbach, J. P., 1991. "Health care expenditure and mortality from amenable conditions in the European community," Health Policy, Elsevier, vol. 19(2-3), pages 245-255, December.
- Sabbat, Jolanta, 1997. "International assistance and health care reform in Poland: barriers to project development and implementation," Health Policy, Elsevier, vol. 41(3), pages 207-227, September.
- Healy, Judith & McKee, Martin, 2002. "Implementing hospital reform in central and eastern Europe," Health Policy, Elsevier, vol. 61(1), pages 1-19, July.
- Kroneman, Madelon & Nagy, Julia, 2001. "Introducing DRG-based financing in Hungary: a study into the relationship between supply of hospital beds and use of these beds under changing institutional circumstances," Health Policy, Elsevier, vol. 55(1), pages 19-36, January.
- Wróblewska, Wiktoria, 2002. "Women's health status in Poland in the transition to a market economy," Social Science & Medicine, Elsevier, vol. 54(5), pages 707-726, March.
- Koupilova, Ilona & McKee, Martin & Holcik, Jan, 1998. "Neonatal mortality in the Czech Republic during the transition," Health Policy, Elsevier, vol. 46(1), pages 43-52, October.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Editorial Office).
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.