Health Care in Small Areas of Three Command Economies: What Do the Data Tell Us?

The present project assembles and analyzes health systems data for small areas in contiguous regions of East Germany, Czechoslovakia, and Poland in 1988. The data were collected and maintained by the Communist central governments of East Germany and Czechoslovakia, and by the voivodships in Poland during the command system era. Analyses of these regions are compared to contemporary data from U.S. regions. Instead of assuming a common goal for each region, the data are studied to ascertain whether they reflect an identifiable, de facto goal. The key findings are that coefficients of variation of health care resource availability are somewhat larger in the command systems; and coefficients of variation in mortality rates are smaller in two of the command systems, suggesting a de facto emphasis on health status equality. The U.S. regions' data appear to be more consistent with an implicit goal of regional health status maximization. Discussions explain the relationships between the alternative goals and suggest which systems succeed in achieving a particular goal.