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Health sector reforms in Central and Eastern Europe


  • FFF1Martin NNN1McKee

    (London School of Hygiene and Tropical Medicine)

  • FFF2Ellen NNN2Nolte

    (London School of Hygiene and Tropical Medicine)


The 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.

Suggested Citation

  • FFF1Martin NNN1McKee & FFF2Ellen NNN2Nolte, 2004. "Health sector reforms in Central and Eastern Europe," Demographic Research Special Collections, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 2(7), pages 163-182, April.
  • Handle: RePEc:dem:drspec:v:2:y:2004:i:7

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    References listed on IDEAS

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. Healy, Judith & McKee, Martin, 2002. "Implementing hospital reform in central and eastern Europe," Health Policy, Elsevier, vol. 61(1), pages 1-19, July.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
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    More about this item


    Central Europe; Eastern Europe; Europe; health; health care reform; population health;

    JEL classification:

    • J1 - Labor and Demographic Economics - - Demographic Economics
    • Z0 - Other Special Topics - - General


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