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Europe and central Asia's great post-communist social health insurance experiment: Aggregate impacts on health sector outcomes


  • Wagstaff, Adam
  • Moreno-Serra, Rodrigo


The post-Communist transition to social health insurance in many of the Central and Eastern European and Central Asian countries provides a unique opportunity to try to answer some of the unresolved issues in the debate over the relative merits of social health insurance and tax-financed health systems. This paper employs regression-based generalizations of the difference-in-differences method on panel data from 28 countries for the period 1990-2004. We find that, controlling for any concurrent provider payment reforms, adoption of social health insurance increased national health spending and hospital activity rates, but did not lead to better health outcomes.

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  • Wagstaff, Adam & Moreno-Serra, Rodrigo, 2009. "Europe and central Asia's great post-communist social health insurance experiment: Aggregate impacts on health sector outcomes," Journal of Health Economics, Elsevier, vol. 28(2), pages 322-340, March.
  • Handle: RePEc:eee:jhecon:v:28:y:2009:i:2:p:322-340

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    References listed on IDEAS

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    10. Wagstaff, Adam & Moreno-Serra, Rodrigo, 2007. "Europe and Central Asia's great post-communist social health insurance experiment : impacts on health sector and labor market outcomes," Policy Research Working Paper Series 4371, The World Bank.
    11. O'Donnell, Owen & van Doorslaer, Eddy & Rannan-Eliya, Ravi P. & Somanathan, Aparnaa & Adhikari, Shiva Raj & Akkazieva, Baktygul & Harbianto, Deni & Garg, Charu C. & Hanvoravongchai, Piya & Herrin, Ale, 2008. "Who pays for health care in Asia?," Journal of Health Economics, Elsevier, vol. 27(2), pages 460-475, March.
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    Cited by:

    1. Obrizan, Maksym, 2017. "Does EU membership prevent crowding out of public health care? Evidence from 28 transition countries," MPRA Paper 81708, University Library of Munich, Germany.
    2. Mark Stabile & Sarah Thomson, 2014. "The Changing Role of Government in Financing Health Care: An International Perspective," Journal of Economic Literature, American Economic Association, vol. 52(2), pages 480-518, June.
    3. Wagstaff, Adam, 2009. "Social health insurance vs. tax-financed health systems - evidence from the OECD," Policy Research Working Paper Series 4821, The World Bank.
    4. Moreno-Serra, Rodrigo & Wagstaff, Adam, 2010. "System-wide impacts of hospital payment reforms: Evidence from Central and Eastern Europe and Central Asia," Journal of Health Economics, Elsevier, vol. 29(4), pages 585-602, July.
    5. Connolly, Sheelah & Wren, Maev-Ann, 2016. "The 2011 proposal for Universal Health Insurance in Ireland: Potential implications for healthcare expenditure," Health Policy, Elsevier, vol. 120(7), pages 790-796.
    6. Gordeev, Vladimir S. & Pavlova, Milena & Groot, Wim, 2011. "Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector," Health Policy, Elsevier, vol. 102(2), pages 270-277.
    7. Adam Wagstaff & Daniel Cotlear & Patrick Hoang-Vu Eozenou & Leander R. Buisman, 2016. "Measuring progress towards universal health coverage: with an application to 24 developing countries," Oxford Review of Economic Policy, Oxford University Press, vol. 32(1), pages 147-189.
    8. Enami, Ali, 2016. "Determinants of Child Mortality in Africa: A Methodological Discussion," MPRA Paper 68671, University Library of Munich, Germany.
    9. Israel Marques, 2014. "Firms And Social Policy In The Post-Communist Bloc: Evidence From Russia," HSE Working papers WP BRP 87/EC/2014, National Research University Higher School of Economics.
    10. repec:bla:ijhplm:v:31:y:2016:i:4:p:580-601 is not listed on IDEAS
    11. Le, Nga T.Q. & Groot, Wim & Tomini, Sonila & Tomini, Florian, 2017. "Effects of health insurance on labour supply: Evidence from the health care fund for the poor in Viet Nam," MERIT Working Papers 050, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    12. Owen Smith & Son Nam Nguyen, 2013. "Getting Better : Improving Health System Outcomes in Europe and Central Asia," World Bank Publications, The World Bank, number 13832.
    13. Achelrod, Dmitrij & Welte, Tobias & Schreyögg, Jonas & Stargardt, Tom, 2016. "Costs and outcomes of the German disease management programme (DMP) for chronic obstructive pulmonary disease (COPD)—A large population-based cohort study," Health Policy, Elsevier, vol. 120(9), pages 1029-1039.


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