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Europe and Central Asia's great post-communist social health insurance experiment : impacts on health sector and labor market 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 a regression-based generalization of the difference-in-differences method and instrumental variables on panel data from 28 countries for the period 1990-2004. The authors 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. The authors also find that adoption of social health insurance reduced employment in the economy as a whole and increased unemployment, although it did not apparently increase the size of the informal economy.

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  • 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.
  • Handle: RePEc:wbk:wbrwps:4371

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    1. Mireille Razafindrakoto & François Roubaud, 2006. "Are international databases on corruption reliable? A comparison of expert opinion surveys and household surveys in sub-Saharan Africa," Working Papers DT/2006/17, DIAL (Développement, Institutions et Mondialisation).
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    3. Knack, Stephen, 2006. "Measuring corruption in Eastern Europe and Central Asia : a critique of the cross-country indicators," Policy Research Working Paper Series 3968, The World Bank.
    4. Omar Azfar & Peter Murrell, 2009. "Identifying Reticent Respondents: Assessing the Quality of Survey Data on Corruption and Values," Economic Development and Cultural Change, University of Chicago Press, vol. 57(2), pages 387-411, January.
    5. Charles Oman & Christiane Arndt, 2006. "Governance Indicators for Development," OECD Development Centre Policy Insights 33, OECD Publishing.
    6. Kaufmann, Daniel & Kraay, Aart & Zoido-Lobaton, Pablo, 1999. "Aggregating governance indicators," Policy Research Working Paper Series 2195, The World Bank.
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    1. 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.

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    Health Monitoring&Evaluation; Health Systems Development&Reform; Population Policies; Health Economics&Finance; Disease Control&Prevention;

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