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This book provides the first in-depth study of healthcare reforms in post-communist Eastern Europe. Combining insights from comparative politics and public policy analysis, it examines health reforms in Slovenia, the Czech Republic, and Poland between 1989 and 2019. The book argues that the post-communist transformation of healthcare policy has entailed a process of policy learning, and that the countries' reform pathways were shaped by a series of initiatives aimed at applying market-oriented policy ideas in healthcare. The success of these initiatives has been influenced by three factors: policy legacies, political competition, and institutional configurations. The book offers a novel comparison of health reform in the region and policy changes more generally. It will appeal to scholars and students of public policy, health policy, and European politics.
Health-care costs are a major financial burden for the transition economies, which have experienced rapidly increasing demand for health-care services. The former communist countries of the Central and Eastern Europe and Central Asia needed to reform the financing of their health-care systems and make efforts to strengthen the role of primary care while limiting the role of hospital care. The growing health needs and, consequently, costs resulted in the increased attention paid to the performance of health systems. The aim of this chapter is to determine the efficiency of health systems in post-communist countries. The data envelopment analysis method was used. The effective health systems were identified and recommendations for the inefficient countries were formulated.
This book presents a novel view of healthcare system transition in post-communist countries. It is the first region-wide comparative study of hospital governance in Eastern Europe. Comprehensive new material shows the evolution and significance of governance, complementing recent publications on the topic from industrialised countries. Throughout the book, governance is described and substantiated as a major component that, together with provider payment mechanisms, defines the hospital sector’s operations. This view subscribes to the economists’ growing appreciation of extra-financial aspects in the discussion of incentives and regulation of healthcare markets. In particular, the book explains how governance arrangements may affect the outcomes of healthcare financing reforms, and should thus be seen as a critical determinant of their success or failure. This new model of thinking about healthcare system transition emerges from an analysis of 22 countries over the course of two decades. While the primary focus of the study is on developing the hospital sector, an extensive background chapter provides a standalone introduction to the dynamically changing landscape of healthcare in Eastern Europe and an overview of the various problems and challenges the region is facing. Practitioners, policy-makers, academics and students interested in Eastern European healthcare systems, their origins, current status and ways forward, will appreciate the book’s reflections on the problem complexity, the clarity of its concepts, and its accessible style of presentation.
Informal payments in the health sector of Eastern and Central Asia are emerging as a fundamental aspect of health care financing and a serious impediment to health care reform. These informal payments, made to individuals or institutions in cash or in kind, are nearly always for services that are meant to be covered by the health care system. Such private payments to public personnel have created an informal market for health care , and are a form of corruption. This problem's roots are traced to declining revenues which have not coincided with a reduction in buildings, hospital beds and health personnel. In these circumstances informal payments compensate for lost earnings, and therefore reforms to modernise the region's health systems must compete with individuals' personal revenues. Options for addressing this problem include comprehensive anticorruption policies, downsizing of the public health system, reducing the set of services sibsidised by the state, encouraging cost sharing with those who can afford it, improving accountability, and promoting private alternatives.
Annotation World Bank Technical Paper No. 293.Presents a conceptual framework for understanding the impact of health sector reforms in Central and Eastern Europe. The book analyzes the various factors involved in the reforms and presents strategies adopted by many countries of the region during the early phases of the transition era.
Reform of the welfare sector is an important yet difficult challenge for all countries in transition from socialist central planning to market-oriented democracies. Here a scholar of the economics of socialism and post-socialist transition and a health economist take on this challenge. This 2001 book offers health sector reform recommendations for ten countries of Eastern Europe, drawn consistently from a set of explicit guiding principles. After discussing sector-specific characteristics, lessons of international experience, and the main set of initial conditions, the authors advocate reforms based on organized public financing for basic care, private financing for supplementary care, pluralistic delivery of services, and managed competition. Policymakers need to achieve a balance, both assuring social solidarity through universal access to basic health services and expanding individual choice and responsibility through voluntary supplemental insurance. The authors also consider the problems that undermine effectiveness of market-based competition in the health sector.
Examines the social causes of the decline in life expectancy in Russia and Eastern Europe. Countries discussed include Russia, Poland, Hungary, Romania, Bulgaria, the Czech Republic and East Germany.
Finalist, PEN Center USA Literary Awards, Research NonfictionRich in oil and strategically located between Russia and China, Kazakhstan is one of the most economically and geopolitically important of the so-called Newly Independent States that emerged after the USSR's collapse. Yet little is known in the West about the region's turbulent history under Soviet rule, particularly how the regime asserted colonial dominion over the Kazakhs and other ethnic minorities.Grappling directly with the issue of Soviet colonialism, Curative Powers offers an in-depth exploration of this dramatic, bloody, and transformative era in Kazakhstan's history. Paula Michaels reconstructs the Soviet government's use of medical and public health policies to change the society, politics, and culture of its outlying regions. At first glance the Soviets' drive to modernize medicine in Kazakhstan seems an altruistic effort to improve quality of life. Yet, as Michaels reveals, beneath the surface lies a story of power, legitimacy, and control. The Communist regime used biomedicine to reshape the function, self-perception, and practices of both doctors and patients, just as it did through education, the arts, the military, the family, and other institutions.Paying particular attention to the Kazakhs' ethnomedical customs, Soviet authorities designed public health initiatives to teach the local populace that their traditional medical practices were backward, even dangerous, and that they themselves were dirty and diseased. Through poster art, newsreels, public speeches, and other forms of propaganda, Communist authorities used the power of language to demonstrate Soviet might and undermine the power of local ethnomedical practitioners, while moving the region toward what the Soviet state defined as civilization and political enlightenment.As Michaels demonstrates, Kazakhs responded in unexpected ways to the institutionalization of this new pan-Soviet culture. Ethnomedical customs surreptitiously lived on, despite direct, sometimes violent, attacks by state authorities. While Communist officials hoped to exterminate all remnants of traditional healing practices, Michaels points to evidence that suggests the Kazakhs continued to rely on ethnomedicine even as they were utilizing the services of biomedical doctors, nurses, and midwives. The picture that ultimately emerges is much different from what the Soviets must have imagined. The disparate medical systems were not in open conflict, but instead both indigenous and alien practices worked side by side, becoming integrated into daily life.Combining colonial and postcolonial theory with intensive archival and ethnographic research, Curative Powers offers a detailed view of Soviet medical initiatives and their underlying political and social implications and impact on Kazakh society. Michaels also endeavors to link biomedical policies and practices to broader questions of pan-Soviet identity formation and colonial control in the non-Russian periphery.