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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.
This book examines the relevance of a theoretical model of health care law-making in several Central and Eastern European countries. Confronted with the legacy of the ancient regime, the countries selected shifted away from a 'socialist' model towards a more 'market-oriented' health care system. From a legal perspective, this change of system imposed on government the need for drastic reforms starting with the introduction of a compulsory health insurance scheme based on the notion of solidarity. Future accession to the EU, requiring the incorporation of the acquis communautaire, has increased the complexity of legal reforms since. Strengthening the reform process, the author developed a method of law-making based on legal-theoretical understanding. Case study research in three selected countries justifies the conclusion that the analytical model rationalises the law-making activity, including the 'EU law approximation process'. What is more, it became apparent that the importance of this theoretical model is not restricted only to the selected countries but may also be a valuable instrument for other countries in transition in the region. Health care law-making in Central and Eastern Europe - Review of a legal-theoretical model provides a unique resource for scholars and policy makers interested in legal reforms in Central and Eastern European health care systems.
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.
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.
This volume explores the central issues driving the present process of healthcare reform in Europe. 17 chapters written by scholars and policy makers from all parts of Europe draw together the available evidence from epidemiology and public health, economics, public policy, organizational behaviour and management theory as well as real world policy making experience, laying out the options that health sector decision-makers confront. Through its cross-disciplinary, cross-national approach, the book highlights the underlying trends that now influence health policy formulation across Europe. An authoritative introduction provides a broad synthesis of present trends and strategies in European health policy.
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.