[go: up one dir, main page]
IDEAS home Printed from https://ideas.repec.org/a/dem/drspec/v2y2004i7.html
   My bibliography  Save this article

Health sector reforms in Central and Eastern Europe

Author

Listed:
  • Martin McKee

    (London School of Hygiene and Tropical Medicine)

  • Ellen Nolte

    (London School of Hygiene and Tropical Medicine)

Abstract
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

  • Martin McKee & Ellen Nolte, 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.
    • Handle: RePEc:dem:drspec:v:2:y:2004:i:7
    DOI: 10.4054/DemRes.2004.S2.7
    as

    Download full text from publisher

    File URL: https://www.demographic-research.org/special/2/7/s2-7.pdf
    Download Restriction: no
    File URL: https://libkey.io/10.4054/DemRes.2004.S2.7?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    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. Gilmore, Anna B. C. & McKee, Martin & Rose, Richard, 2002. "Determinants of and inequalities in self-perceived health in Ukraine," Social Science & Medicine, Elsevier, vol. 55(12), pages 2177-2188, December.
    3. 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.
    4. 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.
    5. 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.
    6. Healy, Judith & McKee, Martin, 2002. "Implementing hospital reform in central and eastern Europe," Health Policy, Elsevier, vol. 61(1), pages 1-19, July.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Agnieszka Fihel & Marketa Pechholdová, 2017. "Between ‘Pioneers’ of the Cardiovascular Revolution and Its ‘Late Followers’: Mortality Changes in the Czech Republic and Poland Since 1968," European Journal of Population, Springer;European Association for Population Studies, vol. 33(5), pages 651-678, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Stillman, Steven, 2006. "Health and nutrition in Eastern Europe and the former Soviet Union during the decade of transition: A review of the literature," Economics & Human Biology, Elsevier, vol. 4(1), pages 104-146, January.
    2. Shuey, Dean A. & Qosaj, Fatime Arenliu & Schouten, Erik J. & Zwi, Anthony B., 2003. "Planning for health sector reform in post-conflict situations: Kosovo 1999-2000," Health Policy, Elsevier, vol. 63(3), pages 299-310, March.
    3. van de Vijsel, Aart R. & Engelfriet, Peter M. & Westert, Gert P., 2011. "Rendering hospital budgets volume based and open ended to reduce waiting lists: Does it work?," Health Policy, Elsevier, vol. 100(1), pages 60-70, April.
    4. Kim, Sang-Weon & Pridemore, William Alex, 2005. "Social support and homicide in transitional Russia," Journal of Criminal Justice, Elsevier, vol. 33(6), pages 561-572.
    5. Pietilä, Ilkka & Rytkönen, Marja, 2008. "Coping with stress and by stress: Russian men and women talking about transition, stress and health," Social Science & Medicine, Elsevier, vol. 66(2), pages 327-338, January.
    6. Jerneja Farkas & Majda Pahor & Lijana Zaletel-Kragelj, 2011. "Self-rated health in different social classes of Slovenian adult population: nationwide cross-sectional study," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(1), pages 45-54, February.
    7. Parida Wubulihasimu & Werner Brouwer & Pieter van Baal, 2016. "The Impact of Hospital Payment Schemes on Healthcare and Mortality: Evidence from Hospital Payment Reforms in OECD Countries," Health Economics, John Wiley & Sons, Ltd., vol. 25(8), pages 1005-1019, August.
    8. Brienna Perelli-Harris, 2008. "Ukraine: On the border between old and new in uncertain times," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 19(29), pages 1145-1178.
    9. Williams, Colin C. & Horodnic, Adrian V., 2017. "Rethinking informal payments by patients in Europe: An institutional approach," Health Policy, Elsevier, vol. 121(10), pages 1053-1062.
    10. Grielen, Saskia J. & Boerma, Wienke G. W. & Groenewegen, Peter P., 2000. "Science in practice: can health care reform projects in central and eastern Europe be evaluated systematically?," Health Policy, Elsevier, vol. 53(2), pages 73-89, September.
    11. Cockerham, William C. & Hinote, Brian P. & Abbott, Pamela, 2006. "Psychological distress, gender, and health lifestyles in Belarus, Kazakhstan, Russia, and Ukraine," Social Science & Medicine, Elsevier, vol. 63(9), pages 2381-2394, November.
    12. Gaal, Peter & McKee, Martin, 2005. "Fee-for-service or donation? Hungarian perspectives on informal payment for health care," Social Science & Medicine, Elsevier, vol. 60(7), pages 1445-1457, April.
    13. Tambor, Marzena & Pavlova, Milena & Rechel, Bernd & Golinowska, Stanisława & Sowada, Christoph & Groot, Wim, 2014. "Willingness to pay for publicly financed health care services in Central and Eastern Europe: Evidence from six countries based on a contingent valuation method," Social Science & Medicine, Elsevier, vol. 116(C), pages 193-201.
    14. Dubas-Jakóbczyk, K. & Albreht, T. & Behmane, D. & Bryndova, L. & Dimova, A. & Džakula, A. & Habicht, T. & Murauskiene, L. & Scîntee, S.G. & Smatana, M. & Velkey, Z. & Quentin, W., 2020. "Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019: a comparative analysis," Health Policy, Elsevier, vol. 124(4), pages 368-379.
    15. Nkiru Edith Obande-Ogbuinya & MaryJoy Umoke & Amari-Omaka L.N. & Aleke C.O. & Omeje C. B. & Eunice Afoke & Chinyere Alo & Chibuzo Uzoho & Jude Nwafor & John Onwe & Pat Ngwakwe, 2020. "Emerging Health Problems among Reproductive Mothers in Abakaliki Urban of Ebonyi State: Implication for Sustainable Development," Global Journal of Reproductive Medicine, Juniper Publishers Inc., vol. 7(3), pages 64-732:7, February.
    16. Adriana Castelli & Olena Nizalova, 2011. "Avoidable mortality: what it means and how it is measured," Working Papers 063cherp, Centre for Health Economics, University of York.
    17. Szende, Agota & Culyer, Anthony Johr, 2006. "The inequity of informal payments for health care: The case of Hungary," Health Policy, Elsevier, vol. 75(3), pages 262-271, February.
    18. Marko Matejic, 2017. "Reconfiguration of acute care hospitals in post-socialist Serbia: spatial distribution of hospital beds," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(2), pages 160-184, April.
    19. Jose L. Vilchez, 2017. "The Solution for the Behavioural Constellation of Deprivation," Psychology and Developing Societies, , vol. 29(2), pages 246-263, September.
    20. Pavlova, Milena & Groot, Wim & van Merode, Godefridus, 2002. "Public attitudes towards patient payments in Bulgarian public health care sector: results of a household survey," Health Policy, Elsevier, vol. 59(1), pages 1-24, January.

    More about this item

    Keywords

    Europe; health; population health; health care reform; Central Europe; Eastern Europe;
    All these keywords.

    JEL classification:

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

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:dem:drspec:v:2:y:2004:i:7. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Editorial Office (email available below). General contact details of provider: https://www.demogr.mpg.de/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.