Publication:
Innovations in Health Services Delivery from Transition Economies in Eastern Europe and Central Asia

No Thumbnail Available
Published
2009
ISSN
1544-5208 (Electronic) 0278-2715 (Linking)
Date
2012-03-30
Author(s)
Fidler, A.
Schlippert, S.
Editor(s)
Abstract
During the past fifteen years, the countries of the former Eastern Bloc transformed their centrally planned, supply-driven health care systems. Modernization of service delivery required innovations in financing and insurance and the restructuring of primary care and hospital networks. This review of experiences from Central and Southeast Europe, the Baltic States, Central Asia, and the Caucasus spot lights innovative health reforms in low- and middle-income countries, including contributions to improved service delivery, access to care, evidence-based medicine, and overall improvement in health system performance.
Link to Data Set
Digital Object Identifier
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    Innovations in Health Service Delivery : The Corporatization of Public Hospitals
    (Washington, DC: World Bank, 2003) Preker, Alexander S.; Harding, April; Preker, Alexander S.; Harding, April
    The question of how best to run our hospitals has been a subject of intense interest for decades with a strong focus over the past 15 years. Hospital care is the largest expenditure category in the health systems of both industrialized and developing countries. Although hospitals play a critical role in ensuring delivery of health services, less is known about how to improve the efficiency and quality of care provided. This book, a well-documented collection of case studies, is an attempt to examine the design, implementation and impact of reforms that introduced market forces in the public hospital sector; and tries to answer three questions: a) what problems did this type of reform try to address; b) what are the core elements of their design, implementation, and evaluation; and c) is there any evidence that this type of reform is successful in addressing problems for which they were intended?. It also provides some insights about recent trends in the reform of public hospitals, with an emphasis on organizational changes such as increased management autonomy, corporatization, and privatization.
  • Publication
    Europe and Central Asia - Health insurance and competition
    (World Bank, 2009-05-05) World Bank
    Health financing systems in some Europe and Central Asia (ECA) countries are undergoing some major reforms. In parallel with the transition from central planning to develop market-based economies, countries in Central Europe have moved within a relatively short period of time from having health systems that were government managed and funded by taxes to single health insurance systems that are payroll-funded. The next chapter (chapter two) describes the insurance context in Austria, the Netherlands, Slovakia, and Switzerland. Chapter three examines risk selection in a multiple insurance system. Risk-adjusters and equalization schemes in different countries are discussed as well as the resulting incentives for insurance companies to develop cost containment strategies. Chapter four discusses whether and how insurers compete for providers, including the different forms of managed care contracts that have evolved under multiple insurance and the impact of such contracts on policy goals. Chapter five describes consumer choice in different health financing systems and whether consumers are exercising their choice to switch insurers and plans. Chapter six presents an overview of the different options for insurance reforms. The final chapter will identify the main lessons drawn from the preceding chapters and will present potential policy solutions for increasing the effectiveness of insurance systems, including the necessary regulatory framework to prevent adverse effects, purchasing, improved risk pooling, and monitoring and evaluation systems.
  • Publication
    Social Health Insurance and Labor Market Outcomes : Evidence from Central and Eastern Europe, and Central Asia
    (2009) Moreno-Serra, R.; Wagstaff, A.
    OBJECTIVE: The implications of social health insurance (SHI) for labor markets have featured prominently in recent debates over the merits of SHI and general revenue financing. It has been argued that by raising the nonwage component of labor costs, SHI reduces firms' demand for labor, lowers employment levels and net wages, and encourages self-employment and informal working arrangements. At the national level, SHI has been claimed to reduce a country's competitiveness in international markets and to discourage foreign direct investment (FDI). The transition from general revenue finance to SHI that occurred during the 1990s in many of the central and eastern European and central Asian countries provides a unique opportunity to investigate empirically these claims. METHODOLOGY/APPROACH: We employ regression-based generalizations of difference-in-differences (DID) and instrumental variables (IV) on country-level panel data from 28 countries for the period 1990-2004. FINDINGS: We find that, controlling for gross domestic product (GDP) per capita, SHI increases (gross) wages by 20%, reduces employment (as a share of the population) by 10%, and increases self-employment by 17%. However, we find no significant effects of SHI on unemployment (registered or self-reported), agricultural employment, a widely used measure of the size of the informal economy, or FDI. IMPLICATIONS FOR POLICY: We do not claim that our results imply that SHI adoption everywhere must necessarily reduce employment and increase self-employment. Nonetheless, our results ought to serve as a warning to those contemplating shifting the financing of health care from general revenues to a SHI system.
  • Publication
    Getting Better : Improving Health System Outcomes in Europe and Central Asia
    (Washington, DC: World Bank, 2013-06-10) Smith, Owen; Nguyen, Son Nam
    This report is about how to improve health system outcomes in countries in the Europe and Central Asia (ECA) region. Long-term historical trends indicate substantial room for improvement, especially when ECA's health outcomes are compared to those of the Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, and the United Kingdom (EU-15). Instead of catching up with their Western neighbors, many countries in ECA have been falling behind. This report, which explores the development challenge facing health sectors in ECA, identifies three key agendas for achieving more rapid convergence with the world's best-performing health systems: (i) the first is the health agenda, in which the main imperative is to strengthen public health and primary care interventions to help achieve the 'cardiovascular revolution' that has taken place in the west in recent decades; (ii) the second is the financing agenda, in which growing demand for medical care must be satisfied without imposing an undue burden on households, by achieving better financial protection, or on government budgets, by ensuring a more efficient use of resources; and (iii) the third agenda relates to broader institutional arrangements. Here, a few key reform ingredients are identified, each of which is common to most advanced health systems but lacking in many ECA countries.
  • Publication
    Improving Health Service Delivery in Developing Countries : From Evidence to Action
    (Washington, DC: World Bank, 2009) Peters, David H.; El-Saharty, Sameh; Siadat, Banafsheh; Janovsky, Katja; Vujicic, Marko
    Decision makers and the public are in need of information to guide their decisions about how to strengthen health services. This book pulls together available evidence concerning strategies to improve health services delivery in low- and middle-income countries (LMICs), using current methods to assemble a knowledge base and analyze the findings. It describes the results of reviews of such strategies, and how such strategies can produce gains for the poor. This type of information is intended to help decision makers in LMICs learn from others and from their own experiences, so that they may develop and implement strategies that will improve health services in their own setting. The book provides some suggestions for what works and how to improve implementation, as the evidence does not hold up for 'blueprint' planning. It finds that there are many ways that can succeed in improving health services. But not nearly enough attention has been paid to demonstrating how to improve services for the poor. Approaches that ask difficult questions, use information intelligently, and involve key stakeholders and institutions are critical to 'learning and doing' practices that underlie successful implementation of health services.

Users also downloaded

Showing related downloaded files

No results found.