Paper/Speech Details of Conference Program for the 16th NISPAcee Annual Conference Program Overview Panel Session on Health Policies and their Implementation Author(s) Juraj Nemec Masaryk University Brno Czech Republic Tatiana Chubarova, Dr., Academy of Sciences, Moscow, Russia Title Health policies in CEE region: Selected constraints File Paper files are available only for conference participants, please login first. Presenter Abstract After 1989, all Central and Eastern European (CEE) countries implemented large-scale health care reforms. The reform starting phase was almost identical – “Semashko type“ centralized health care model providing a comprehensive but medium quality system of health care for all members of the society financed from general taxation. The concrete reform approaches and measures differ among the CEE countries, depending very much on the specific local conditions. A lot was expected as the outcome of the changes. However, recent evidence indicates that many expectations from the reforming of health care in CEE region were not fulfilled. Health systems in CEE, now financed dominantly on the base of social/private insurance basis perform relatively effectively from the point of view of ration between outputs and inputs, but significantly fail from aspects like universal access, cost containment and organizational and medical quality of services. Our paper focuses on two issues – impact of financial constraints on the chance to achieve real reforms success and the problem of motivation of main stakeholders to cost-containment. 1. Health care reforms in CEE region Basic set of data concerning health reforms in CEE. Introducing of health insurance, privatization of primary and specialized ambulatory care. Different approaches to hospital level. Concerning access two groups of countries might be found: - countries continuing to focus on universal access as one of main principles of heath sector - countries, where access is not any more guaranteed. 2. CEE health reforms outcomes Indicators: a/ output- input ratio b/ universalism of access c/ cost control d/ quality 3. Lack of resources as explanation factor for limited access and quality, but relatively high efficiency 4. Motivation of main stakeholders as explanation factor for cost-containment problems The tool would be the analysis of utility functions of main players. This analysis might help to explain why all CEE countries from this group suffer from large problems connected with health care financing. Main selected players are: A: Hospitals (health establishments) – are not constrained by hard fiscal discipline, their management has enough space to channel proper part of finance to private pockets. B: Medical doctors – are not constrained by hard financial discipline, can do what they want, produce suppliers induced demand in all dimensions (extra treatments, extra equipment, extra drugs, etc.). Have enough space for shadow incomes. C: Politicians – by allowing extra resources “satisfy” needs of their voters for “free” universal coverage D: Bureaucrats – with extra resources have more power. E: Patients – who may get and appreciate better (more expensive) drugs or treatments. The outcome of such situation might be described by following chart: There are more forms, how to secure health care debt financing, including shifting the burden to the private sector. Luckily, external constraints arising from EU memberships might limit such behavior.
