Post-Soviet transition: improving health services delivery and management

Area of Science:

• Health Policy
• Public Health Systems
• Comparative Health Systems

Background:

• Ex-Communist countries in Eastern Europe and the former Soviet Union have been implementing major health system reforms over the past two decades.
• These nations are transitioning from the Soviet-type Semashko health model to new management principles, with varying degrees of success.
• Reform agendas include shifts in financing schemes (Bismarck, Beveridge, mixed) and new health delivery management policies.

Observation:

• The study reviews common characteristics of Semashko health systems and discusses the adoption of "new public management" (NPM) principles in post-Communist countries.
• Two case studies, Russia and Albania, illustrate the experiences with NPM principles in practice.
• Challenges identified include low healthcare financing, depreciated infrastructure, and conflicting health policies.

Findings:

• Ex-Semashko health systems have not fully realized the benefits of NPM due to persistent issues like inadequate funding and outdated infrastructure.
• In Russia, a pharmaceutical coverage scheme suffered from moral hazard and adverse selection, undermining efficient medicine access.
• Albania's implementation of NPM was hampered by delayed investment in human resource reform within an underfinanced system.

Implications:

• Successful health system reform in post-Communist nations requires addressing fundamental issues of financing, infrastructure, and human resources.
• Effective leadership with experience in managing health system transitions is crucial for capitalizing on NPM principles.
• Policy interventions must be carefully designed and managed to avoid unintended consequences, such as those observed in pharmaceutical access and human resource development.