Market-based health care reforms in Central and Eastern Europe: lessons after ten years of change

After 1989, all Central and Eastern European (CEE) countries implemented large-scale health care reforms. The changes differ among CEE countries, depending very much on the specific conditions present at the start of and during the processes. However, there are some common issues - most notably, the introduction of several market-based instruments, including introducing health insurance financing systems to replace general taxation-based models, privatization and the introduction of private payments and co-payments. Much was expected as the outcome of the changes. However, recent evidence indicates that many expectations from the 'marketization' of health care were not fulfilled. Such failures confirm that the transformation processes in CEE countries cannot be based just on the simple transfer of western good practice. The success of the implementation of new approaches has been a function of the effective combination of western and local expertise and the respecting of the specific local environment. One must be able to predict (as much as possible) the impact of new mechanisms in specific transitional conditions. The inability to do this has come at great cost to the citizens of the region.