Implementing health financing reform



Since 1990, the paths of the so-called transition countries of central and eastern Europe, the Caucasus, and central Asia have diverged with regard to their social and economic policies, including the implementation of reforms in the financing of their health systems. Until now, this rich experience has not been analysed in a systematic way.

The book begins with the background to health financing systems and reform in these countries, starting with the legacy of the systems in the USSR and central Europe before 1990 and the consequences (particularly fiscal) of the transition for their organization and performance. Relying on in-depth country case experiences, reforms are analysed first from a functional perspective, with chapters focusing on how policies were implemented to change mechanisms for revenue collection, pooling, purchasing and policy on benefit entitlements. Highlighted in subsequent chapters are particular reform topics, such as:

  • financing of capital costs
  • links between health financing reform and the wider public finance system
  • financing of public health services and programmes
  • role of voluntary health insurance
  • informal payments
  • accountability in health financing institutions.

With many authors having practical experience of implementing, advising, or evaluating health financing policies in the region, the book offers important lessons as well as pitfalls to avoid in reform processes. This book is essential reading for health finance policy-makers, advisers, and analysts in this region and beyond.

The editors

Joseph Kutzin is Regional Advisor for Health Systems Financing and Head of the Barcelona Office for Health Systems Strengthening, WHO Regional Office for Europe.

Cheryl Cashin is Research Fellow at the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare, School of Public Health, University of California, Berkeley, United States.

Melitta Jakab is Senior Health Financing Policy Analyst at the Barcelona Office for Health Systems Strengthening, WHO Regional Office for Europe.