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Who is Paying for Health Care in Eastern Europe and Central Asia?

Who is Paying for Health Care in Eastern Europe and Central Asia?
Author: Maureen A. Lewis
Publisher: World Bank Publications
Total Pages: 44
Release: 2000-01-01
Genre: Health & Fitness
ISBN: 9780821348062

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Informal payments in the health sector of Eastern and Central Asia are emerging as a fundamental aspect of health care financing and a serious impediment to health care reform. These informal payments, made to individuals or institutions in cash or in kind, are nearly always for services that are meant to be covered by the health care system. Such private payments to public personnel have created an informal market for health care , and are a form of corruption. This problem's roots are traced to declining revenues which have not coincided with a reduction in buildings, hospital beds and health personnel. In these circumstances informal payments compensate for lost earnings, and therefore reforms to modernise the region's health systems must compete with individuals' personal revenues. Options for addressing this problem include comprehensive anticorruption policies, downsizing of the public health system, reducing the set of services sibsidised by the state, encouraging cost sharing with those who can afford it, improving accountability, and promoting private alternatives.


Getting Better

Getting Better
Author: Owen Smith
Publisher: World Bank Publications
Total Pages: 214
Release: 2013-06-10
Genre: Medical
ISBN: 0821398849

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Fifty years ago, health outcomes in the countries of Eastern Europe and Central Asia were not far behind those in Western Europe and well ahead of most other regions of the world. But progress since then has been slow. While life expectancy in the ECA region today is close to the global average, the gap with its western neighbors has doubled, and other middle-income regions have all surpassed ECA. Some countries in the region are doing better, but full convergence with the world’s most advanced health systems is still a long way off. At the same time, survey evidence suggests that the health sector is the top priority for additional investment among populations across the region. The experience of high-income countries also suggests that popular demand for strong and accessible health systems will only grow over time. Yet these aspirations must be reconciled with current fiscal realities. In brief, health sector issues are a challenge here to stay for policy-makers across the ECA region. This report draws on new evidence to explore the development challenge facing health sectors in ECA, and highlights three key agendas to help policy-makers seeking to achieve more rapid convergence with the world’s best performing health systems. The first is the health agenda, where the task is to strengthen public health and primary care interventions to help launch the “cardiovascular revolution” that has taken place in the West in recent decades. The second is the financing agenda, in which growing demand for medical care must be satisfied without imposing undue burden on households or government budgets. The third agenda relates to broader institutional arrangements. Here there are some key reform ingredients common to most advanced health systems that are still missing in many ECA countries. A common theme in each of these three agendas is the emphasis on improving outcomes, or “Getting Better”.


System-Wide Impacts of Hospital Payment Reforms

System-Wide Impacts of Hospital Payment Reforms
Author: Rodrigo Moreno-Serra
Publisher:
Total Pages:
Release: 2012
Genre:
ISBN:

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Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian countries shifted from paying hospitals through historical budgets to fee-for-service or patient-based-payment methods (mostly variants of diagnosis-related groups). Using panel data on 28 countries over the period 1990-2004, the authors of this study exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. They use a regression version of difference-in-differences and two variants that relax the difference-in-differences parallel trends assumption. The results show that fee-for-service and patient-based-payment methods both increased national health spending, including private (out-of-pocket) spending. However, they had different effects on inpatient admissions (fee-for-service increased them; patient-based-payment had no effect), and average length of stay (fee-for-service had no effect; patient-based-payment reduced it). Of the two methods, only patient-based-payment appears to have had any beneficial effect on "amenable mortality," but there were significant impacts for only a couple of causes of death, and not in all model specifications.


System-Wide Impacts of Hospital Payment Reforms

System-Wide Impacts of Hospital Payment Reforms
Author: Rodrigo Moreno-Serra
Publisher:
Total Pages: 57
Release: 2017
Genre:
ISBN:

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Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian countries shifted from paying hospitals through historical budgets to fee-for-service or patient-based-payment methods (mostly variants of diagnosis-related groups). Using panel data on 28 countries over the period 1990-2004, the authors of this study exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. They use a regression version of difference-in-differences and two variants that relax the difference-in-differences parallel trends assumption. The results show that fee-for-service and patient-based-payment methods both increased national health spending, including private (out-of-pocket) spending. However, they had different effects on inpatient admissions (fee-for-service increased them; patient-based-payment had no effect), and average length of stay (fee-for-service had no effect; patient-based-payment reduced it). Of the two methods, only patient-based-payment appears to have had any beneficial effect on "amenable mortality," but there were significant impacts for only a couple of causes of death, and not in all model specifications.


Implementing Health Financing Reform

Implementing Health Financing Reform
Author: Joseph Kutzin
Publisher: World Health Organization
Total Pages: 438
Release: 2010
Genre: Medical
ISBN:

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Analyses the experience with the financing reforms implemented by the countries of Central Europe, Eastern Europe, the Cauxasus and Central Asia.


Health

Health
Author: Marc Suhrcke
Publisher: European Observatory
Total Pages: 249
Release: 2007-01-01
Genre: Asia, Central
ISBN: 9789289072823

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This report is the first comprehensive effort to analyse the economic impact of ill health in the CEE-CIS (Central and Eastern Europe and the Commonwealth of Independent States) Region. This book explores the interdependence of health and economic development, focusing on the Region's significant economic burden of ill health.


Golden Aging

Golden Aging
Author: Maurizio Bussolo
Publisher: World Bank Publications
Total Pages: 363
Release: 2015-06-23
Genre: Business & Economics
ISBN: 1464803536

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Compared to other regions, Europe and Central Asia are by far the oldest. Moreover, population aging is set to accelerate further over the coming decades as large segments turn old. Additionally, some countries such as Russia and certain Eastern European countries are facing a shrinkage of their population. Against this backdrop, this report investigates what stands in the way of societies reaping the full benefits of increased longevity--that is, longer lives and potentially prolonged payoffs from human capital--and what can help to mitigate the possible negative impacts of a smaller and older workforce. Beginning with a focus on demographic trends, the report puts the rapid decline in fertility and contrasting migration trends in the region in a historical perspective and looks forward to the varying paths that population change may follow in the region. Next, it examines the evidence on the likely impact of demographic change on growth and savings, the labor force, firm and economy-wide innovation, poverty and inequality, and intergenerational solidarity. Finally, the report goes beyond diagnostics and puts an emphasis on what we know regarding successful policy interventions, presenting evidence on what has and has not worked in the past.--Publisher description.