Index A Age structure of population, 31 Aggregate health spending, national product and, 27 29 Albania health-care system, 106 Ambulatory care, 10 Anecdotal evidence, 18 Armenia, corporatised hospitals in, 118 Australian National University library, 101 Autonomisation, 12, 172, 173 Azerbaijan health-care system, 106 107 B Belarus health-care system, 107 Budget-based financing, 11 Bulgaria, corporatised hospitals, 119 120 C Casemix payments, 99 reimbursement, 211 Caucasus/Central Asia, HCSs of, 249 Central and Eastern Europe (CEE), 8 post-communist health-care transition in, 64 65 Central-Eastern Europe and the Commonwealth of Independent States (CEE/CIS) Herculean task for, 249 hospital governance transformation in, 250 251 reform efforts in, 248 social health insurance, 249 Centralisation, 161 arguments in favour of, 164 Civilisation diseases, 31 33 Commonwealth of Independent States (CIS), 8 Communism, 155 156 Communist economy model, 154 Control of Corruption and Government Effectiveness, 59 Control variables, hospital governance, 216 217 Corporation, 12 Corporatisation, 173 and new public management, 175 177 Corporatised hospitals in Armenia, 118 in Bulgaria, 119 120 the Czech Republic, 120 121 in Estonia, 121 122 flexibility of, 134 135 in Latvia, 122 in Lithuania, 122 123 Corruption, 11, 59 61 presence and forms, 68 69 perceptions index, 58 Cost control, 154 Cost-of-illness studies, 29 Czech Republic, corporatised hospitals, 120 121 D Decentralisation, 196 arguments in favour of, 163 facility management Springer Science+Business Media Singapore 2016 P.M. Sowa, Governance of Hospitals in Central and Eastern Europe, DOI 10.1007/978-981-287-766-6 255
256 Index Decentralisation (cont.) in Kazakhstan s, 109 110 in Kyrgyzstan, 110 111 in Moldova, 111 112 Russian Federation, 112 113 and fiscal federalism, 161 162 inevitability of, 160 161 ownership, 100, 101 post-communist experiences with, 168 169 variety of approaches to, 130 131 Decentralisation processes, ambiguities surrounding, 166 168 Devolution of hospital ownership in Hungary, 113 114 in Poland, 114 116 in Romania, 116 117 in Slovakia, 117 118 Diagnosis-related groups (DRGs), 11 Diverse economies, transition pathways, 25 26 Doctor, 10 Dominant provider payment method, 199 E Eastern Bloc populations, 253 Eastern Europe, health-care transition in. See Health-care transition in Eastern Europe Eastern European health systems, transformation of, 248 Economic incentives decision-makers, 150 features and performance, 151 155 HCS decentralisation, 151 health-care production, 150 make/buy dilemma, 159 160 need for balance, 164 165 physicians motivations, 150 primary care, 151 state-of-the-art medicine, 152 Economic inequalities, 30 31 Economic models, of hospital behaviour, 177 178 Education, schooling, 31 Effi ciency, 10 Estonia, corporatised hospitals in, 121 122 Euro health consumer index, 43 European observatory on health systems and policies, 102 Evidence-based policy-making, 78 Expected outcomes, theoretical implications, 228 229 Explanatory variables hospital governance, 209 alternative interpretations of, 209 211 control variables, 216 217 in Czech Republic, 211 provider payment mechanisms, 211 214 system inputs, 214 216 model specification, 197, 198 F Facility management, decentralisation in Kazakhstan s, 109 110 in Kyrgyzstan, 110 111 in Moldova, 111 112 Russian Federation, 112 113 Federalism, fiscal and nonfiscal in, 165 166 Fee-for-service, 11, 99, 211 Financial planning, 153 Financial responsibility, measurement, 134 Financing reform in CEE/CIS, 50 synergy with, 132 Fiscal federalism decentralisation and, 161 162 in health care, 165 166 Fixed-effect (FE) estimation, 202 alternative specifications, 239 robustness of result, 207 208 G Gross domestic product (GDP) hospital governance reforms, 199 transition mapping, 136 Georgia, privatised hospital sector in, 123 124 Governance, 12 Governance, health-care sector overall strength of, 136 transition mapping, 136 138 Governance reform common mistakes of, 185 186 directions, 183 184 pillars of, 184 185 Government failure, 158 159 and private sector, 156 157 rationale and forms, 157 158
Index 257 H Harding-Preker model, 179 181, 179 Health-care provision, 51 Health-care revenue collection, 27 Health-care system (HCS), 2, 200, 248, 249 of Caucasus/Central Asia, 249 defined by World Health Organisation, 10 economic incentives, decentralisation, 151 efficiency, 10 extended typology of, 251 fiscal and nonfiscal federalism in, 165 166 performance, 10, 199 Health-care transition, 10 Health-care transition in Eastern Europe aspects of reform quality, 131 background, 99 101 corporatised hospitals in Armenia, 118 in Bulgaria, 119 120 the Czech Republic, 120 121 in Estonia, 121 122 fl exibility of, 134 135 in Latvia, 122 Lithuania, 122 123 decentralised facility management in Kazakhstan s, 109 110 in Kyrgyzstan, 110 111 in Moldova, 111 112 Russian Federation, 112 113 devolved hospital ownership in Hungary, 113 114 in Poland, 114 116 in Slovakia, 117 118 Romania, 116 117 financial responsibility, 134 governance, conceptual model, 102 104 governance matters, 130 integrated state financing and provision in Albania, 106 in Azerbaijan, 106 107 in Belarus, 107 in Tajikistan, 107 in Turkmenistan, 108 in Ukraine, 108 109 in Uzbekistan, 109 limitation, 104 105 managerial capacity, 132 methods and data, 101 102 Ministry of Health, 135 136 overall strength of governance, 136 politically sensitive matter, 133 134 privatised hospital sector, 123 124 stages summary, 124 130 synergy with financing reform, 132 transition mapping, 136 138 typology, 138 139 variety of approaches, 130 131 Health system reforms capacity, 53 54 CEE/CIS hospital issues, 81 82 complexity of, 104 consistency and quality of, 53 evidence, absence/disregard, 55 flaws in design, 55 56 goals and strategies, 54 55 idiosyncratic issues, 61 path dependence, 60 61 problems in, 83 85 reasons for, 80 81 regulatory capture and government effectiveness, 58 60 sector unsusceptible to, 82 83 stakeholder resistance, 56 58 time and pace of, 56 in transition, 102, 210 Health transition, 10 Healthy ageing policies, 31 Herculean task, CEE/CIS reformers, 249 Heteroscedasticity, hospital governance reforms, 200 Hospital behaviour, economic models of, 177 178 Hospital care, 10 Hospital governance, 250 251 activity-based financing, 250 251 alternative interpretations of, 209 211 capacity for reform, 250 251 coherent and realistic governance configuration, 250 251 deconcentration and devolution processes, 250 251 economic efficiency, 182 economic theory, 250 251 hypothesised pattern, 250 251 idiosyncratic issues, 250 251 policy implications, 250 251 quantity of care, 250 251 statistical evidence, 250 251 transformation in CEE/CIS, 250 251 transforming, 250 251 Hospital governance reforms alternative interpretations, 212 213 alternative specifications estimation results, 236 fixed-effect estimation, 239 institutional arrangements, 240
258 Index lagged effects, 239 240 quadratic individual country trends, 239 quadratic time function, 236 238 comment on unbalanced panels, 204 discussion of findings, 234 236 dominant hospital payment mechanisms, 215 empirical analysis, 199 estimation results, 230, 231 233, 236 238 estimation strategy, 197 expected outcomes, 228 229 expected signs of coefficients, 230 explanatory variables, 209 alternative interpretations of, 209 211 control variables, 216 217 in Czech Republic, 211 provider payment mechanisms, 211 214 system inputs, 214 216 heterogeneity, 198 heteroscedasticity, 200 impacts of, 196 limitation, 241 242 log-log specification, 200 model specification, 197 203 mortality, 222 225 non-reform processes, 198 presentation of results, 230 233 resources and utilisation, 220 221 response variables, 197 affect aggregate health expenditures, 228 mortality, 221 228 resources and utilisation, 217 221 results, 233 robustness, 241 robustness of results, 206 alternative coding, 208 fixed-effect estimation, 207 208 lagged effects, 208 quadratic individual country trends, 206 207 quadratic time function, 206 variables types, 216 Hospital governance transformation, in post-semashko health systems, 181 183 Hospital ownership devolution in Hungary, 113 114 in Poland, 114 116 Romania, 116 117 Slovakia, 117 118 Hospital performance, 7 Hospital sector aspects of, 200 CEE/CIS, 195 extended typology of, 138 139 Hungary devolved hospital ownership, 113 114 unit autonomisation, 133 I Informal payments forms, 70 71 Institutional arrangements, alternative interpretations of, 208, 240 Institutions, organisations, 11 Ischaemic heart disease (IHD), 217 K Kazakhstan s, decentralised facility management in, 109 110 Kyrgyzstan, 24 decentralised facility management, 110 111 L Lagged effects, 208 alternative specifications, 239 240 Latvia, 24 corporatised hospitals in, 122 Legal regulations, 23 Lifestyle changes, 31 32 Lithuania, corporatised hospitals, 122 123 Long-term care, 79 Low-income countries, 66 M Make/buy dilemma, economic incentives, 159 160 Medical care, provision, 152 Medical poverty trap, 128 Medical supplies, shortages, 17 Mental health care reform, 80 Ministries of Health, 10, 10, 210 role, 135 136 Moldova, decentralised facility management, 111 112 Mortality rates, Russia and the Baltic states, 18
Index 259 N National product, aggregate health spending, 27 29 Negative social capital, 22 New Public Management (NPM), corporatisation, 175 177 Non-profit, 12 Non-SHI countries, 43 Not-for-profit, 12 O Ordinary least squares (OLS) estimation, 203 Organisations, institutions, 11 Out-of-pocket (OOP) payments, 36, 38, 45 Ownership, 169 171 Ownership decentralisation, 100, 101 P Paternalism, 22 Patient-based payments, 11 Payment mechanisms, 46 48 Payroll-based earmarked contributions, 27 Pharmaceutical sector, 76 77 Physician, 10 Poland devolved hospital ownership, 114 116 policy makers in, 99 Pooling function, public funds, 40 41 Post-communist health-care systems, reform guidelines, 2 Post-communist health-care transition, 53 60, 80 85 age structure of population, 31 Caucasus and Central Asia, 66 68 in Central and Eastern Europe, 64 65 civilisation diseases, 31 33 corruption, presence and forms, 68 69 diverse economies and transition pathways, 25 26 of doctrine change, 22 23 economic inequalities, 30 31 economic performance, shared challenges, 62 63 education and schooling, 31 evidence-based policy-making, 78 extended typology, 138 139 former Soviet republics, 65 66 general reform directions, 35 38 health-care provision, 51 health system reforms capacity, 53 54 CEE/CIS hospital issues, 81 82 consistency and quality of, 53 evidence, absence/disregard, 55 flaws in design, 55 56 goals and strategies, 54 55 idiosyncratic issues, 61 path dependence, 60 61 problems in, 83 85 reasons for, 80 81 regulatory capture and government effectiveness, 58 60 sector unsusceptible to, 82 83 stakeholder resistance, 56 58 time and pace of, 56 health technology assessment, 77 implications, 71 informal payments forms, 70 71 long-term care, 79 market allocation, 20 22 mental health care reform, 80 motivations for change, 33 35 national product and aggregate health spending, 27 29 payment mechanisms, 46 48 pharmaceutical sector, 76 77 pooling of public funds, 40 41 private funds role, 48 50 privatisation, 51 53 public health, 79 responses, 74 75 reasons for existence, 72 73 revenue collection, 38 40 shared inheritance, 24 25 SHI consequences, 41 43 similarities and dissimilarities of countries, 24 social and demographic determinants, 29 statutory coverage and benefit entitlement, 44 46 in sub-regional layout, 64 workforce, 75 76 Post-communist hospital sector, 250 Post-Semashko health systems, 98 hospital governance transformation in, 181 183 transformation of (see Health-care transition in Eastern Europe) Post-Semashko region, 3 gross domestic product per capita, 2 life expectancy, 2 map of, 9 population in, 2 Post-Soviet health-care systems, 19 Primary care, 16 Private funds, 48 50
260 Index Private sector, government, 156 157 Privatisation, 12, 51 53, 171 172 Privatised hospital sector, Georgia, 123 124 Provider, 10 Provider payment mechanisms, explanatory variables, 211 214 Provider payment method, 199 Public funds, pooling, 40 41 Public health, post-communist health-care transition, 79 Public hospitals autonomy and governance of, 172 175 ownership and legal forms of, 169 172 Public share, controlling, 200 Q Quadratic time function alternative specifications, 236 240 robustness of result, 206 Quasi-decentralisation, 24 Quasi-market characteristics, 186 R Reform quality, aspects, 131 Regulatory capture, government effectiveness, 58 60 Response variables hospital governance, 197 affect aggregate health expenditures, 228 mortality, 221 228 resources and utilisation, 217 221 Revenue collection, 38 40 Robustness, base model result, 206 alternative coding, 208 fixed-effect estimation, 207 208 lagged effects, 208 quadratic individual country trends, 206 207 quadratic time function, 206 Romania, devolved hospital ownership, 116 117 Russian Federation, decentralised facility management, 112 113 S Schooling, education, 31 Semashko health-care model, 16 Semashko model communism, 155 156 economic features and performance, 151 155 selection of countries, 6 Soviet health-care system, 10 Semashko systems, 196 in post-war decades, 18 unreformed, 201 Shock therapy, 21 Slovakia, devolved hospital ownership, 117 118 Social and demographic determinants, health, 29 Social health insurance (SHI), 11, 36, 38, 39, 44, 45, 196, 249 Socialist inheritance, 249 Soviet health-care system, 10 Stakeholder resistance, 56 58 Standardised death rates (SDRs), 19 Stata command, 207, 208 State-of-the-art medicine, 152 State-owned health system, 152 Statutory coverage, benefit entitlement, 44 46 System inputs, explanatory variables, 214 216 System of Health Accounts, 214 T Tajikistan health-care system, 107 Total expenditure on health (TEH), 200 Transition, 8, 10 Turkmen health-care system, 108 U Ukraine health-care system, 108 109 Unbalanced panels, comment, 204 Units of service, 11 Uzbekistan health-care system, 109 V Voluntary health insurance, 11 W Welfare reforms, USA, 196 World Bank report, corruption, 60 World Bank s upper middle to high-income classification, 3 World Development Indicators database, 215, 217 World Health Organisation, 10