Health Care during Transition and Health Systems Reform: Evidence from the Poorest CIS Countries

Abstract

The poorest seven countries of the former Soviet Union (CIS- ) moved from a centralized system of health-care funding and delivery to a range of institutional and financial arrangements. The different paths chosen have implied different results in terms of available resources, internal efficiency, health-care inequality, and the corresponding incidence of public expenditures. This paper examines the level, composition and allocation of public spending on health, in light of the evolution of the health systems during the transition. The financial constraints experienced by CIS- countries were reflected in the decrease of health-care quality, the collapse of the already inefficient public health activities, and the increased incidence of out-of-pocket expenditures. These factors, alongside the increase in poverty, resulted in a decrease in health-care utilization, suggesting that these countries may experience difficulties in achieving the health-related Millennium Development Goals.

What determines healthcare utilization and related out-of-pocket expenditures in Tajikistan? Lessons from a national survey

“…Second, the package should have carefully calibrated targeting criteria so as to effectively reach out to the neediest segments of society. The effectiveness of the package is often low in transitional countries since the identification of the poor and vulnerable is difficult and often inefficient in the context of transitional economies 6 . Under these circumstances, one possible approach to the efficient identification of the poor is to link the receipt of subsidized healthcare with the receipt of targeted social assistance benefits.…”

“…Being one of the poorest countries among the republics of the former Soviet Union, Tajikistan has a per capita GDP of US$ 180 5 . Healthcare sector expenditures in the country constitute approximately 1 percent of GDP, the second lowest level, after Georgia, among all transitional countries 6 . In real terms, expenditures on the healthcare sector are at less than a tenth of their pre-transitional levels 7 .…”

The inequity in out-of-pocket expenditures for healthcare in Tajikistan: evidence and implications from a nationally representative survey

“…Several studies on the middle-income countries of Eastern Europe and the western republics of the former Soviet Union show that private OPEs have functioned as the primary means of filling the gap in funding for healthcare, which emerged as a result of the continuing economic constrains in public financing (Aarva et al 2009;Cockcroft et al 2008;Szende and Culyer 2006;Lohlein et al 2003). The situation is even more dire in the transitional countries of the Caucasus and Central Asia, where money coming from OPEs have become the major source of healthcare financing, and where OPEs far exceed public levels of funding (Balabanova et al 2004;Bonilla-Chacin et al 2005;Gotsadze et al 2005;Belli et al 2004;Sari et al 2000;McKee et al 1998).…”

“…Furthermore, Tajikistan has suffered from a cruel civil war and an economic recession that was more profound and prolonged than those in other transitional countries (Mirzoev et al 2007). The country's public expenditures on healthcare have decreased dramatically since the beginning of transition, and are the second lowest among all low-income transitional countries, at approximately 1% of gross domestic product (Bonilla-Chacin et al 2005). Over the same period, the transition has been accompanied by an increase in incidents of infectious diseases, child and maternal mortality, and a drastic decline in total fertility and life expectancy (Government of Tajikistan 2005).…”

Hospitalization in Tajikistan: determinants of admission, length of stay, and out‐of‐pocket expenditures. Results of a national survey

“…War and economic crisis have also undermined the governments' ability to finance the healthcare system. Presently, expenditures for healthcare comprise about 1 per cent of the GDP, one of the lowest levels among all transitional countries (Bonilla-Chacin et al, 2005). The health status of the population has also deteriorated, and increased incidents of communicable disease and infant, child and maternal mortality have been reported.…”