Trends in health systems in the former Soviet countries

Abstract

Background The post-Soviet countries had very similar starting points after gaining independence in 1991, yet embarked on widely varying developments. More than two decades since the collapse of the Soviet Union, it is time to review the progress the post-Soviet countries have made in reforming their health systems, and the lessons this experience offers to other countries. This abstract presents findings of a study undertaken by the European Observatory on Health Systems and Policies in 2012-2014, to be published in time for the European Public Health (EPH) conference. Methods This study builds on the extensive country monitoring by the European Observatory on Health Systems and Policies through its Health Systems in Transition (HiT) health system reviews. This was complemented by a review of the scientific literature and the consultation of researchers and HiT authors in the countries. Results The health systems of the region still struggle with achieving their fundamental goal of improving population health, as the countries continue to lag far behind Western Europe. However, the quantity and quality of data to judge health system performance remains poor. While the countries differ in many aspects, most notably their socio-economic development and the levels of health spending per capita, they also share other common challenges, such as persisting inequities between urban and rural areas, lack of transparency and accountability, and high levels of out-of-pocket expenditure, with resulting problems in financial access. One of the most pressing problems in many countries is access to outpatient pharmaceuticals, which are generally excluded from benefit packages. Furthermore, there is a continued reliance on hospital care and a resulting neglect of primary care. Poor quality of care is another common problem. Conclusions Available resources need to be spent more wisely, such as through establishing more effective mechanisms for strengthening primary health care, including through revised mechanisms for paying providers, as well as through strengthened mechanisms for financial protection. Quality of care should be another priority. Overall, health will have to gain a higher place on the political agenda of most countries of the region.

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