The evolution of the health system outcomes in Central and Eastern Europe and their association with social, economic and political factors: an analysis of 25 years of transition

BACKGROUND After the fall of communism, the countries of Central and Eastern Europe started the process of political, economic, and social transformation. In health system the reform directions were often similar, despite differences in transition dynamics and the degree of government determination to implement reforms. Nonetheless, for most post-communist countries, there is a gap in evidence regarding the effectiveness of implemented reforms and their impact on health system performance. The presented study attempts to analyse and evaluate the results of health reforms in CEE countries with regard to their influence on health system outcomes. We also analysed the external and internal health system environments during the transition period to determine the factors affecting the effectiveness of health reforms. METHODS We compared the indicators of population health status, lifestyle, occupational safety issues and health system resources in 21 post-communist countries between sub-periods across the entire transition period at the aggregate level. The dynamics of change in health system outcomes in individual countries, as well as between countries, was also compared. Finally, we analysed the correlations between health system outcomes gathered into one synthetic measure and factors considered as potential determinants affecting the effectiveness of health reforms. The analyses were performed based on one-dimensional, two-dimensional and multidimensional statistical methods. The data were retrieved from the international databases, such as WHO, World Bank, International Labour Organization, World Value Survey and the European Social Survey. RESULTS Among the factors positively stimulating improvements in health system outcomes were the total expenditure on health and a lower financial burden on patients, but primarily they were determined by the broader economic context of the country. Another finding was that better initial position positively determined health system outcomes at later stages, but did not affect the degree of improvements. Countries that embarked on comprehensive reforms early on tended to achieve the greatest improvements in health system outcomes. CONCLUSIONS Poorer countries may have only limited ability to improve health system outcomes by committing more financial resources to the health system. Progress can still be made in terms of health behaviours, since policies to address these have so far been insufficient or ineffective.