Lessons from health financing reform in central and eastern Europe and the former Soviet Union.

Policy makers in the so-called transition countries, as in all countries, face the challenge of improving the performance of their health systems. These countries share a unique historical experience – the period and collapse of communist rule – and all embarked on an unprecedented social, political and economic transition that began at the end of the 1980s. Despite this shared history, differences emerged (or became more apparent) in the early years of transition. Most obviously, there are large economic differences between the countries, with the richest country, Slovenia, having an estimated purchasing power parity-adjusted per capita gross national income in 2008 of $26,910 compared with that of $1860 in the poorest, Tajikistan (World Bank, 2009) (Table 1). The transition created particular challenges and opportunities for their health systems, in general, and for health financing systems, in particular. And indeed, most of the countries introduced either comprehensive or piecemeal reforms in a number of areas, including the introduction of compulsory health insurance (CHI) funds, changes in provider payment methods and changes in benefit packages and user charges. A recently completed edited volume (Kutzin et al., 2010) reviewed the experience of transition countries with two decades of health financing reform and synthesised lessons learnt to date, some of which may resonate for countries