{"id":987643237,"date":"2023-09-12T14:42:29","date_gmt":"2023-09-12T13:42:29","guid":{"rendered":"https:\/\/p4h.world\/?p=987643237"},"modified":"2023-09-27T12:24:06","modified_gmt":"2023-09-27T11:24:06","slug":"ever-growing-health-expenditure-and-mandatory-social-health-insurance-whats-next-2","status":"publish","type":"post","link":"https:\/\/p4h.world\/en\/ever-growing-health-expenditure-and-mandatory-social-health-insurance-whats-next-2\/","title":{"rendered":"Ever-growing health expenditure and mandatory social health insurance: what\u2019s next? – Part 2 of a 3-part series"},"content":{"rendered":"

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Recap: <\/strong>For the<\/em> post-<\/em>Soviet countries, independence they gained in<\/em>\u00a0<\/strong><\/em>1990 and 1991 was also an opportunity to freely define goals and tactics for reforming their health systems. That was a big moment. Most of the<\/em>m<\/em> elected to adopt a contributory health insurance model and while doing so, they have implemented <\/em>a<\/em> series of related reforms<\/em>.<\/em> In this blog<\/em>post<\/em>, <\/em>the author<\/em>\u00a0<\/em>illustrate<\/em>s<\/em> how the Soviet model of health care delivery was adversely impacting health financing and led to reconsideration of both the infrastructure and financing approaches. Health financing reforms were sweeping and required close attention<\/em> at the highest level of government<\/em>.<\/em>\u00a0<\/em>Such reforms<\/em> helped to improve governance<\/em> and quality of<\/em>\u00a0<\/em>care<\/em>, allowed for digitalization and <\/em>brought many positive<\/em> changes in other sectors<\/em>.<\/em><\/p>\n

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The first blog post in this series, \u201cFrom Soviet-era central planning to the post-Soviet social health insurance umbrella<\/a>\u201d,\u00a0illustrates\u00a0why\u00a0a contributory health insurance system was chosen by the post-Soviet countries. Here, I wish to elaborate on the drawbacks of the Soviet decades-long reliance on public budget transfers and taxation exclusively. I will also illustrate the significance of social health insurance (SHI)\u00a0reform scale for the countries that implemented it.<\/p>\n

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A budget-based health system led to inefficiencies of a state-run\u00a0health system across all 15 nations that gained independence in 1990-1991. Countries inherited an environment of public and underfunded facilities with an inflated volume of health services and a surplus of health workers, especially in the hospital sector.<\/p>\n

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A vertical structure and separate administration of certain care programmes diverted limited public resources from needs-based care to efforts aimed at running\u00a0inpatient health facilities.<\/p>\n<\/blockquote>\n

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A relatively small city or town would have a dozen underutilized public hospitals that lacked a good laboratory and other resources because they were too numerous, and it was impossible for the state to equip all of them well. They were designed to treat different diseases or different groups of people, but that division was not sustainable. A classic collection of hospitals in a regional city would include an infectious disease hospital for adults, an infectious disease hospital for children, a skin disease and sexually transmitted disease hospital, a tuberculosis hospital, a cancer hospital, a maternity hospital, a general pediatric hospital, a general adult hospital (could be a separate surgical hospital and an internal disease hospital), an adult emergency care (acute care) hospital, a narcology (substance abuse) hospital, and hospitals that belong to other ministries \u2013 such as police workers\u2019 (interior ministry) hospital, railroad workers\u2019 hospital, national security workers\u2019 hospital.<\/p>\n

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At the same time, the Semashko model is well known for its strong focus on primary health care. Primary health care was centrally organized through a network of geographically accessible providers and\u00a0was well funded by the government. Yet, the burden of running the hospital sector overwhelmed countries in the years of economic crisis that followed independence. The sector had to be reformed.\u00a0<\/p>\n

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Furthermore, people realized such\u00a0a health system did not\u00a0correspond\u00a0with their needs.\u00a0Other weaknesses were the lack of provider choices (despite the large number of hospitals, the limitation came from their narrow scope of services), the absence of incentives to improve quality and patient safety, and the lack of public voice in shaping health care.\u00a0Policymakers\u00a0concluded that the system could not effectively respond to the growing demand for patient-centered, quality-driven efficient delivery and organization of health\u00a0care.<\/p>\n

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In contrast, financing health care through contributory health insurance enabled newly independent countries to provide access to\u00a0better and more appropriately targeted health services. Private practice was allowed now, and the private sector could respond to people\u2019s needs in a patient-centered manner.
As stated earlier, an array of related reforms enhanced the benefits of contributory health insurance among the post-Soviet countries:<\/p>\n