This book provides the first in-depth study of healthcare reforms in post-communist Eastern Europe. Combining insights from comparative politics and public policy analysis, it examines health reforms in Slovenia, the Czech Republic, and Poland between 1989 and 2019. The book argues that the post-communist transformation of healthcare policy has entailed a process of policy learning, and that the countries' reform pathways were shaped by a series of initiatives aimed at applying market-oriented policy ideas in healthcare. The success of these initiatives has been influenced by three factors: policy legacies, political competition, and institutional configurations. The book offers a novel comparison of health reform in the region and policy changes more generally. It will appeal to scholars and students of public policy, health policy, and European politics.
Author(s): Tamara Popic
Publisher: Palgrave Macmillan
Year: 2023
Language: English
Pages: 228
City: Cham
About the Book
Acknowledgements
Contents
About the Author
Abbreviations
List of Tables
Chapter 1: Introduction
Introduction
Market-Oriented Health Reforms
Healthcare Reforms in Post-Communism
Systemic Change: From ‘Semashko’ to ‘Bismarck’
Policy Change: Introduction of Markets
Explaining the Variation in Post-Communist Health Reforms: Argument
Data and Methods
Overview of the Book
References
Chapter 2: The Politics of Policy Learning
Introduction
Alternative Explanations
Professional Power
External Actors
Economic Pressures
The Politics of Policy Learning
Ideas, Paradigms, Learning, and Policy Change
Socialist Health Policy Legacies
Post-Communist Institutions and Party Competition
Conclusion
References
Chapter 3: Slovenia
Introduction
Slovenian Healthcare Under Socialism
Introduction of the Socialist Policy Paradigm
Emergence of Market Idea: Shift to Workers’ Self-Management
The Socialist Healthcare Crisis
Institutional and Political Context of Post-Communist Health Reform
Institutions: Light Veto Points Configurations
Party Politics: Weak Party Divide on Health Policy
Key Episodes in Post-Communist Healthcare Reform
Initial Post-Communist Healthcare Reform Debates
Introduction of Social Health Insurance and Co-payments for Health Services
Introduction of Complementary Private Insurance
First Attempt to Abolish Complementary Private Insurance
Adaptation of Complementary Private Insurance
Second Attempt to Abolish Complementary Private Insurance
Limited Privatisation of Primary Care
Lack of Hospital Privatisation
Conclusion
References
Chapter 4: The Czech Republic
Introduction
Czech Healthcare Under Socialism
Introduction of the Socialist Policy Paradigm
The Socialist Healthcare Crisis
Emergence of Market Ideas
Institutional and Political Contexts of Post-Communist Health Reform
Institutions: Medium Strong Veto Points Configurations
Party Politics: Moderate Party Divide on Health Policy
Key Episodes in Post-Communist Healthcare Reform
Initial Post-Communist Reform Debates
Introduction of Social Health Insurance and Managed Competition
Regulation of Competition
Privatisation of Primary Care
Introduction of User Fees
Partial Withdrawal of User Fees
Hospital Privatisation
Conclusion
References
Chapter 5: Poland
Introduction
Polish Healthcare Under Socialism
Introduction of the Socialist Policy Paradigm
The Socialist Health Crisis
Emergence of Market Ideas
Institutional and Political Context of Post-Communist Health Reform
Institutions: Thick Veto Points Configuration
Party Politics: Strong Party Divisions on Health Policy
Key Episodes in Post-Communist Healthcare Reform
Initial Post-Communist Reform Debate
Privatisation of Primary Care
Introduction of Social Health Insurance
Shift Towards Managed Competition
Shift Towards Centralised Health Insurance
Attempts to Return to Managed Competition
Attempts to Introduce Private Health Insurance
Attempt to Privatise Hospitals
Conclusion
References
Chapter 6: Conclusion
Introduction
Legacies: Contrasting Slovenian, Czech, and Polish Health Reform
Institutions and Party Politics: Contrasting Slovenian, Czech, and Polish Health Reform
Health Reforms in the Context of COVID-19
Policy Implications
Future Research Agenda
References
Appendix: List of Interviewees
Slovenia
Czech Republic
Poland
Index
