Kornai János: “Choice and Solidarity: The Health Sector in Eastern Europe and Proposals for Reform.” Co-authored with Karen Eggleston. International Journal of Health Care Finance and Economics, 2001, 1(1): 59-84.
1 Abstract: The citizens of Eastern Europe have witnessed an unprecedented social and economic transformation during the past decade of transition from socialism to market-based economies. We describe the legacy of socialism and summarize the current state of the health sector in ten Eastern European countries, including financing, delivery, purchasing, physician incomes and the widespread phenomenon of under-the-table payments. The proposals for reform, derived from explicit guiding principles, are based on organized public financing for basic care, private financing for supplementary care, pluralistic delivery of services, and managed competition, with attention to incentives and regulation to impose a constraint on overall health spending. Introduction The citizens of Eastern Europe have witnessed an unprecedented social and economic transformation during the past decade of transition from socialism to market-based economies. Health sectors have been swept up in the dramatic changes, which reflect a starting point of ownership, financing, organization and ideology almost the opposite of that of the US and quite different from many other established market economies. This article describes the current state of the health sector in ten countries of Eastern Europe: Albania, Bulgaria, Croatia, the Czech Republic, Hungary, Macedonia, Poland, Romania, Slovakia and Slovenia.1 We focus on similarities, although the health sectors—just as the political and economic systems—differ in many aspects not highlighted here. Several studies have described the health sectors of Eastern Europe and/or advocated reforms. We seek to contribute to the literature by synthesizing information from many sources to present a concise, up-to-date summary of the current situation, and by offering proposals for reform tailored to the unique challenges of the region, based on explicit ethical and institutional guiding principles.