Search

During the post-Soviet transition of the last 2 decades, ex-Communist countries of the Eastern Bloc, including eastern and central Europe, the Soviet Union, and its satellite and aligned states, have undergone major health system reforms. Many health systems of those countries--previously adopting a Soviet-type Semashko model--are currently called "in transition," as reform agendas, such as shifting to a Bismarck, Beveridge, or mixed financing scheme or adopting new health delivery management policies, are still in development. In this article, we first review common characteristics of Semashko health systems (the predominant health system of Communist countries during the Soviet era) and then discuss the "new public management" principles that ex-Communist countries have recently started to adopt with various degrees of success. We then illustrate experiences with these principles using 2 case studies, from Russia and Albania, and propose health policy options for both cases. Based on a review of the literature and on the our work experience in Russia and Albania, we found that the 2 ex-Semashko systems have not fully capitalized on expected positive outcomes of new public management principles due to low local healthcare financing levels, depreciated healthcare infrastructure and operational capacities, overlapping and contradicting ideology and policies of the former and newer health systems, and finally, lack of leadership that has successful experience with these principles. In the case of pharmaceutical pricing, reimbursement, and access in Russia, we show how a well-intentioned but suboptimally designed and managed pharmaceutical coverage scheme has suffered moral hazard and adverse selection and has adversely impacted the new public management promise of efficient medicine coverage. In the case of Albania, the delayed investment in human resource reform within a depreciated and underfinanced delivery system has adversely affected the implementation of new public management principles., (© 2011 Mount Sinai School of Medicine.)

The existence of medical attention in Soviet labour camps was dictated not by humane reasons but by economical motives. It was just a wish to regenerate physical strength of some labour camp's slaves in order to exploit them to work out definite production as well as ideological plans. However, despite the lack of medicines, equipment, proper housing conditions and qualified staff, employed in labour camp's medical service people--doctors, hospital attendants, nurses, etc.--that were mostly recruited from amongst prisoners, showed a great deal of kindness and did their best to come to unwell and ill patients' assistance. Prisoners' lives were not uncommonly saved through exemption from work by a doctor's decision sending to hospital or transfer to another health category. In comparison with gehenna of labour camp's slave everyday life a sojourn in camp hospital seemed a paradise and a rescue from death to prisoners.