Informal payments in the health sector of Eastern and Central Asia are emerging as a fundamental aspect of health care financing and a serious impediment to health care reform. These informal payments, made to individuals or institutions in cash or in kind, are nearly always for services that are meant to be covered by the health care system. Such private payments to public personnel have created an informal market for health care , and are a form of corruption. This problem's roots are traced to declining revenues which have not coincided with a reduction in buildings, hospital beds and health personnel. In these circumstances informal payments compensate for lost earnings, and therefore reforms to modernise the region's health systems must compete with individuals' personal revenues. Options for addressing this problem include comprehensive anticorruption policies, downsizing of the public health system, reducing the set of services sibsidised by the state, encouraging cost sharing with those who can afford it, improving accountability, and promoting private alternatives.

Central Asia remains one of the least known parts of the former Soviet Union. The five central Asian republics gained their unexpected independence in 1991. They have faced enormous challenges over the last decade in reforming their health care systems, including adverse macro-economic conditions and political instability. To varying extents, each country is diverging from a hierarchical and unsustainable Soviet model health care system. Common strategies have involved devolving the ownership of health services, seeking sources of revenue additional to shrinking state taxes, 'down-sizing' their excessive hospital systems, introducing general practitioners into primary care services, and enhancing the training of health professionals. This book draws on a decade of experience of what has worked and what has not. It is an invaluable source for those working in the region and for others interested in the experiences of countries in political and economic transition.

Fifty years ago, health outcomes in the countries of Eastern Europe and Central Asia were not far behind those in Western Europe and well ahead of most other regions of the world. But progress since then has been slow. While life expectancy in the ECA region today is close to the global average, the gap with its western neighbors has doubled, and other middle-income regions have all surpassed ECA. Some countries in the region are doing better, but full convergence with the world’s most advanced health systems is still a long way off. At the same time, survey evidence suggests that the health sector is the top priority for additional investment among populations across the region. The experience of high-income countries also suggests that popular demand for strong and accessible health systems will only grow over time. Yet these aspirations must be reconciled with current fiscal realities. In brief, health sector issues are a challenge here to stay for policy-makers across the ECA region. This report draws on new evidence to explore the development challenge facing health sectors in ECA, and highlights three key agendas to help policy-makers seeking to achieve more rapid convergence with the world’s best performing health systems. The first is the health agenda, where the task is to strengthen public health and primary care interventions to help launch the “cardiovascular revolution” that has taken place in the West in recent decades. The second is the financing agenda, in which growing demand for medical care must be satisfied without imposing undue burden on households or government budgets. The third agenda relates to broader institutional arrangements. Here there are some key reform ingredients common to most advanced health systems that are still missing in many ECA countries. A common theme in each of these three agendas is the emphasis on improving outcomes, or “Getting Better”.

Compared to other regions, Europe and Central Asia are by far the oldest. Moreover, population aging is set to accelerate further over the coming decades as large segments turn old. Additionally, some countries such as Russia and certain Eastern European countries are facing a shrinkage of their population. Against this backdrop, this report investigates what stands in the way of societies reaping the full benefits of increased longevity--that is, longer lives and potentially prolonged payoffs from human capital--and what can help to mitigate the possible negative impacts of a smaller and older workforce. Beginning with a focus on demographic trends, the report puts the rapid decline in fertility and contrasting migration trends in the region in a historical perspective and looks forward to the varying paths that population change may follow in the region. Next, it examines the evidence on the likely impact of demographic change on growth and savings, the labor force, firm and economy-wide innovation, poverty and inequality, and intergenerational solidarity. Finally, the report goes beyond diagnostics and puts an emphasis on what we know regarding successful policy interventions, presenting evidence on what has and has not worked in the past.--Publisher description.

This book is the first of its kind about healthcare reform efforts in Kazakhstan since its independence within the context of the public sector reform movement. The book provides a brief background of Kazakhstan and its Soviet legacy and the country’s efforts to modernize the health system, before creating an overview of the existing system, the reforms since independence, and the future of healthcare in Kazakhstan. This book will be of interest to policymakers, analysts, and development economists.

Future growth in the countries in Eastern Europe and Central Asia (ECA) will increasingly depend on innovation. And innovation requires skills. This makes it important, as countries plan for recovery, to undertake reforms to reduce the skills shortages that the previous growth episode exposed. Education systems have a very important role to play in creating the right skills. But education systems in the region fall short of the demands of their economies in two major ways. The first is that despite high levels of enrollment they do not produce enough graduates with the right skills. Students graduate with diplomas, not with skills, because the quality of the education for many students is poor. In large part this is because education systems remain focused on providing an excellent education to a few at the expense of improving the quality of learning for the majority. Moreover, the systems are still making the transition from teaching the basics to inculcating higher order skills such as critical-thinking and problem solving. The second way in which education systems fall short is that outside of a few countries in the EU there are few opportunities for adults to retrain, or acquire new skills. This book argues that generating more of the right skills requires a fundamental change of approach in the education systems in the region so that they aim for, and deliver, higher quality education for the vast majority of students (“not just diplomas but skills”). To start with, education systems need to “turn the lights on” and take seriously the measurement of what students actually learn as opposed to measurement of the inputs into the education process on the implicit assumption that learning follows. Policy makers also need to move away from the focus on inputs and processes and increase the emphasis on incentives.

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.

The ebook edition of this title is Open Access and freely available to read online. Examining the impact of drug criminalisation on a previously overlooked demographic, this book argues that women are disproportionately affected by a flawed policy approach.

In the nineteenth century, Kentucky was one of the nation's leading producers of racehorses, whiskey, tobacco -- and new counties. By 1886 the three original Kentucky counties had been carved into 119 (belated 120th was to be formed in 1912). These small divisions commanded the fierce loyalty of their citizens and for most Kentuckians formed the center of political and community life. The County in Kentucky History shows the bitter strife of countywide feuds and the conviviality of court day, the sporadic outbreaks of ill-feeling between town and country and the high-spirited brawls that regularly accompanied elections. Robert M. Ireland traces the structural changes in county government from the days when justices of the peace made up a self-perpetuating county court to the more democratic period when the buying of votes replaced the buying of offices. The most beneficial change that could come to local government -- consolidation into fewer units -- Ireland sees as unlikely where the tradition of county loyalties and rivalries remains as strong as it does in Kentucky.

This book empirically examines health care financing reforms and popular responses in three major cities in East Asia: Shanghai, Singapore, and Hong Kong. It adopts a new revised version of the theory of historical institutionalism to compare and explain the divergent reform paths in these three places over the past three decades. It also examines forces that propel institutional change. The book provides three detailed case studies on the development of health care financing reforms and the politics of implementing them. It shows that health care systems in Shanghai, Singapore, and Hong Kong were the products of Western presence in the nineteenth century. It illustrates how greater attention is paid to the roles played by ideas, actors, and environmental triggers without abandoning the core assumptions that political institutions and policy feedback remain central to impact health care financing reforms. It shows that health care financing reform is shaped by a complex interplay of forces over time. It also provides the most updated material about health care financing reforms in Shanghai, Singapore, and Hong Kong. The central argument of this book is that health care financing reform is both an evolving process responding to changing circumstances and a political process revealing an intricate interplay of power relationships and diverse interests. It shows that institutional changes in health care financing system can be incremental but transformative in nature. It argues that social policies will continue to develop and welfare states will continue to adapt and evolve in order to cope with new risks and needs. This book sheds new lights on understanding the politics of health care financing reform and sources and modes of institutional change.