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The Politics of Healthcare Reform in Postcommunist Europe: The Importance of Access

Published online by Cambridge University Press:  22 October 2009

Andrew Roberts
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Abstract

Why do countries move from public to private financing of healthcare? This paper explores this issue by looking at the divergent reform trajectories of three postcommunist countries – the Czech Republic, Hungary, and Poland. While existing accounts emphasize veto points to explain changes in healthcare systems, the present analysis finds that moves towards private financing can be better explained by differences in access to the policymaking arm of the state. Specifically, a penetrable single-party government and weak bureaucratic capacities allow physicians to capture the reform process and implement their preferred policies. The results suggest that scholars of health policy should focus more attention on the actors seeking change and their access to policy makers.

Keywords

accessveto pointshealthcare
Type
Research Article
Information
Journal of Public Policy , Volume 29 , Issue 3 , December 2009 , pp. 305 - 325
Copyright
Copyright © Cambridge University Press 2009

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References

Bossert, Thomas and Włodarczyk, Cesary. 2000. ‘Unpredictable Politics: Policy Process of Health Reform in Poland.’ Harvard School of Public Health. International Health Systems Group.Google Scholar
Chellaraj, Gnanaraj, Ellen, Goldstein, Preker, Alexander S., Adeyi, Olusoji. 1996. ‘Trends in Health Status, Services, and Finance.’ World Bank Technical Paper #43. Washington, D.C.: The World Bank.Google Scholar
Ekiert, Grzegorz and Kubik, Jan. 1999. Rebellious Civil Society: Popular Protest and Democratic Consolidation in Poland, 1989–1993. Ann Arbor: University of Michigan Press.CrossRefGoogle Scholar
Filinson, Rachel, Chmielewski, Piotr and Niklas, Darek. 2003. ‘Back to the Future: Polish Health Care Reform.’ Communist and Post-Communist Studies 36 (4): 385–403.CrossRefGoogle Scholar
Füzesi, Zsuzsanna, Ivády, Vilmos, Kovácsy, Zsombar and Orban, Krisztián. 2005. ‘Hungarian Healthcare Reforms in the 1990s.’ In Shakarishvili, George, ed. Decentralization in Healthcare: Analyses and Experiences in Central and Eastern Europe in the 1990s. Budapest: Open Society Institute.Google Scholar
George, Alexander L. and Bennett, Andrew. 2005. Case Studies and Theory Development in the Social Sciences. Cambridge, MA: MIT Press.Google Scholar
Grzymala-Busse, Anna. 2001. ‘Coalition Formation and the Regime Divide in New Democracies: East Central Europe.’ Comparative Politics 34 (1): 85–104.CrossRefGoogle Scholar
Hacker, Jacob S. 1997. The Road to Nowhere: The Genesis of President Clinton's Plan for Health Security. Princeton: Princeton University Press.Google Scholar
Immergut, Ellen. 1992. Health Politics: Interests and Institutions in Western Europe. Cambridge: Cambridge University Press.Google Scholar
Jakab, Melitta, Preker, Alexander and Harding, April. 2002. ‘Linking Organizational Structure to the External Environment: Experiences from Hospital Reform in Transition Economies.’ In Martin, McKee and Healy, Judith, eds. Hospitals in a Changing Europe. Buckingham: Open University Press.Google Scholar
Jaroš, Jan, Kalina, Kamil, Dlouhý, Martin and Malina, Antonìn. 2005. ‘Decentralization and Governance of Healthcare in the Czech Republic in the 1990s.’ In Shakarishvili, George, ed. Decentralization in Healthcare: Analyses and Experiences in Central and Eastern Europe in the 1990s. Budapest: Open Society Institute.Google Scholar
Kornai, Janos and McHale, John. 2000. ‘Is Post-Communist Health Spending Unusual? A Comparison with Established Market Economies.’ Economics of Transition 8 (3): 369–399.CrossRefGoogle Scholar
Lawson, Colin and Nemec, Juraj. 2003. ‘The Political Economy of Slovak and Czech Health Policy: 1989–2000.’ International Political Science Review 24 (2): 217–235.CrossRefGoogle Scholar
Linz, Juan and Stepan, Alfred. 1996. Problems of Democratic Transition and Consolidation: Southern Europe, South America, and Post-Communist Europe. Baltimore: Johns Hopkins University Press.CrossRefGoogle Scholar
Maioni, Antonia. 1998. Parting at the Crossroads: The Emergence of Health Insurance in the United States and Canada. Princeton: Princeton University Press.CrossRefGoogle Scholar
Marrée, Jörgen and GroenewegenPeter, P. Peter, P. 1997. Back to Bismarck: Eastern European Health Care Systems in Transition. Brookfield, VT: Avebury.Google Scholar
McMenamin, Iain and Timonen, Virpi. 2002. ‘Poland's Health Reform: Politics, Markets and Informal Payments.’ Journal of Social Policy 31 (1): 103–118.CrossRefGoogle Scholar
Mihályi, Peter. 2000. ‘Post-Socialist Health Systems in Transition: Czech Republic, Hungary, and Poland.’ Central European University, Department of Economics, WP4/2000.Google Scholar
Nelson, Joan. 2001. ‘The Politics of Pension and Health Care Reforms in Hungary and Poland.’ In Kornai, Janos, Haggard, Stephan and P. Kaufman, Robert, eds. Reforming the State: Fiscal and Welfare Reform in Post-Socialist Countries. Cambridge: Cambridge University Press.Google Scholar
Orosz, Eva. 1998. ‘Health Financing in Hungary – Taking Stock.’Paper presented to the 2nd International Research Conference on Social Security, International Social Security Association, Jerusalem,25–28 January.Google Scholar
Orosz, Eva, Ellena, Guy and Jakab, Melitta. 1998. ‘Reforming the Health Care System: The Unfinished Agenda.’ In Bokros, Lajos and Dethier, Jean-Jacques, eds. Public Finance Reform during the Transition: The Experience of Hungary. Washington, D.C.: The World Bank.Google Scholar
Osiatynski, Wiktor. 1996. ‘The Roundtable Talks in Poland.’ In Elster, Jon, ed. Roundtable Talks and the Breakdown of Communism. Chicago: University of Chicago Press.Google Scholar
Potůček, Martin. 1994. ‘Transformace zdravotnì peče v České republice v letech 1990–1992.’ Praha: Nadace START.Google Scholar
Preker, Alexander S. and Feachem, Richard G.A.. 1994. ‘Health and Health Care’. In Barr, Nicholas, ed., Labor Markets and Social Policy in Central and Eastern Europe. Oxford: Oxford University Press.Google Scholar
Starr, Paul. 1982. The Social Transformation of American Medicine. New York: Basic Books.Google Scholar
Steinmo, Swen and Watts, Jon. 1995. ‘It's the Institutions, Stupid! Why Comprehensive National Health Insurance Always Fails in America.’ Journal of Health Politics, Policy, and Law, 20 (2): 329–372.CrossRefGoogle ScholarPubMed
Tokes, Rudolf. 1996. Hungary's Negotiated Revolution. Cambridge: Cambridge University Press.Google Scholar
Tuohy, Carolyn Hughes. 1999. Accidental Logics: The Dynamics of Change in the Health Care Arena in the US, Britain, and Canada. New York: Oxford University Press.CrossRefGoogle Scholar
Wheaton, Bernard and Kavan, Zdenek. 1992. The Velvet Revolution: Czechoslovakia, 1988–1991. Boulder: Westview Press.Google Scholar
Wilensky, Harold. 1975. The Welfare State and Equality: Structural and Ideological Roots of Public Expenditures. Berkeley: University of California Press.Google Scholar
Williams, Kieran. 1997. The Prague Spring and Its Aftermath: Czechoslovak Politics, 1968–1970. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Włodarczyk, W. Cezary and Karkowska, Dorota. 2005. ‘Decentralizing the Healthcare Sector in Poland in the 1990s.’ In Shakarishvili, George, ed. Decentralization in Healthcare: Analyses and Experiences in Central and Eastern Europe in the 1990s. Budapest: Open Society Institute.Google Scholar
World, Bank. 1991. The Czech and Slovak Republic. The Health Sector: Issues and Priorities. Washington, D.C.: The World Bank.Google Scholar
World, Bank. 1992. Poland Health System Reform: A World Bank Country Study. Washington, D.C.: The World Bank.Google Scholar