Health Reforms in Post-Communist Eastern Europe: The Politics of Policy Learning

Description

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. 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