Public-private mix and performance of health care systems in CEE and CIS countries
Keywords:health care system, public-private mix, transition economies, health status
The role of the public and private sector in health care systems remains one of the crucial problems of these systems' operation. The purpose of this research is to identify the relationships between the performance of health systems in CEE and CIS (Central and Eastern Europe and Commonwealth of Independent State) countries, and the mix of public-private sector in the health care of these countries. The study uses a zero unitarization method to construct three measures of health system performance in the following areas: (1) resources; (2) services; and (3) health status. The values of these measures are correlated with the share of public financing that represents the public-private mix in the health systems. The data used is from World Health Organization?s Health for All Database for 23 CEE and CIS countries and comprises the year 2010. The results show that the performance of health systems in the countries investigated is positively associated with a higher proportion of public financing. The strongest relationship links public financing with performance in the area of services production. For policy makers, these results imply that health systems in post-communist transition economies could be susceptible to a decreasing role of the state and that growing reliance on the market mechanism in health care can deteriorate the operation of these systems.
Cumming, J., & Scott, C. D. (1998). The Role of Outputs and Outcomes in Purchaser Accountability: Reflecting on New Zealand Experiences. Health Policy, 46(1). DOI: http://dx.doi.org/10.1016/S0168-8510(98)00049-9.
Donabedian, A. (1988). The Quality of Care. How Can It Be Assessed? JAMA, 260(12). http://dx.doi.org/10.1001/jama.1988.03410120089033.
Donaldson, C., Gerard, K. (2005). Economics of Health Care Financing: The Visible Hand, London: Palgrave Macmillan.
Götze, R., & Schmid, A. (2012). Healthcare Financing in OECD Countries Beyond the Public-Private Split. TranState Working Papers, No. 160. DOI: http://dx.doi.org/10.2139/ssrn.1998037.
Holden, Ch. (2005). Privatization and Trade in Health Services: A Review of the Evidence. International Journal of Health Services, 35(4). DOI: http://dx.doi.org/10.2190/38br-kxhb-m8y8-chbj.
Kruk, M. E., & Freedman, L. P. (2008). Assessing Health System Performance in Developing Countries: A Review of the Literature. Health Policy, 85(3). DOI: http://dx.doi.org/10.1016/j.healthpol.2007.09.003.
Kukuła, K. (2000). Metoda unitaryzacji zerowanej. Warszawa: PWN.
Kukuła, K., & Bogocz, D. (2012). Zero Unitarization Method and Its Application in Ranking Research in Agriculture. Economic and Regional Studies, 7(3).
Maarse, H. (2006). The Privatization of Health Care in Europe: An Eight-Country Analysis. Journal of Health Politics, Policy and Law, 31(5). DOI: http://dx.doi.org/10.1215/03616878-2006-014.
Młodak, A. (2006). Analiza taksonomiczna w statystyce regionalnej. Warszawa: Difin.
Murray, C. J. L., & Frenk, J. (2000). A Framework for Assessing the Performance of Health Systems. Bulletin of the World Health Organization, 78(6).
Murray, C. J. L., Salomon, J. A., & Mathers, C. (2000). A Critical Examination of Summary Measures of Population Health. Bulletin of the World Health Organization, 78(8).
Rechel, B., Roberts, B., Richardson, E., Shishkin, S., Shkolnikov, V. M., Leon, D. A., Bobak, M., Karanikolos, M., & McKee, M. (2013). Health and Health Systems in Commonwealth of Independent States. Lancet, 381(9872). DOI: http://dx.doi.org/10.1016/S0140-6736(12)62084-4.
Rothgang, H., Cacace, M., Frisina, L., & Schmid A. (2008). The Changing Public-Private Mix in OECD Healthcare Systems. In M. Seeleib-Kaiser (Ed.). Welfare State Transformations in Comparative Perspective: Shifting Boundaries of 'Public' and 'Private' Social Policy. Basingstoke: Palgrave Macmillan
Rothgang, H., Cacace, M., Grimmeisen, S., & Wendt C. (2005). The Changing Role of the State in Healthcare Systems. European Review, 13(S1). DOI: http://dx.doi.org/10.1017/S1062798705000256.
Saltman, R. B. (2003). Melting Public-Private Boundaries in European Health Systems. European Journal of Public Health, 13(1). DOI: http://dx.doi.org/ 10.1093/eurpub/13.1.24.
Tchouaket, É. N., Lamarche, P. A., Goulet, L., & Contandriopouos, A. P. (2012). Health Care System Performance of 27 OECD Countries. International Journal of Health Planning and Management, 27(2). DOI: http://dx.doi.org/10. 1002/hpm.1110.
Touhy, C. H., Flood, C. M., & Stabile, M. (2004). How Does Private Finance Affect Public Health Care Systems? Marshaling the Evidence from OECD Nations. Journal of Health Politics, Policy and Law, 29(3). DOI: http://dx.doi.org/ 10.1215/03616878-29-3-359.
WHO (2000). World Health Report: Health Systems Improving Performance. Geneva: WHO.
WHO (2002). The role of the private sector and privatization in European health systems. Regional Committee for Europe, Copenhagen: WHO.
WHO Regional Office for Europe (2014). European Health for All Database (HFA-DB). WHO Europe. Retrieved from http://data.euro.who.int/hfadb/ (01.03.2015).