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Health Care Systems in Transition

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Health Care Systems in Transition Health Care Systems in Transition Russian Federation World Health Organization Regional Office for Europe Copenhagen 1998 2 Health care systems in transition — Finland CARE 04 03 06 Target 36.01.01 Keywords DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEMS PLANS – organization and administration RUSSIAN FEDERATION ©World Health Organization 1998 This document may be freely reviewed or abstracted, but not for commercial purposes. For rights of reproduction, in part or in whole, application should be made to the WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark. The WHO Regional Office for Europe welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The names of countries or areas used in this publication are those which were obtained at the time the original language edition of the publication was prepared. The views expressed in this document are those of the contributors and do not necessarily represent the decisions or the stated policy of the World Health Organization. World Health Organization Regional Office for Europe Copenhagen 1998 3 CONTENTS FOREWORD............................................................................................................................................ IV FOREWORD..............................................................................................................................................V ACKNOWLEDGEMENTS....................................................................................................................... 6 INTRODUCTION AND HISTORICAL BACKGROUND.................................................................... 7 INTRODUCTORY OVERVIEW AND HISTORICAL BACKGROUND .................................................................... 7 Political Transition and Health Status................................................................................................ 7 Political Transition and the Economic Impact on Health Status........................................................ 9 Health System Reform: A Response to the Challenges of Political Transition ................................. 10 Historical Background ...................................................................................................................... 12 ORGANIZATIONAL STRUCTURE AND MANAGEMENT ........................................................... 15 ORGANIZATIONAL STRUCTURE OF THE HEALTH CARE SYSTEM ............................................................... 15 PLANNING, REGULATION AND MANAGEMENT ......................................................................................... 20 Planning............................................................................................................................................ 20 Regulation ......................................................................................................................................... 23 Management...................................................................................................................................... 25 Decentralization of the health care system ....................................................................................... 27 HEALTH CARE FINANCE AND EXPENDITURE............................................................................ 30 MAIN SYSTEM OF FINANCE AND COVERAGE............................................................................................ 30 HEALTH CARE BENEFITS AND RATIONING ............................................................................................... 33 COMPLEMENTARY SOURCES OF FINANCE................................................................................................ 36 Out-of-pocket payments .................................................................................................................... 37 Voluntary health insurance ............................................................................................................... 38 External sources of funding............................................................................................................... 39 HEALTH CARE EXPENDITURE .................................................................................................................. 41 Structure of health care expenditures ............................................................................................... 45 HEALTH CARE DELIVERY SYSTEM ............................................................................................... 47 Structure of the soviet health care system ......................................................................................... 47 PRIMARY HEALTH CARE AND PUBLIC HEALTH SERVICES......................................................................... 49 Public health services........................................................................................................................ 52 SECONDARY AND TERTIARY CARE.......................................................................................................... 54 SOCIAL CARE .......................................................................................................................................... 61 HUMAN RESOURCES AND TRAINING........................................................................................................ 62 PHARMACEUTICALS AND HEALTH CARE TECHNOLOGY ASSESSMENT ...................................................... 68 FINANCIAL RESOURCE ALLOCATION ....................................................................................................... 70 THIRD-PARTY BUDGET SETTING AND RESOURCE ALLOCATION................................................................ 71 PAYMENT OF HOSPITALS......................................................................................................................... 73 PAYMENT OF PHYSICIANS ....................................................................................................................... 76 HEALTH CARE REFORMS ................................................................................................................. 78 DETERMINANTS AND OBJECTIVES........................................................................................................... 78 CONTENT OF REFORMS AND LEGISLATION .............................................................................................. 80 Health for all policy .......................................................................................................................... 81 REFORM IMPLEMENTATION .................................................................................................................... 82 CONCLUSIONS ...................................................................................................................................... 84 REFERENCES......................................................................................................................................... 85 Sources in addition to those listed in the footnotes only ................................................................... 85 4 Health care systems in transition — Finland Introduction and historical background v Foreword The Health Care Systems in Transition (HiT) profiles are country-based documents that provide an analytical description of the health care system and of any reform programmes under development. HiTs form the basis of the information system on health care systems and reforms at the World Health Organization Regional Office for Europe (WHO/Europe). The aim of the HiT initiative is to provide relevant comparative information to support the development of health care systems and reforms in countries in the European Region of WHO. This initiative has four main objectives: • to learn about different approaches to financing, organization and delivery of health care services in the European Region of WHO; • to describe the process and content of health care reform programmes and to monitor their implementation; • to highlight common challenges and areas that require more in-depth analysis and which could benefit in particular from cooperation and exchange of experiences between countries; • to provide a tool for dissemination and exchange of information on health care systems and reform strategies between different countries in the WHO European Region. The HiT profiles are produced by country experts in collaboration with staff in WHO/Europe’s Health Systems Analysis programme. In order to maximize comparability between countries, a standard template and a questionnaire have been developed. These provide detailed guidelines and specific questions, definitions and examples to assist in the process of developing the HiT profile. Quantitative data on health services are based on the WHO/Europe health for all database, OECD health data and World Bank data. Compiling the HiT profiles poses a number of methodological problems. In many countries, there is relatively little information available on health care systems and the impact of health reforms. Most of the information in the HiTs is based on material submitted by individual experts
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