European Observatory on Health Care Systems Belarus Health Care Systems in Transition I IONAL B AT AN RN K E F T O N R I WORLD BANK PLVS VLTR R E T C N O E N M S P T R O U L C E T EV ION AND D The European Observatory on Health Care Systems is a partnership between the World Health Organization Regional Office for Europe, the Government of Norway, the Government of Spain, the European Investment Bank, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine Health Care Systems in Transition Draft Belarus Belarus II European Observatory on Health Care Systems CARE 04 03 06 Target 36.01.01 Unedited Keywords DELIVERY O! HEALTH CARE EVALUATION STUDIES !INANCING, HEALTH HEALTH CARE RE!ORM HEALTH SYSTEM PLANS organization and administration BELARUS Draft©World Health Organization 1997 This document may be freely reviewed or abstracted, but not for commercial purposes. !or rights of repro- duction, 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 1997 Belarus Health Care Systems in Transition III Contents Contents ............................................................................................. iii oreword............................................................................................. v Acknowledgements .......................................................................... vii Introduction, historical background ................................................ 1 Introductory overview .................................................................... 1 Historical background .................................................................... 3 Organizational structure and management ................................... 11 Organizational structure of the health care system ....................... 11 Organizational structure of the health care system ....................... 12 Planning, regulation and management .......................................... 19 Health care finance and expenditure ............................................. 33 Main system of finance and coverage .......................................... 33 Health care benefits and rationing ................................................ 38 Complementary sources of finance .............................................. 39 Health care expenditure ................................................................ 43 Health careDraft delivery system ............................................................ 49 Primary health care and public health services ............................ 49 Secondary and tertiary care .......................................................... 57 Social care .................................................................................... 64 Human resources and training and research ................................. 65 Pharmaceuticals and health care technology assessment ............. 73 inancial resource allocation .......................................................... 77 Third-party budget setting and resource allocation ...................... 77 Payment of hospitals .................................................................... 80 Payment of physicians .................................................................. 81 Health care reforms ......................................................................... 83 Determinants and objectives ........................................................ 83 Content of reforms and reform implementation ........................... 84 Reform implementation ................................................................ 85 Conclusions ....................................................................................... 87 Belarus IV European Observatory on Health Care Systems Draft Belarus Health Care Systems in Transition V oreword he Health Care Systems in Transition (HiT) profiles are country-based Tdocuments that provide an analytical description of the health care sys- tem 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 betweenDraft 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/Europes Health Systems Analysis programme. In order to maximize comparability between countries, a standard template and a ques- tionnaire 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/Eu- rope 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 Belarus VI European Observatory on Health Care Systems is based on material submitted by individual experts in the respective coun- tries. As a result, some statements and judgements may be coloured by per- sonal interpretation. In addition, the wide diversity of systems in the WHO European Region means that there are inevitably large differences in under- standing and terminology. As far as possible, these have been addressed by the development of a set of definitions, but some differences may remain. These caveats are not limited to the HiT profiles, however, but apply to most attempts to study health care systems. The HiT profiles are a source of descriptive, up-to-date and comparative information on health care systems, which should enable policy-makers to identify key experiences relevant to their own national situation. They consti- tute a comprehensive source of information which can form the basis for more in-depth comparative analysis of reforms. The current series of HiT profiles covers over half of the countries in the European Region. This is an ongoing initiative with plans to extend coverage to all countries in the Region, to up- date the material at regular intervals and to monitor reforms over the longer term. World Health Organization Regional Office for Europe Department of Health Policy and Services DraftHealth Systems Unit Belarus Health Care Systems in Transition VII Acknowledgements he current series of the Health Care Systems in Transition profiles has been prepared by a team led by Josep Figueras and comprising Tom TMarshall, Martin McKee, Suszy Lessof, Ellie Tragakes (regional edi- tors), Phyllis Dahl and Zvonko Hocevar (data analysis and production) in the Health Systems Analysis programme, Department of Health Policy and Serv- ices, WHO Regional Office for Europe. Data on health services were extracted from the WHO/Europe health for all database. Special thanks are extended to OECD for the data on health services in western European countries, and to the World Bank for the data on health expenditure in central and eastern European (CEE) countries. The HiT on Belarus was written by Genryh Karnitski and edited by Suszy Lessof. Draft Belarus VIII European Observatory on Health Care Systems Draft Belarus Health Care Systems in Transition 1 Introduction and historical background Introductory overview elarus is located in the centre of Europe and borders Latvia, Lithuania, Poland, the Russian Federation and Ukraine. It covers 208 000 km2 and has a population of some 10 million. Population density is low B 2 1 (49.2/km ) but the majority (65.5%) live in urban areas . Belarus is divided into six administrative regions or oblasts2 that are further subdivided into districts or rayons3. The capital, Minsk, has the status of an independent administrative/territorial unit and is home to approximately 15% of the total population (1.7 million). Almost 80% of the population are defined as