Health Care Delivery Systems: Opportunities for Public Management Education in Central and Eastern Europe [antikvár]

IntroductionAllan Rosenbaum *The last fifteen years have been ones of extraordinary transition for the countries of Central and Eastern Europe (CEE) and the Newly Independent States (NIS). Simulta-neously, these countries have undergone many very significant changes. These changes have profoundly impacted their political and economic systems, often have produced the restructuring of their societies and, in somé cases, have created massive social and political upheaval.Not surprisingly, these dramatic changes have often resulted in profound changes in the type and extent of public services available to the citizens of these countries. In many, if not all, of these countries the delivery of public services has been profoundly altered. In many instances, one has seen not only a massive decentralization of service delivery, with increasingly impoverished national governments turning over major responsibility for the financing of public services to local or régiónál governments, but alsó the major introduction of priváté sector activity and financial responsibility.Nowhere has this pattern been more pronounced than in the delivery of health care services. In virtually every country of the region a major restructuring has occurred. As the country studies that follow will clearly illustrate, there has been a massive shift of responsibility for the delivery of health care services. In most countries a large part of the responsibility for the delivery of such services has moved from national to local governments; from health ministries to newly created insurance corporations (both public and priváté); and from state monopolized to mixed public/private delivery systems.These changes have not taken place without somé significant dislocation and institu-tional re-structuring. In somé cases, the consequences of these processes of change have been positive, but in many cases there have been somé very severe negative consequences. Again, as the country studies that follow will suggest, a wide array of problems have plagued the restructuring of heath care systems in many of the region's countries.Among the most significant of these problems have been, in somé cases, the shortage of drugs, materials and necessary equipment. Many countries are alsó finding themselves having to deal with the problem of worn out buildings and equipment. There are alsó major problems of staff morale - in part, a problem of low salaries and, in part, a con-sequence of working in a complex and sometimes highly dysfunctional environment. In too many instances, this has resulted in a declining commitment of health care personnel to the effective delivery of services in their countries (as reflected in the out-migration of health care personnel from many countries) and the growing problem of under-the--table (or "gratuity") payments.