Within the triangle of healthcare legacies: comparing the performance of South-Eastern European health systems

J Med Econ. 2017 May;20(5):483-492. doi: 10.1080/13696998.2016.1277228. Epub 2017 Jan 17.

Abstract

Objective: Inter-regional comparison of health-reform outcomes in south-eastern Europe (SEE).

Methods: Macro-indicators were obtained from the WHO Health for All Database. Inter-regional comparison among post-Semashko, former Yugoslavia, and prior-1989-free-market SEE economies was conducted.

Results: United Nations Development Program Human Development Index growth was strongest among prior-free-market SEE, followed by former Yugoslavia and post-Semashko. Policy cuts to hospital beds and nursing-staff capacities were highest in post-Semashko. Physician density increased the most in prior-free-market SEE. Length of hospital stay was reduced in most countries; frequency of outpatient visits and inpatient discharges doubled in prior-free-market SEE. Fertility rates fell for one third in Post-Semashko and prior-free-market SEE. Crude death rates slightly decreased in prior-free-market-SEE and post-Semashko, while growing in the former Yugoslavia region. Life expectancy increased by 4 years on average in all regions; prior-free-market SEE achieving the highest longevity. Childhood and maternal mortality rates decreased throughout SEE, while post-Semashko countries recorded the most progress.

Conclusions: Significant differences in healthcare resources and outcomes were observed among three historical health-policy legacies in south-eastern Europe. These different routes towards common goals created a golden opportunity for these economies to learn from each other.

Keywords: Health indicators; Health resources; Population health; Post-Semashko; Socioeconomic transition; South-eastern Europe; Trend; Utilization; Yugoslavia.

MeSH terms

  • Birth Rate / trends
  • Cross-Cultural Comparison
  • Europe, Eastern / epidemiology
  • Health Policy*
  • Health Services / statistics & numerical data*
  • Hospital Bed Capacity / statistics & numerical data
  • Hospitalization / statistics & numerical data
  • Humans
  • Life Expectancy / trends
  • Medical Staff, Hospital / statistics & numerical data
  • Mortality / trends
  • Nursing Staff, Hospital / statistics & numerical data