Informal payments in the health sector of Eastern and Central Asia are emerging as a fundamental aspect of health care financing and a serious impediment to health care reform. These informal payments, made to individuals or institutions in cash or in kind, are nearly always for services that are meant to be covered by the health care system. Such private payments to public personnel have created an informal market for health care , and are a form of corruption. This problem's roots are traced to declining revenues which have not coincided with a reduction in buildings, hospital beds and health personnel. In these circumstances informal payments compensate for lost earnings, and therefore reforms to modernise the region's health systems must compete with individuals' personal revenues. Options for addressing this problem include comprehensive anticorruption policies, downsizing of the public health system, reducing the set of services sibsidised by the state, encouraging cost sharing with those who can afford it, improving accountability, and promoting private alternatives.

Fifty years ago, health outcomes in the countries of Eastern Europe and Central Asia were not far behind those in Western Europe and well ahead of most other regions of the world. But progress since then has been slow. While life expectancy in the ECA region today is close to the global average, the gap with its western neighbors has doubled, and other middle-income regions have all surpassed ECA. Some countries in the region are doing better, but full convergence with the world’s most advanced health systems is still a long way off. At the same time, survey evidence suggests that the health sector is the top priority for additional investment among populations across the region. The experience of high-income countries also suggests that popular demand for strong and accessible health systems will only grow over time. Yet these aspirations must be reconciled with current fiscal realities. In brief, health sector issues are a challenge here to stay for policy-makers across the ECA region. This report draws on new evidence to explore the development challenge facing health sectors in ECA, and highlights three key agendas to help policy-makers seeking to achieve more rapid convergence with the world’s best performing health systems. The first is the health agenda, where the task is to strengthen public health and primary care interventions to help launch the “cardiovascular revolution” that has taken place in the West in recent decades. The second is the financing agenda, in which growing demand for medical care must be satisfied without imposing undue burden on households or government budgets. The third agenda relates to broader institutional arrangements. Here there are some key reform ingredients common to most advanced health systems that are still missing in many ECA countries. A common theme in each of these three agendas is the emphasis on improving outcomes, or “Getting Better”.

Analyses the experience with the financing reforms implemented by the countries of Central Europe, Eastern Europe, the Cauxasus and Central Asia.

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance-based care is key to the public policy debate of whether to extend insurance to low-income populationsand if so, how to do itor to serve them through other means.

Future growth in the countries in Eastern Europe and Central Asia (ECA) will increasingly depend on innovation. And innovation requires skills. This makes it important, as countries plan for recovery, to undertake reforms to reduce the skills shortages that the previous growth episode exposed. Education systems have a very important role to play in creating the right skills. But education systems in the region fall short of the demands of their economies in two major ways. The first is that despite high levels of enrollment they do not produce enough graduates with the right skills. Students graduate with diplomas, not with skills, because the quality of the education for many students is poor. In large part this is because education systems remain focused on providing an excellent education to a few at the expense of improving the quality of learning for the majority. Moreover, the systems are still making the transition from teaching the basics to inculcating higher order skills such as critical-thinking and problem solving. The second way in which education systems fall short is that outside of a few countries in the EU there are few opportunities for adults to retrain, or acquire new skills. This book argues that generating more of the right skills requires a fundamental change of approach in the education systems in the region so that they aim for, and deliver, higher quality education for the vast majority of students (“not just diplomas but skills”). To start with, education systems need to “turn the lights on” and take seriously the measurement of what students actually learn as opposed to measurement of the inputs into the education process on the implicit assumption that learning follows. Policy makers also need to move away from the focus on inputs and processes and increase the emphasis on incentives.

Central Asia remains one of the least known parts of the former Soviet Union. The five central Asian republics gained their unexpected independence in 1991. They have faced enormous challenges over the last decade in reforming their health care systems, including adverse macro-economic conditions and political instability. To varying extents, each country is diverging from a hierarchical and unsustainable Soviet model health care system. Common strategies have involved devolving the ownership of health services, seeking sources of revenue additional to shrinking state taxes, 'down-sizing' their excessive hospital systems, introducing general practitioners into primary care services, and enhancing the training of health professionals. This book draws on a decade of experience of what has worked and what has not. It is an invaluable source for those working in the region and for others interested in the experiences of countries in political and economic transition.

Compared to other regions, Europe and Central Asia are by far the oldest. Moreover, population aging is set to accelerate further over the coming decades as large segments turn old. Additionally, some countries such as Russia and certain Eastern European countries are facing a shrinkage of their population. Against this backdrop, this report investigates what stands in the way of societies reaping the full benefits of increased longevity--that is, longer lives and potentially prolonged payoffs from human capital--and what can help to mitigate the possible negative impacts of a smaller and older workforce. Beginning with a focus on demographic trends, the report puts the rapid decline in fertility and contrasting migration trends in the region in a historical perspective and looks forward to the varying paths that population change may follow in the region. Next, it examines the evidence on the likely impact of demographic change on growth and savings, the labor force, firm and economy-wide innovation, poverty and inequality, and intergenerational solidarity. Finally, the report goes beyond diagnostics and puts an emphasis on what we know regarding successful policy interventions, presenting evidence on what has and has not worked in the past.--Publisher description.