OREANDA-NEWS. June 10, 2013. While the countries of Europe and Central Asia (ECA)[1] have enjoyed robust economic growth in the last two decades, the long-term progress of health outcomes has been more modest; in fact, it has been among the slowest in the world over the past fifty years. To enhance their health systems, countries need to act on three main fronts – improve health outcomes, ensure proper financing, and strengthen institutional arrangements, says a new World Bank report “Getting Better: Improving Health System Outcomes in Europe an Central Asia”.

“Health is a major development challenge facing the region today,” said Philippe Le Houerou, World Bank Vice President for Europe and Central Asia. “It’s a top priority for populations across the region and a major determinant of overall welfare. To respond to people’s aspirations, health systems need to be affordable, efficient, and they need to provide high quality of care.”

The life expectancy gap between ECA and Western Europe has widened significantly since the 1960s, while other middle-income regions have caught up and overtaken ECA. However, the story is not uniform across the region. Turkey has experienced very large health gains, Central Europe has steadily improved since the 1990s, and the Western Balkan countries have performed in line with global norms. But many other countries in the region are lagging behind.  Very recently the trend across the entire region has improved, but full parity with Western Europe is still a distant goal.

“The three major objectives of the health systems in Europe and Central Asia are improving population health outcomes, protecting households against the high and uncertain costs of medical care, and ensuring the efficiency of government health spending,” emphasized Ana Revenga, World Bank Director for Human Development in Europe and Central Asia. “Achieving these goals requires strengthening the underlying institutional arrangements.”
Results Agenda

“The major cause of the populations’ ill health in ECA is heart disease,” said Owen Smith, World Bank Senior Health Economist and co-author of the report. “These conditions account for over half of the life expectancy gap between ECA and Western Europe. The predominance of cardiovascular disease across the whole region represents an obvious target for policy action.”

The starting point for reducing cardiovascular disease mortality is to address its major risk factors in the general population, before individuals need medical care. Among the most important of these are tobacco and alcohol use. Tackling high blood pressure and cholesterol at the primary health care level will also significantly improve health outcomes in the region.

In addition to heart disease, two other factors that negatively affect life expectancy in the region are neonatal mortality (death in the first 28 days of life) and external causes or accidents, which are mainly due to alcohol-related road traffic injuries. While the predominant role of cardiovascular disease is common everywhere, the significance of infant deaths is more marked in Central Asia and the Caucasus, and the importance of external causes is most notable in Belarus, Kazakhstan, Russia, Ukraine, and the three Baltic nations.

The report suggests that both prevention and treatment must play a central role in the future health agenda in countries across the region, in particular through wider implementation of cost-effective measures.

Financing Agenda
Both in ECA and globally, health financing is drawn largely from either household out-of-pocket sources or from the government budget, including social health insurance. Too much out-of-pocket spending for health care can undermine the financial stability of households, while too much government spending poses a risk to fiscal sustainability.

“To ensure that better health care is financed in a way that does not impose an excessive burden either on households or on governments, we recommend a set of actions to improve financial protection of vulnerable groups while increasing the efficiency of government health spending,” said Son Nam Nguyen, World Bank Senior Health Specialist and co-author of the report.

Improving financial protection will require some combination of expanded benefit packages, better targeting of health programs to vulnerable groups, and measures to reduce informal payments. To protect government budgets from wasteful health spending, the report suggests improving efficiency by eliminating excess hospital infrastructure, introducing service delivery innovations, and strengthening information about provider performance. Lastly, it will also be important to achieve lower pharmaceutical expenditures by households and governments alike by adopting more rational prescription practices and smarter procurement methods.

Institutional Agenda
According to the report, there is no single ideal health system model or “recipe” for achieving better outcomes.  Instead, the way to strengthen the institutional arrangements that govern health systems in the region is by adopting some key “ingredients” that are common to most advanced countries but still absent in much of ECA. The report identifies five such ingredients for reforming ECA’s health systems: introducing patient-based payment methods; offering a greater degree of autonomy to health providers; making better use of information for decision-making; ensuring adequate risk pooling; and supporting all these efforts with committed, credible leadership for health reform.

[1] The Europe and Central Asia region includes Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Hungary, Kazakhstan, Kosovo, Kyrgyz Republic, Latvia, Lithuania, FYR Macedonia, Moldova,  Montenegro, Poland, Romania, Russia, Slovak Republic, Slovenia, Serbia, Tajikistan, Turkey, Turkmenistan, Ukraine, and Uzbekistan.