Health care reforms on the European scene: evolution, revolution or seesaw?

In rough terms a tripartite picture characterized the European health care delivery map until the late 1980s. The Beveridge model has its roots in the British National Health Service, the Bismarck model for sickness insurance arose in Germany, and the centrally controlled Semashko model was developed in the USSR All three modes are undergoing reforms with similar aims expressed in similar language. Differences in the content and speed of reforms stem from the different circumstances and models of health care organization and financing in the countries. Practically all of the CCEE/NIS have declared their determination to change their health services financing from a centrally run system into a health insurance based structure, meaning a switch from the Semashko to the Bismarck models. Hungary, the Czech Republic, Slovakia and some other CCEE have already passed and implemented health insurance legislation, but considerable problems have arisen in the form of budget deficit, which has had to be filled by state budgets. The NIS are following behind, but no practical change has so far has come in sight. Going beyond the popular slogans of privatization and market economy is difficult during a situation of political instability, when the real transition will inevitably mean readjustment in the form of cuts and constraints, and painful reorganization in the priorities of health services.