McKee M, Figueras J, Chenet L
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, UK.
Int J Health Plann Manage. 1998 Apr-Jun;13(2):131-47. doi: 10.1002/(SICI)1099-1751(199804/06)13:2<131::AID-HPM506>3.0.CO;2-8.
Health services in the former Soviet Republics of Central Asia face many challenges, not least a rising burden of disease and severe economic constraints. Each government has developed proposals for reform. This paper describes the key elements of the proposals developed in each country. They have many features in common, such as financing based on social insurance, although they also have many differences, reflecting national political, economic and historical circumstances. While most attention so far has concentrated on the design of the proposed systems, it is argued here that there has been inadequate attention to the obstacles to implementation. These stem from the many adverse factors in the context within which reforms are taking place, weaknesses in the process of reform, and failure to involve the groups whose actions will be necessary for success. It is argued that governments and those advising them must place greater emphasis on the challenges of implementation, including the development of a much better understanding of the context within which change must take place.
中亚的前苏联加盟共和国的卫生服务面临诸多挑战，尤其是疾病负担不断加重和严重的经济制约。各国政府都制定了改革提案。本文描述了各国所制定提案的关键要素。它们有许多共同特征，比如基于社会保险的筹资方式，不过也存在诸多差异，这反映了各国的政治、经济和历史情况。虽然迄今为止大部分注意力都集中在拟议系统的设计上，但本文认为对实施过程中的障碍关注不足。这些障碍源于改革所处背景中的诸多不利因素、改革过程中的薄弱环节，以及未能让改革成功所必需的群体参与进来。本文认为，各国政府及其顾问必须更加重视实施方面的挑战，包括要更好地了解变革必须发生的背景。
