Rechel Bernd, McKee Martin
European Observatory on Health Systems and Policies, London, UK.
Lancet. 2009 Oct 3;374(9696):1186-95. doi: 10.1016/S0140-6736(09)61334-9.
In the two decades since the fall of the Berlin Wall, former communist countries in Europe have pursued wide-ranging changes to their health systems. We describe three key aspects of these changes-an almost universal switch to health insurance systems, a growing reliance on out-of-pocket payments (both formal and informal), and efforts to strengthen primary health care, often with a model of family medicine delivered by general practitioners. Many decisions about health policy, such as the introduction of health insurance systems or general practice, took into account political issues more than they did evidence. Evidence for whether health reforms have achieved their intended results is sparse. Of crucial importance is that lessons are learnt from experiences of countries to enable development of health systems that meet present and future health needs of populations.
自柏林墙倒塌后的二十年里，欧洲的前共产主义国家对其卫生系统进行了广泛变革。我们描述了这些变革的三个关键方面——几乎普遍转向医疗保险系统、越来越依赖自费支付（包括正式和非正式的），以及加强初级卫生保健的努力，通常采用由全科医生提供的家庭医学模式。许多关于卫生政策的决策，如引入医疗保险系统或全科医疗，更多地考虑了政治问题而非证据。关于卫生改革是否取得预期成果的证据很少。至关重要的是，要从各国的经验中吸取教训，以便发展出能够满足民众当前和未来健康需求的卫生系统。
