Lietuvos ir Estijos sveikatos apsaugos raida: panašios sąlygos, skirtingi rezultatai

LTStraipsnyje lyginamos Lietuvos ir Estijos sveikatos apsaugos sistemos. Įvertinamas jų istorinis kontekstas, aprašoma raida po nepriklausomybės atkūrimo, pateikiami duomenys, kaip paskirstomi sveikatos apsaugos ištekliai ir kokie šių sistemų veiklos rezultatai. Straipsnyje teigiama, kad, nepaisant panašių istorinių ir ekonominių sąlygų, pokomunistinė Lietuvos ir Estijos sveikatos apsaugos raida skiriasi. Nors ir yra finansuojama panašiu lygiu, Estijos sveikatos apsauga daugeliu svarbių aspektų pranoksta Lietuvos (ir Latvijos) sveikatos apsaugą. Argumentuojama, kad esminį poveikį Baltijos šalių sveikatos apsaugos tendencijų išsiskyrimui turėjo priimti sprendimai dėl sveikatos sistemos finansavimo ir valdymo ankstyvuoju pokomunistinės transformacijos laikotarpiu. [Iš leidinio]Reikšminiai žodžiai: Baltijos šalys (Baltic states); Estija (Estonia); Sveikatos apsauga; Baltic countries; Health care; Healthcare; Lithuania.

ENArticle deals with the development of healthcare in Lithuania and Estonia. Data on Latvia are also presented. It is argued that the time, speed and achieved results in reforming the health system significantly differ in these states. Estonia introduced compulsory health insurance as early as in 1991, thus crucially reforming the healthcare financing. This move was important for seeking an effective governance. It secured the health budget from the general economic downturn in the beginning of the postcommunist transformation, allowed to begin in time to optimise the over-extensive network of healthcare institutions inherited from the Soviet rule, and to delimit the possibilities of the politicians to interfere in the routine operation of the system. In the other Baltic countries, there were also plans to change the Soviet model of financing healthcare from the general budget by introducing compulsory health insurance, but these plans were implemented only partially. Continuing to finance healthcare mostly from the state budget, the governance of the system remained dependent on the general processes of the fiscal policy, more sensible to economic fluctuations and more open to political pressure. Accordingly, the results of the Baltic countries’ health systems also differ. There are notable differences in life expectancy and its long-term development trends, mortality from diseases amenable by medical intervention, effectiveness of using resources, the relation of public means vis-à-vis payments that inhabitants have to make from their pockets, spread of illegal payments, as well as ratings of international agencies and public satisfaction with the services provided by the health system.Despite the fact that healthcare in the Baltic countries has been financed to a similar extent, the Estonian health system excels the healthcare of the other Baltic countries in all the aforementioned essential aspects. It is necessary to emphasise that, Estonia usually called the most “neoliberal” country in the Baltic region (and in the whole CEE), has implemented the reforms that ensured a financially more equitable and secured as well as more effectively functioning healthcare system. All this contradicts with the usual notion that sets off the radical reforms of postcommunist transformation against the necessity to retain solidarity in society. At least a comparative analysis of the Baltic countries’ healthcare development shows opposite tendencies. The countries that delayed to reform the system or carried out it incoherently have created the background for debilitating the state’s role and increasing the “informality” of the system. The explanation why the Baltic countries headed towards different transformation directions of their healthcare draws attention to the role of Estonian professional medical organisations and their pressure “from the bottom” to introduce compulsory insurance. It also reflects the general explanations of the Baltic countries’ postcommunist transformation that indicate the vibrancy of civic organisations in Estonia before re-establishing its independence and their importance for creating a favourable environment for the subsequent emergence of a reform-oriented elite. [From the publication]

• Politikos mokslai / Political sciences
• Vadyba / Management