Variations on Bismarck: Translations of Social Health Insurance in Post-Communist Healthcare Reforms in Central and Eastern Europe—The Role of Vertical and Horizontal Interdependencies

Abstract

AbstractIn the 1990s, Central and Eastern Europe (CEE) countries (except for Latvia) moved away from tax-based financing of healthcare in favour of social health insurance (SHI). This paradigmatic change was domestically driven; the World Bank’s recommendations to retain tax-based healthcare financing were ignored. Yet, in defining the institutional set-up of the emerging SHI systems, CEE countries did rely on the expertise of international organisations as well as experts from Western Europe (mainly Germany and France). The external advisors tailored their recommendations to the diverse national contexts, which facilitated policy learning. Consequently, rather than strictly following the Bismarckian blueprint, CEE healthcare systems have developed into hybrids, combining Bismarckian, Beveridgean and private healthcare elements, thus diverging from Western European points of reference as well as among each other.