Central and Eastern Europe

the.networktufh.org

Central and Eastern Europe

Changes in health

systems in South

Eastern Europe

since 1989

1


Content






Definitions

A fairy tale

What has happened next

Where are we now

Predicting the future

2


What are we talking about?

DEFINITIONS

3


Divisions in Europe

4


Central and Eastern Europe




Central and Eastern Europe is a term describing former communist

states in Europe, after the collapse of the iron curtain in 1989/90.

It includes all the Eastern bloc countries west of the post - World war II

border with the former Soviet Union, the independent states in former

Yugoslavia (which were not considered part of the Eastern bloc), and the

three Baltic States: Estonia, Latvia and Lithuania.

Belarus, Ukraine, Moldova and Russia are members of CIS

(Commonwealth of Independent States) and are not included in CEE.

Source: Wikipedia

5


Southeastern Europe


..is a relatively recent political designation for the Balkan peninsula

states. There are no clear and universally accepted geographical or

historical divisions that delineate this region. The countries located fully

in the peninsula are the following: Albania, Bosnia and Herzegovina,

Kosovo, Bulgaria, Greece, Macedonia and Montenegro. The geographic

definition may also include countries which are significantly located in the

peninsula: Croatia (1/2) and Serbia (up to 2/3) and some countries which

are located mostly outside the peninsula as defined by the rivers:

Slovenia(1/5), Romania (6%) and Turkey (3%).

6


Former Yugoslavia


6 (7) countries, that

became independent after

the breakup of former

Yugoslavia

• Slovenia

• Croatia

• Bosnia and Herzegovina

• Serbia

• Montenegro

• FYR Macedonia

• (Kosovo)

7


Some characteristics





Different political

systems

Lower GDP

Dramatic changes since

1989

Relative lack of

scientific information

8


How it all began?

A FAIRY TALE

9


A long, long time ago, in a country far,

far away…

10 10


International Conference on Primary Health Care,

Alma-Ata, USSR, 6-12 September

1978




Primary health care is the key to attaining health for all.

All governments should formulate national policies, strategies

and plans of action to launch and sustain primary health care

as part of a comprehensive national health system and in

coordination with other sectors.

the whole world community should support national and

international commitment to primary health care and channel

increased technical and financial support to it, particularly in

developing countries.

http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf

11 11


MAIN MODELS IN THE

REGION

12


THE SEMASKO MODEL




Based on policlinics

Salaried GPs with low

esteem (therapists)

No academic

recognition of primary

care

13


YUGOSLAV MODEL




Based on community

based primary health

centres

Salaried physicians

Family medicine

officially recognised as

a speciality, not always

academic

14


What happened next?

CRISIS: AN INABILITY TO

KNOW WHICH DIRECTION TO

TAKE

15


MMC UPDATE

“I’m all for progress,

it’s change I can’t cope

with”

Mark Twain

16


Reasons: major societal trends






Loss of belief in figures in authority and downfall of heroic

figures

Knowledge explosion through popular books, media, and

internet

Rise of consumerism

Rise in litigation

Rise of managerialism

17


New concepts in medicine






Community orientation

Patient empowerment, patient autonomy,

patient participation

Academic family medicine

Quality of care

….

Some titles from: Buetow S, ed.: Ideological Debates in Family Medicine

(in press)

18


Political results




Collapse of communist

ideology

War in the Balkans

Globalisation

19


The crisis of medicine



Some concerns:

• Ability to pay

• Control of medical profession

• Consumerism and leo-liberalism

• Globalisation

Crisis of academic medicine

20


Where are we now?

DESCRIPTION OF THE

SITUATION

21


Do we know

where we are?

22


SOURCES OF INFORMATION




The FATMEE study

The “Post - YU PHC”

study

Personal experience

23


Study designs





Two key informants from each country

Triangulation

Validation

Summarising

24


SLOVENIA





Both medical schools with

university departments since

1994

Obligatory VT (4 years)

Obligatory reaccreditation

Health care reform aimed at

strenghtening PHC

25


CROATIA





University departments at all

medical schools

10 years no VT!!

Reaffirmation of discipline

At least 3 organisations of

GPs

Source:

Hebrang A, Henigsberg N, Erdeljic V, Foro S, Turek S, Zlatar M. Privatization of the Croatian health care

system: effect on indicators of health care accessibility in general medicine] Lijec Vjesn. 2002 Aug-

Sep;124(8-9):239-43.

Personal information Mladenka Vrcić Keglević, Milica Katić, Dragomir Petric 26


BOSNIA AND HERZEGOVINA





University departments and teaching

centres

Family medicine re-establishmnet

through numerous programs

Canadian family medicine

development programme

Problems with infrastructure, and

resources

Source:

Godwin M, Hodgetts G, Bardon E, Seguin R, Packer D, Geddes J.

Primary care in Bosnia and Herzegovina. Health care and health status in general practice ambulatory care centres. Can

Fam Physician. 2001 Feb;47:289-97.

Personal contacts

27


SERBIA




University position within

public health

10 years of isolation

Family medicine at

undergraduate level at most

medica schools

Source:

Personal information by Smiljka Radić 28


MONTENEGRO




Health care reform, started in

2003

Re-training of doctors and nurses

as teams

Implementation of full

specialisation and formal retraining

29


FYR MACEDONIA





Health care reform

Introducing family medicine

oriented primary care

Re-training all PHC doctors

Establishment of department etc.

Source: Svab I. The blind spot issue. Eur J Gen Pract 2011.

30


KOSOVO





A course was developed by the WHO,

which became the first year of a two year

specialisation in family medicine.

Family medicine unit in the university

was established

21 candidates on the specialisation

programme enrolled on a MSc in family

medicine

The unit has now become the Centre for

the Development of Family Medicine

with responsibility for developing

academic family medicine

Source: Hedley R, Maxhuni B. Development of family medicine in Kosovo. BMJ 2005

31


Summary of findings 1





Formally family medicine exists as a separate and a recognized specialty in all

countries and its position is legally recognized.

The practical implementation of these principles is a problem.

Positive effects of EU regulation

In most countries, family medicine is just one of the many medical specialities in

primary care.

This is especially true for the care of children and women, which are taken care of

by paediatricians and gynaecologists, leaving family medicine as a specialty for

adults in some of the countries.

32


Summary of findings 2



Mostly family medicine is provided by solo practices.

Health centres have remained on different levels with different roles in

most countries.

There are no common European standards of family medicine, but EU is

important in setting standards.

33


Where are we going?

PREDICTING THE FUTURE

34


The age of primary care is in front of us, not behind us *

Larry Green, October 4, 2007. BMJ Listserver discussion

35


PREDICTING THE FUTURE


Increased cooperation among the countries

• CSAKOS initiative

• Association of family medicine of Southeast

Europe

• The EURACT Bled course

36

More magazines by this user
Similar magazines