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Getting Better: Improving Health System Outcomes in Europe and Central Asia
The report brings new evidence to bear on each of these major agendas. A household survey, which was implemented in six countries with a focus on health-related behaviors and utilization of medical care, yielded results that can be compared to existing data sources for all European Union (EU) member states. A quality-of-care survey was undertaken in five countries to assess how providers respond to hypothetical patient “vignettes.” Existing household surveys in 11 countries were used to analyze the burden of out-of-pocket spending for health. Last, a questionnaire on the institutional characteristics of health systems was deployed across all ECA countries to systematically assess the health reform agenda across the region. Some cross-cutting themes common to these data collection efforts include benchmarking ECA against the EU-15, balancing an overview of health systems as a whole with a focus on specific diseases, and emphasizing key outcomes or “results” relevant to each of the three agendas.
The Health Agenda: Achieving a Cardiovascular Revolution Identifying a health policy agenda for ECA should begin with an understanding of why its performance has lagged behind that of other regions. There are many determinants of individual and population health: a list would have to include genes, early childhood conditions, nutrition, knowledge about the factors that affect health, educational level, personal behaviors, the environment, socioeconomic status, and medical care. Each is likely to be relevant for ECA at least to some degree. While it is not possible to say exactly how much of a population’s ill health is due to each of the many underlying causes, two lines of inquiry can go a long way toward establishing a preliminary diagnosis of what ails ECA. The first is to account for the proximate determinants of mortality in the form of common measures of disease burden. The second is to look at the historical evidence on health improvements in longer-living countries such as those in the EU-15 over the past 50 years. In both cases, the evidence points to the same major cause: heart disease. Health outcomes in ECA have not converged with those of the EU-15 in large part because the region has yet to achieve the “cardiovascular revolution” that has taken place in the West over the past 50 years. Circulatory diseases account for over half the life expectancy gap between ECA and the EU-15, and better cardiovascular outcomes were similarly responsible for over half the health gains in the EU-15 in recent decades (figure O.6). Perhaps more than in any
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