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Improving Institutions: Ingredients, Not Recipes

an incentive for better quality of care. Individually, these measures are not uniformly used across the OECD, but the tendency is in that direction. In eastern ECA, these information tools are almost nonexistent. A related ingredient is analytical expertise and institutional structures (for example, health information centers) that can maximize the use of this information. Some ECA countries have invested in these areas, but much remains to be done. As noted, the unifying theme of these three ingredients for successful health systems is the concept of accountability. This concept has been defined as both “answerability” and sanctions and has been divided into financial, performance, and political accountability (Brinkerhoff 2004). Thus, payment that follows the patient helps signal what providers are accountable for; autonomy affords them the ability to make decisions for themselves as they seek to fulfill their responsibilities; and information flows generate the necessary data for “asking questions,” assessing their performance, and taking action (or not), accordingly. An additional channel for improving accountability is through mechanisms that promote patient rights. The stock-taking exercise described in the previous section revealed that most countries in all regions have adopted some measures with this objective. These may include a formal definition of patient rights in legislation or elsewhere, complaint desks at hospitals, or an ombudsman. But there is sometimes a wide gap between the de jure and the de facto patient empowerment afforded by these mechanisms, with potential channels for asserting rights typically less meaningful in eastern regions of ECA than in the OECD.

Two Additional Ingredients: Adequate Risk Pooling and Committed Leadership In addition to the three ingredients for accountable institutions already noted, it is also worth highlighting two others that are required for successful health reform. The first is adequate risk pooling. No health system, regardless of how well its institutions correspond to those prevailing in advanced countries, will be able to achieve key system objectives if risk-pooling arrangements are inadequate and fragmented. The counterfactual—a high reliance on OOP spending—can be self-defeating in the pursuit of health reform. Health financing institutions that ensure adequate risk pooling are not only important for financial protection and equity but also for helping create the conditions for stronger purchasing power and regulatory authority.

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Profile for World Bank Group Publications

Getting Better  

Fifty years ago, health outcomes in the countries of Eastern Europe and Central Asia were not far behind those in Western Europe and well ah...

Getting Better  

Fifty years ago, health outcomes in the countries of Eastern Europe and Central Asia were not far behind those in Western Europe and well ah...