GENEVA - While the fall of the Soviet Union has brought freedom to
Eastern Europe, the economic disruption resulting from the transition between
a collectivist system and a market economy has brought about an overall
near collapse of the health care system.
Lack of funding for the state health care system, compounded by an either
non-existent or over-priced private care service has resulted in large
segments of the population being denied even the most basic medical service.
This grim situation is further compounded by an ongoing AIDS epidemic,
the end result being that life expectancy throughout Eastern Europe has
suffered its first decline since the end of World War II.
In a survey of the region, the International Labor Office (ILO) found
that 88 percent of families in Ukraine and 82 percent in Hungary are unable
to afford basic health care. Meanwhile, 78 percent of health care workers
surveyed in Ukraine reported that their wages were worse than the average
for all workers. In Moldova, the poorest country in Europe, the health
service is close to collapse and workers are paid months late, if at all.
In the Czech Republic and Lithuania, most health care workers said that
their working conditions and pay has worsened in the past five years. In
relatively prosperous Poland, 5 percent of hospitals have closed in the
last three years.
The crisis stems from governments cutting public funding and decentralizing
funding responsibilities, leaving many local authorities without the resources
or administrative capacity to meet new obligations. Lack of funds has encouraged
doctors and others in direct contact with patients to demand or expect
illegal payments. In Russia, for example, such "under-the-table" arrangements
represent an estimated 40 percent of all expenditures by persons seeking
medical care.
Other factors degrading public health include such practices as extensive
"administrative leave", in which large proportions of the health care workers
in such countries as Kyrgyzstan, Armenia and Moldova fail to come to work
because hospitals and clinics lack funds to pay them. Other countries are
experiencing the growing phenomenon of "presenteeism" - whereby workers
who are ill remain on the job for fear of losing their posts and thus tend
to transmit their diseases to their co-workers.
While there has been an overall collapse of the pay of health care workers,
doctors' pay has tended to rise, notably in countries such as Belarus,
Croatia and the Czech Republic, due to the kickbacks demanded from
patients. Many doctors have also opened parallel undeclared private
practices and are rarely present at their assigned hospitals.
The overall economic situation in certain counties in Central and Eastern
Europe puts them on a par with many developing countries. For example,
two out of five Romanians live on less than US$30 per month which is lower
than India, where the minimum monthly is $36.