Health Reforms in Post-Communist Eastern Europe

This book provides the first in-depth study of healthcare reforms in post-communist Eastern Europe. Combining insights from comparative politics and public policy analysis, it examines health reforms in Slovenia, the Czech Republic, and Poland between 1989 and 2019. The book argues that the post-communist transformation of healthcare policy has entailed a process of policy learning, and that the countries' reform pathways were shaped by a series of initiatives aimed at applying market-oriented policy ideas in healthcare. The success of these initiatives has been influenced by three factors: policy legacies, political competition, and institutional configurations. The book offers a novel comparison of health reform in the region and policy changes more generally. It will appeal to scholars and students of public policy, health policy, and European politics.

“Tamara Popic’s excellent book significantly advances our understanding of the different reform trajectories of public health care systems in Eastern European countries after the end of the communist regime. Her book particularly focuses on reforms that aimed at marketizing health care systems in three exemplary cases, Slovenia, Poland, and the Czech Republic. Rather than merely assessing how partisan politics, institutions, and professional interests affected such reform trajectories, Popic’s study is based on a novel and original argument emphasizing the importance of endogenous factors, such as policy learning and policymakers’ prior exposure to experiences with market mechanisms, in shaping policy change. This innovative argument is supported by masterfully crafted in-depth case studies based on a wealth of original sources such as expert interviews, legal documents, and parliamentary debates. Overall, Popic’s book is a substantive and timely addition to an understudied dimension of the restructuring process of post-communist welfare state: the field of public health care.” (Evelyne Hübscher, Central European University, Austria.)

“After the fall of communism, healthcare marketization invested Eastern European countries, often to the detriment of equality and fairness. The volume reveals, however, that in the last three decades such wave of reforms generated a variety of marketized healthcare arrangements across countries. Then, carefully investigating the “politics of health privatization” in Slovenia, the Czech Republic and Poland, Popic’s work illuminates the factors and mechanisms accounting for such cross-country variation. Challenging existing interpretations in the literature, the volume conceptualizes policy change as an endogenous process based on “learning”, thus leading the reader to a fascinating journey into how the never-ending “ballet” between ideas and interests shaped the politics of reform and, ultimately, policy outputs.” (Matteo Jessoula, University of Milan, Italy)

“Tamara Popic’s Health reforms in Post-Communist Eastern Europe offers us deep insights into how neo-liberal ideas were translated into real health reforms in Eastern Europe after the fall of communism. Popic shows how ideas were translated into specific policy trajectories in different institutional and historical contexts. This excellent book demonstrates not only that ideas are important, but also how and why policy ideas evolve. Popic’s theory of policy learning offers deep insights into both the evolution of health policies in several countries and why we see such different policy outcomes in different societies. This well written book will be of interest to anyone interested in the ways in which ideas, institutions and policy legacies interact over time.” (Sven Steinmo, University of Colorado, Boulder, USA)

Tamara Popic is Lecturer at the School of Politics and International Relations, Queen Mary University of London, UK. Her research interests include health politics and policy in post-communist countries. She is the co-editor of Health Policy in Europe: A Handbook (2021)