Privatization of Health Care Provision in a Transition Economy: Lessons From the Republic of Macedonia

摘要

In 1996 the Government of Macedonia began a comprehensive Health Sector Transition Project (HSTP) under a World Bank credit. The RAND Corporation was under contract to provide technical assistance to the Government of Macedonia on aspects of the health sector financial reforms for primary health care (PHC). The author was part of the RAND project team, living in the country from 1996 to 1998. The survey research conducted as part of the HSTP Technical Assistance project was supplemented with additional fieldwork and research to examine the behavior of physicians in the existing private sector in PHC and the prospects for further privatization. To address these issues, this study employs a dual research approach. First, the policy environments governing primary care, both currently and as proposed by the reforms, are examined with respect to their ability to facilitate the introduction of market forces in health care. Secondly, data from a survey of public and private PHC physicians is analyzed in a novel production function framework to investigate how physician workload and resource utilization are influenced by the financial and regulatory incentives that they face. Together, these approaches yield a rich set of recommendations to improve the effectiveness and fairness of the introduction of market forces into health markets in a transition economy.