This paper exploits the staggered adoption of major concurrent health reforms in countries in Europe and Central Asia after 1990 to estimate their impact on public health expenditure, utilization, and avoidable deaths. While the health systems all derived from the same paradigm under central planning, they have since introduced changes to policies regarding cost-sharing, provider payment, financing, and the rationalization of hospital infrastructure. Social health insurance is predicted to increase this share, although the leads of both social health insurance and primary care fee-for-service suggest endogeneity may be an issue with the outpatient share regressions. Provider payment reforms produce the largest impact on spending, with fee-for-service increasing spending and patient-based payment reducing it. The impact on avoidable deaths is generally negligible, but there is some evidence of improvements due to fee-for-service. Considering the corresponding relative reduction in inpatient admissions and the incentives fee-for-service provides to deliver additional services, perhaps there is an overprovision of services in the primary care setting and an underutilization of more specialized hospital services.
(hospitalfee-for-service) with reimbursement via budgets as the reference category. The dummy SHI captures the effect of social health insurance compared to general revenue financing.
Indicators of hospital capacity and human capital are represented by the variables HOSP , the number of hospitals per 100,000, BED , the number of hospital beds per 100,000, and DOC , the number of physicians per 100,000.
Control variables that may be correlated with the policies and also determine the outcomes are included in the X it vector. These are GDP per capita; the share