Czechoslovakia's changing health care system.

Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.

The medical care system of Hungary.

Medical care in Hungary has made significant progress since World War II in spite of other social priorities which have limited financial support of the health system. A shortage of hard currency in a high technological era is now having a particularly severe adverse impact on further development. Decentralized administration and local finance have, however, provided some room for progress. Preventive efforts are hampered by a deeply entrenched life style which is not conducive to improving the population's health status.

Elderly care: similarities and solutions in Denmark and the United States.

Denmark, like the United States and other developed countries, is experiencing an increase in the percentage of dependent elderly in its population. They consume a disproportionate share of health and social services at a time when government is attempting to contain costs. Both countries face similar problems in caring for the elderly--problems of escalating hospital costs, dramatically increased nursing home costs, and insufficient public revenues to cover their entire care. Denmark has developed a wide range of services for the elderly--home help, home nursing, adult day care centers, day nursing homes, and sheltered housing. The response in the United States has taken somewhat different directions, although in both countries home and community services have been expanded as a substitute for expensive institutional care. The possible relevance of the U.S. experience in these areas to Denmark and lessons that the United States might learn from the Scandinavian country are discussed.

The effect of economic constraints on the health care system in New Zealand.

The New Zealand government, in addition to budget restrictions, has introduced population-based hospital funding to contain hospital costs. Moreover, a health services reorganization to increase area-wide integration and coordination of services on a voluntary basis has been advocated. Diffusion and use of expensive medical technologies have been delayed or thwarted. Private hospitals have increased and provide an outlet for those who are able to escape prolonged waiting for treatment and the deteriorating accommodations in public hospitals.

The New Zealand health system.

New Zealand has developed a dual public/private system of healthcare that gives a high standard of care to all regardless of financial status. Its challenge is to maintain that standard while allowing an opportunity for those who wish to make their own provisions for more agreeable and convenient service.