RESUMO
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine differentapproaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Since independence, the health system in Belarus retained many of the key features of the Semashko system. The system is still characterized by a hierarchical management structure, line-item budgeting and domination of inpatient care, although capitation funding has been introduced in some areas and there havebeen consistent efforts to strengthen the role of primary care. The incremental change approach, rather than introducing radical reforms, allowed stability in health care funding and service provision during severe fiscal difficulties in the 1990s. However, the incremental reform approach has not yet led to improvements in service quality or a significant reduction of excess hospital beds. High levelsof health expenditure, universal access and a comprehensive package of care reflect the Government’s commitment to the population’s well-being. Issues of high costs in the hospital sector and of overburden in primary caredemonstrate the necessity of moving forward with the reform programme. The focus for future reform is on strengthening primary care and improving the quality and efficiency of health services. The key challenges in achieving thisinvolve reducing excess hospital capacity, improving health care management, use of evidence-based treatment and diagnostic procedures, and the development of cost-effective technologies. Involving all stakeholders in the development of further reform planning and achieving consensus among them will be key to its success.
