Dataciencia

Colección SciELO Chile

Sustainability Challenge of Eastern Europe-Historical Legacy, Belt and Road Initiative, Population Aging and Migration

Indexado

WoS	WOS:000726770300001
Scopus	SCOPUS_ID:85116812234

DOI

10.3390/SU131911038

Año

2021

Tipo

revisión

Citas Totales

Autores Afiliación Chile

Instituciones Chile

% Participación
Internacional

Autores
Afiliación Extranjera

Instituciones
Extranjeras

Abstract

The historical legacy of Eastern European and the Balkans’ health systems was mutually interdependent and shaped by local socioeconomic circumstances. Three distinctive systems of risk sharing and health financing developed since the late XIX century were the Bismarck, Beveridge, and Semashko systems. Modern day healthcare systems in these countries are challenged by population aging, accelerated innovation in medical technology, growing purchasing power and rising demand for healthcare services. Supply‐side changes contribute to demand‐side efficiency bottle-necks in financing, driving up the costs of the already expensive medical care. All of the nations have a large share of citizens experiencing difficulty with affordability and access to medical care, particularly in rural and remote areas. Network of health technology assessment agencies have mushroomed over the past three decades. Principles of health economics theory and cost‐effective resource allocation are slowly gaining ground in governing authorities’ mindset and decision‐mak-ing processes. For many years to come, pharmaceuticals and medical services will remain depend-ent on out‐of‐pocket spending. Currently, accelerating and spreading 4.0 Industrial Revolution, together with the Belt and Road Initiative, are likely to substantially impact the further economic development of this vast region. Post‐pandemic “green” recovery strategies adopted by many of the Eastern European governments shall also make this transition toward sustainable development more difficult and challenging, given the large dependency of all these economies on traditional carbon fuels.

Revista

Revista	ISSN
Sustainability	2071-1050

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Disciplinas de Investigación

WOS
Environmental Sciences
Environmental Studies
Green & Sustainable Science & Technology

Scopus
Sin Disciplinas

SciELO
Sin Disciplinas

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Publicaciones WoS (Ediciones: ISSHP, ISTP, AHCI, SSCI, SCI), Scopus, SciELO Chile.

Colaboración Institucional

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Autores - Afiliación

Ord.	Autor	Género	Institución - País
1	Jakovljevic, Mihajlo	Hombre	Hosei University - Japón University of Kragujevac - Serbia Hosei Univ - Japón Univ Kragujevac - Serbia
2	Cerda Urrutia, Arcadio Alberto	Hombre	Universidad de Talca - Chile
3	Liu, Yansui	-	Chinese Academy of Sciences - China CASSACA - China
4	GARCIA-PEREZ, LEIDY YOMARY	Mujer	Universidad de Talca - Chile
5	Timofeyev, Yuriy	Hombre	National Research University Higher School of Economics - Rusia Natl Res Univ - Rusia HSE University - Rusia Hosei University - Japón
6	Krstic, Kristijan	Hombre	Clinical Center Kragujevac - Serbia Univ Clin Ctr Kragujevac - Serbia University Clinical Center Kragujevac - Serbia
7	Fontanesi, John	Hombre	University of California, San Diego - Estados Unidos Univ Calif San Diego - Estados Unidos

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Financiamiento

Fuente
Ministarstvo Prosvete, Nauke i Tehnoloskog Razvoja
Ministry of Education Science and Technological Development of the Republic of Serbia

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Agradecimientos

Agradecimiento
Although regional diversity is huge, the national health systems, mostly throughout the XIXth and XXth centuries, share many similar features and challenges. In the Russian Empire, the establishment of national health care occurred earlier, during the XVIIIth cen‐ tury, with the introduction of medicine studies at the Imperial Moscow University (Императорский Московский Университет) in 1755 and a network of public hospitals and educational institutes in 1758 [6]. The Ottoman Empire had its health system con‐ ceived with the establishment of The Imperial Military School of Medicine (Mekteb‐I Tıbbiye‐I Şahane) in 1827, on orders by Sultan Mahmud II [7]. The Austro‐Hungarian Em‐ pire led by the House of Habzburg was a long lasting statehood that left profound im‐ prints in many Eastern European and Balkan cultures. In the area of its geopolitical out‐ reach, the Deutsch language was effectively Lingua Franca of a large part of Eastern Eu‐ rope. Its oldest medical establishments date back to 1784 when Emperor Joseph II estab‐ lished the first state‐run general hospital in continental Europe, the Algemeines Kranken‐ haus (the General Hospital) [8]. Slightly earlier, in the mid‐1740s, began a set of reforms at Vienna Medical School aimed at closing the existing gap in the medical technology frontier after the Western European colonial powerhouses [9]. The milestone event for the entire region was the emergence of three contemporary systems of risk sharing. These early health and social insurance and tax collection strate‐ gies were created in order to secure financing of a brand‐new invention of the late XIXth century, i.e., the hierarchical national health system. They are mostly known as the Ger‐ man Bismarck system established in 1884, British Beveridge system established in 1948, and Soviet‐Russian Semashko system grounded in the reforms of 1921 and officially con‐ secrated in the early 1930s. Otto von Bismarck, the Chancellor of the German Empire, in‐ troduced the “Social Health Insurance Model”. It pioneered the first large‐scale compul‐ sory insurance coverage to establish universal healthcare in Germany, and later, in large part to Europe [10]. The Bismarckian system was rooted in the Prussian Industrial Revo‐ lution, involving a tripartite relationship between trade unions, employers, and the state. The situation was different in the largely agrarian Balkans. This is one of the reasons why Greece, sharing the Balkan agrarian traditions, failed to develop comprehensive health insurance. Its core limitation was the fact that it covered only a narrow range of industrial workers families [11], which represented a minority in an agricultural German society [12,13]. Sir William Beveridge, a British economist has created grounds for the creation of Great Britain’s National Health Services (NHS) in 1948 [14]. It introduced effective uni‐ versal health insurance coverage, while removing the responsibility from citizens to co‐ fund medical care via out‐of‐pocket spending [15]. Its core weaknesses are long‐term shortages of physicians and nursing staff [16]. The tendency to over‐utilize the system benefits of affordable medical care generates long wait times for patients, particularly in expensive and complex medical procedures [17]. This system still delivers a strong degree of social protection in access to outpatient, hospital medical care and pharmaceuticals for the large layers of lower‐ and middle‐income citizens [18]. Regardless of negative contemporary perceptions of that era, the Soviet Union’s First People’s Commissar of Health (1918–1930) Nikolai Alexandrovich Semashko (1874–1949) created a unique system well ahead of its time [19]. It pioneered universal health insurance coverage in a socialist state, which guaranteed full free‐of‐charge access to the existing medical technologies to the entire population [20]. Ideals of social justice and equality played a pivotal role in the social theory of Marxism. Universal health insurance coverage was delivered and funded by a state‐owned and centrally controlled economy. Histori‐ cally, this was the first case of universal health coverage (UHC) delivered in a large nation ravaged by WWI and the Civil War [21]. None of the hierarchical traditional European societies guaranteed anything comparable to their citizens back in the 1920s and 1930s. Eventually, Semashko’s theory and practice spread throughout most of Eastern Eu‐ rope [22] and the Balkans, while taking roots in Central Asia in earlier decades as part of
FundingSerbian part of this Lancet Europe contribution was co-funded through grant OI 175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia.

Agradecimiento

Although regional diversity is huge, the national health systems, mostly throughout the XIXth and XXth centuries, share many similar features and challenges. In the Russian Empire, the establishment of national health care occurred earlier, during the XVIIIth cen‐ tury, with the introduction of medicine studies at the Imperial Moscow University (Императорский Московский Университет) in 1755 and a network of public hospitals and educational institutes in 1758 [6]. The Ottoman Empire had its health system con‐ ceived with the establishment of The Imperial Military School of Medicine (Mekteb‐I Tıbbiye‐I Şahane) in 1827, on orders by Sultan Mahmud II [7]. The Austro‐Hungarian Em‐ pire led by the House of Habzburg was a long lasting statehood that left profound im‐ prints in many Eastern European and Balkan cultures. In the area of its geopolitical out‐ reach, the Deutsch language was effectively Lingua Franca of a large part of Eastern Eu‐ rope. Its oldest medical establishments date back to 1784 when Emperor Joseph II estab‐ lished the first state‐run general hospital in continental Europe, the Algemeines Kranken‐ haus (the General Hospital) [8]. Slightly earlier, in the mid‐1740s, began a set of reforms at Vienna Medical School aimed at closing the existing gap in the medical technology frontier after the Western European colonial powerhouses [9]. The milestone event for the entire region was the emergence of three contemporary systems of risk sharing. These early health and social insurance and tax collection strate‐ gies were created in order to secure financing of a brand‐new invention of the late XIXth century, i.e., the hierarchical national health system. They are mostly known as the Ger‐ man Bismarck system established in 1884, British Beveridge system established in 1948, and Soviet‐Russian Semashko system grounded in the reforms of 1921 and officially con‐ secrated in the early 1930s. Otto von Bismarck, the Chancellor of the German Empire, in‐ troduced the “Social Health Insurance Model”. It pioneered the first large‐scale compul‐ sory insurance coverage to establish universal healthcare in Germany, and later, in large part to Europe [10]. The Bismarckian system was rooted in the Prussian Industrial Revo‐ lution, involving a tripartite relationship between trade unions, employers, and the state. The situation was different in the largely agrarian Balkans. This is one of the reasons why Greece, sharing the Balkan agrarian traditions, failed to develop comprehensive health insurance. Its core limitation was the fact that it covered only a narrow range of industrial workers families [11], which represented a minority in an agricultural German society [12,13]. Sir William Beveridge, a British economist has created grounds for the creation of Great Britain’s National Health Services (NHS) in 1948 [14]. It introduced effective uni‐ versal health insurance coverage, while removing the responsibility from citizens to co‐ fund medical care via out‐of‐pocket spending [15]. Its core weaknesses are long‐term shortages of physicians and nursing staff [16]. The tendency to over‐utilize the system benefits of affordable medical care generates long wait times for patients, particularly in expensive and complex medical procedures [17]. This system still delivers a strong degree of social protection in access to outpatient, hospital medical care and pharmaceuticals for the large layers of lower‐ and middle‐income citizens [18]. Regardless of negative contemporary perceptions of that era, the Soviet Union’s First People’s Commissar of Health (1918–1930) Nikolai Alexandrovich Semashko (1874–1949) created a unique system well ahead of its time [19]. It pioneered universal health insurance coverage in a socialist state, which guaranteed full free‐of‐charge access to the existing medical technologies to the entire population [20]. Ideals of social justice and equality played a pivotal role in the social theory of Marxism. Universal health insurance coverage was delivered and funded by a state‐owned and centrally controlled economy. Histori‐ cally, this was the first case of universal health coverage (UHC) delivered in a large nation ravaged by WWI and the Civil War [21]. None of the hierarchical traditional European societies guaranteed anything comparable to their citizens back in the 1920s and 1930s. Eventually, Semashko’s theory and practice spread throughout most of Eastern Eu‐ rope [22] and the Balkans, while taking roots in Central Asia in earlier decades as part of

FundingSerbian part of this Lancet Europe contribution was co-funded through grant OI 175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia.