**6. Conclusion**

The next step of the analysis is to provide a projection, that is the directions and magnitudes of changes that should be introduced by the inefficient countries in order to achieve the efficiency of leaders. This is illustrated in **Table 4**. The calculations were carried out for the year 2013.

**Data Change Data Change Data Change**

30.0 −0.445 29.0 −0.460 33.8 −0.230

51.9 −0.680 48.0 −0.675 41.6 −0.375

Serbia 39.5 −0.578 37.9 −0.587 29.1 −0.103 Slovakia 30.0 −0.445 22.1 −0.292 26.1 −0.003 Tajikistan 69.4 −0.769 60.1 −0.749 30.5 −0.177 Turkmenistan 34.5 −0.537 34.5 −0.565 40.8 −0.387 Uzbekistan 45.5 −0.671 42.8 −0.671 24.7 −0.284

**Table 4.** Projection of changes in the inefficient countries for the year 2013.

Albania 51.6 −0.678 51.5 −0.697 29.0 −0.102 Armenia 58.3 −0.717 54.7 −0.716 30.5 −0.152 Azerbaijan 58.3 −0.795 54.7 −0.785 30.5 −0.200 Belarus 34.6 −0.518 31.9 −0.508 26.5 −0.016

Bulgaria 40.7 −0.593 39.6 −0.606 36.0 −0.280 Estonia 22.1 −0.241 18.9 −0.165 33.2 −0.208 Georgia 78.5 −0.789 61.9 −0.748 41.35 −0.374 Hungary 36.4 −0.542 27.5 −0.430 30.6 −0.147 Kazakhstan 46.9 −0.648 46.3 −0.665 27.5 −0.060 Kyrgyzstan 41.0 −0.600 36.4 −0.577 27.4 −0.063 Latvia 38.1 −0.564 36.5 −0.572 35.5 −0.267 Lithuania 33.4 −0.501 32.6 −0.519 35.2 −0.257 Macedonia 31.1 −0.465 31.1 −0.497 44.05 −0.409 Moldova 54.0 −0.694 44.6 −0.652 29.2 −0.113 Montenegro 42.7 −0.610 42.7 −0.633 32.2 −0.190 Poland 30.4 −0.452 22.8 −0.313 32.4 −0.195 Romania 20.3 −0.184 19.7 −0.209 34.9 −0.257

**Country PR\_TE OOP\_TE GINI**

Bosnia and Herzegovina

106 Advances in Health Management

Russian Federation

*Source*: Own computation.

The health care systems of the post‐communist countries are financed according to the historical burden of the past: the Central Europe is dominated by funding with health insurance contri‐ butions, while in Eastern Europe and Central Asia the budgetary financing prevails. Financing health care from health insurance premiums appears to be more stable than budget financing, although it is also vulnerable to economic fluctuations. However, as in the Western European countries, the health insurance system should be supplemented with budget funds. The prob‐ lem of the former Eastern bloc countries is the low amounts that may be used to finance health care services, medications, rehabilitation or additional services. The costs of medical equip‐ ment and medicines are similar in all the countries, and in many of them, only basic treat‐ ments and therapies with generic drugs instead of original (modern) ones are financed. Thus, in many countries, there are difficulties in access to modern medical technologies.

Limiting the extensive infrastructure of the health care sector and the financing of the health needs of the population, as opposed to facilities, is the key to improving the performance of health systems. An unsolved problem related to the efficiency and financing is low salaries of medical staff in the surveyed countries.

The study of health systems efficiency in 28 post‐communist countries indicates significant differences between the compared countries (DMUs). As a target and, at the same time, the basis for comparison, the aggregated health system of the 16 developed countries of Western Europe, which achieves very good health outcomes (DE16), was indicated. Comparable health outcomes are also achieved by three most developed countries of Central and Eastern Europe: Slovenia, Czech Republic and Croatia. In Croatia, the infant mortality rate is currently slightly higher than in the case of the other leaders.

It is postulated that in all the countries a system of co‐payments for the use of health care, understood as the cost of access to the health care system, should be introduced. The aim of such action would be to rationalize demand. It could also reduce the scale of informal fees and slightly raise the total funding of the system. It is also postulated that the countries of Central Asia should increase public funding in order to provide citizens with access to health care (e.g. Kyrgyzstan).

It is also necessary to determine the exact package of benefits—health services which will be financed from public funds. This would allow for the development of voluntary health insur‐ ance, from which above‐standard services would be funded.

It is imperative to strengthen the role of the general practitioner and ambulatory health care, as well as reduce the number of inpatients. In many countries, doctors working as general practitioners have rather low qualifications and the raising their qualifications is necessary [32].

The instability of employment, lack of social protection, low wages, income inequalities and psychological stress additionally contribute to high number of suicides, large number of civi‐ lization‐related disease cases, and as a result, shorter life expectancy. In transition countries, the life expectancy is on average 8 years shorter than in Western Europe, while healthy life expectancy is 7 years shorter.

The problem of excessive alcohol consumption in some post‐Soviet countries and the high percentage of tobacco consumers remains unresolved. Another problem is the unhealthy life‐ style, poor nutrition, inactivity and a high percentage of overweight people. The post‐socialist way of thinking and the low performance of health care systems combined with low financing are the causes of poor health care outcomes.
