A look at the Health of Nations Index reveals a few seemingly anomalous results in the assessment of countries' healthcare inputs. Russia, for example, ranks alongside Norway, Japan, the Netherlands and other rich-world countries as "well above average". The Czech Republic is also included in this group, while Ukraine, Hungary and Slovakia earn an "above average" rating, similar to the likes of Australia, Germany, Sweden and Switzerland. Yet in the measure of healthcare outcomes, the Czech Republic and Slovakia rate "below average", and Russia, Ukraine and Hungary fall into the "well below average" group. (The healthcare outcomes of the other countries cited above are all "above average" or "well above average".) What explains such a disconnect between inputs and outcomes for these countries?
The inputs pillar of the index focuses on quantities—of hospital beds, physicians and nurses, for example. And when it comes to sheer numbers, few excel like Europe's former communist nations. Russia, for example, ranks second among all index countries in terms of numbers of hospital beds and physicians, and 18th in the number of its nurses. Where hospital beds are concerned, Ukraine ranks just behind Russia, and the Czech Republic and Hungary are also in the index top ten. (All these indicators are on a per population basis.)
These results seem impressive, but the health systems of eastern Europe have traditionally been oversupplied with hospitals and undersupplied with primary care facilities and services. This is a result of earlier policies that channelled patients to hospitals for many types of care, as well as a focus on the development of hospital-based specialists. Russia's large numbers of physicians include many of the latter, but the health system suffers from too few primary care physicians. In Ukraine only 2% of physicians are general practitioners (GPs), compared with 50% in some west European countries.
Current healthcare reform efforts under way throughout the region aim to redress these and other imbalances. One key objective common to all is expand the provision—and improve the quality—of primary care and out-patient services. In Russia, Ukraine and Hungary, for example, hospitals are being closed (also owing to budget stringencies) and hospital beds eliminated. Russia's reform plans envisage the elimination of many specialist positions and the training of new GPs and front-line care providers.
Not all the high input numbers are misleading. Vaccinations are an important measure to safeguard children's health, and eastern Europe's health systems have traditionally taken great efforts to ensure vaccination programmes are implemented across all parts of the region's countries. According to data collected by the WHO and reported by the World Bank, 99% of the population in Russia and Slovakia and 98% in Ukraine had received measles vaccination. Similarly, vaccination rates for diphtheria, pertussis and tetanus were as high as 99% in the same year in the Czech Republic, Hungary, Poland and Slovakia, and 98% in Russia and Ukraine. In both indicators, these are among the highest vaccination rates in the world.
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