Doctoral Dissertations

Date of Award

12-1998

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Human Ecology

Major Professor

Bill C. Wallace

Committee Members

Michael Betz, Robert Kirk, Jack Pursley

Abstract

The purpose of this dissertation was to present an overview of health care reform in the Baltic. Latvia was primary focus; the reform process in Estonia and Lithuania was used as a point of comparison. A brief review of the health care in former Soviet Union was presented as a foundation for understanding the reason for reform. The primary data base was published government legislative materials and reports from international sources. Professional medical journals, symposia materials, and relevant newspaper articles also were used. The main constraints influencing health care reform were political and economic factors, and international organizations. State legislators and local politicians represented the political and economic views of the parties who selected them for legislative and administrative positions. Legislators were inexperienced in how to formulate laws. Many inadequately designed policies were destined for failure, and subject to frequent amendments. Recurrent administrative changes in the Ministry of Welfare lowered reform efficiency; each new government had their own ideas and directions. Economic decisions were influenced by the local economic situation although international lending agencies and foreign consultants influenced the reform even more by proposing decentralization, privatization, increased role of market forces, and a balanced budget. There was a danger of increasing dependence on the international advice; foreign advisors may be guided more by experiences in their own countries and not sufficiently orientated toward local needs. The main players in the reform process were the State, health care providers, academic institutions, pharmaceutical/medical industry and patients. Although the government decentralized responsibilities and management, they were re-creating a large bureaucratic institutions. The pharmaceutical sector was monitored relatively well; organizational structures were established and basic legislation implemented. Health care providers and patients were experienced difficulties to find and to define their role in the reform process. Health care providers were loosing their influence by being divided between different professional organizations and political parties. Patients are being challenged to learn how to become more responsible for their own health.

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