Changing the healthcare financing paradigm: Domestic actors and international organizations in the agenda setting for diffusion of social health insurance in post‐communist Central and Eastern Europe

Abstract

AbstractThis study elucidates the role of international organizations and domestic actors in post‐communist healthcare reforms aiming at a paradigmatic shift in healthcare financing and the introduction of social health insurance in Albania, Latvia and Poland. It inductively derives a causal mechanism behind the reform processes from these case studies. We demonstrate that the agenda setting for changing the healthcare financing paradigm was domestically driven and underpinned by the “nothing like the old regime” causal mechanism. In the context of post‐communist transition in Central and Eastern Europe this mechanism translated into an “anti‐communist backlash”. The backlash defined the domestic actors' perception of social health insurance as the only acceptable policy option because of its dissimilarity to the previous healthcare financing paradigm, and led to the rejection of World Bank suggestions to retain tax‐based healthcare financing in Poland and Albania. Doctors as policy entrepreneurs played the key role in agenda setting. Pre‐communist experience with social health insurance schemes and transnational cooperation with German and French experts and doctors served as sources of internal and external validation for the new paradigm.