Unity of diversity? Task profiles of general practitioners in Central and Eastern Europe

Abstract

Background: The countries of Central and Eastern Europe, where - until the end of the 1980s - the Semashko health care system prevailed, are often perceived as a homogeneous group. If this highly centralized system, with its tight state control, together with the ‘equalizing’ influence of communism, has led to a uniformity in the provision of health services, this could be reflected in the service profiles of general practitioners (GPs). The aim of this paper was to find out whether this picture is justified and investigate differences between the former communist countries. Methods: In 1993 and 1994, standardized questionnaires were sent to (mostly random) samples of GPs (7,233 in total) in 30 European countries. Four areas of service provision were measured: the GPs' position in first contact with health problems and their involvement in the application of medical techniques, disease management and preventive medicine. Variation patterns and mean scores were analyzed by way of multilevel analysis. Results: There is no more uniformity in Central and Eastern Europe than in Western Europe. In Eastern Europe there are in fact considerable differences: GPs in former Yugoslavia have the most comprehensive service profile, whereas the lowest scores were found among doctors in the former Soviet Union. The countries which had a social insurance system before the Second World War, such as the Czech republic and Hungary, are situated in between. Conclusions: There are distinctive national differences in GPs' task profiles in Central and Eastern Europe, which provide clues for the country-specific design and implementation of primary care-oriented reforms.