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We don’t know if health system changes in eastern Europe have improved quality

BMJ 2012; 344 doi: (Published 25 June 2012) Cite this as: BMJ 2012;344:e3923
  1. Tomasz Tomasik, chair of internal medicine and gerontology, Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
  1. mmtomasi{at}

Twenty years have passed since the countries of eastern and central Europe began the substantial reorganisation of their health systems. The Soviet model had been centrally planned, government run, and oriented to hospital care. Universal coverage was an ideological priority, and the phrase “quality of care” was hardly used.

Central to the reforms was the implementation of family medicine. In countries such as Estonia, Lithuania, and Poland, district internists and paediatricians were retrained to become family physicians; in countries such as Slovakia and the Czech Republic they changed their titles to general practitioners for adults and general practitioners for children. This accompanied privatisation in healthcare provision and the disintegration of polyclinics into separate, smaller outpatient clinics. These changes seemed to the public to be well planned, and the objective of improving quality of care was commonly cited.

However, it is unclear whether this reorganisation has resulted in any improvement in quality in primary care. The international literature, according to …

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