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Are Reforms From a Centrally Planned to a Market System Bad for Health?

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  • Suhrcke, Marc

Abstract

Alerted by the dramatic mortality increase in Russia after the onset of transition, and inspired by Sen (1997) to interpret mortality as an indicator of economic performance, mortality data is used as the benchmark, by which to judge the success or failure of transition in Central and Eastern Europe. In particular, it is examined whether reforms from a centrally planned to a market system did have a detrimental effect on health during transition, as it has allegedly been the case in Russia. Controlling for other determinants of health such as GDP growth and health provision, the hypothesis that reforms are bad for health cannot be supported. Instead, good reforms do have a beneficial effect, quite independently of GDP growth. In the 23 countries examined for the period 1989-96, health provision can only account for the development of infant, child and female mortality rates, but not for adult male mortality, which seems to be largely due to stress-related phenomena, that are generally considered to be quite unrelated to health care provision. Further, in contrast to the growth in transition-literature, there seems to be no trade-off between short-term costs and long-term benefits of reform. Good reform directly translates into better health. Several mechanisms are discussed to shed light on the link between good reform and good health. A particularly worrying trend with potentially wide-ranging long-term implications for the CEECs' development paths derives from the observation of a substantial degree of divergence in health status across the region, given the important role of health in determining future growth prospects. Alarmiert durch den dramatischen Anstieg der Sterblichkeitsrate in Russland in den ersten Jahren der Transformation und basierend auf Sen's (1997) Idee, Sterblichkeit als Indikator ökonomischer Performance zu interpretieren, verwenden wir Sterblichkeitsraten als Maßstab zur Evaluierung von Erfolg oder Mißerfolg der Transformation in Mittel- und Osteuropa. Insbesondere wird untersucht, ob die strukturellen Reformen von der Plan- zur Marktwirtschaft eine negative Auswirkung auf den Gesundheitsstatus hatten, wie das Negativ-Beispiel Russland suggeriert. Wenn für andere Determinanten der Gesundheitsentwicklung kontrolliert wird- wie z.B. die Wachstumsraten des Bruttosozialproduktes und die Bereitstellung von Gesundheitsdiensten, zeigt sich, dass diese Hypothese nicht aufrechterhalten werden kann. Im Gegenteil, eine "gute" Reformpolitik verrringert die Sterblichkeitsraten relativ unabhängig vom BSP-Wachstum. In den 23 untersuchten Ländern für den Zeitraum 1989-1996 kann die Bereitstellung an Gesundheitsdiensten nur die Entwicklung der Kinder- und Frauensterblichkeit erklären, nicht jedoch die der erwachsenen Männer. Letztere scheint in der Tat eher von stress-induzierten Phänomenen verursacht worden zu sein, die grundsätzlich als vergleichsweise unabhängig von Gesundheitsdiensten gilt. Darüber hinaus zeigt sich im Gegensatz zur Literatur über Wachstum in der Transformation, daß es keinen trade-off zwischen kurzfristigen Kosten und langfristigem Nutzen der Reform zu geben scheint: Gute Reformen führen unmittelbar zu einem verbesserten Gesundheitsstatus. Einige Mechanismen werden diskutiert, die für diesen Zusammenhang verantwortlich sein könnten. Aufgrund der erheblichen Bedeutung der Gesundheit als Bestandteil des Humankapitals ergibt sich ein besonders besorgniserregender Trend mit potentiell weitreichenden Konsequenzen für die Entwicklungsperspektiven der MOEs aus der Beobachtung zunehmender Divergenz der Sterblichleitsraten innerhalb der Region.

Suggested Citation

  • Suhrcke, Marc, 2000. "Are Reforms From a Centrally Planned to a Market System Bad for Health?," Discussion Paper Series 26142, Hamburg Institute of International Economics.
  • Handle: RePEc:ags:hwwadp:26142
    DOI: 10.22004/ag.econ.26142
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    2. David Stuckler & Lawrence P. King, 2007. "Social Costs of Mass Privatization," William Davidson Institute Working Papers Series wp890, William Davidson Institute at the University of Michigan.

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