As with the political structure and with other spheres of the economy, the health sector in the various Eastern European countries inherited from the socialist system situations that differed in many respects. However, this chapter concentrates on similarities rather than differences. Most of the common attributes are described here, while some others will be clarified later, when the reform proposals are discussed.

The economic mechanism of “classical socialism”

The socialist system underwent many changes over several decades of history. The model of the Stalin period, before the reforms oriented towards “market socialism,” is referred to as the “classical” socialist system. Of course, there were differences between countries even in the classical period. This account confines itself to the main common characteristics. We omitted from chapter 4 (p. 111) a description of the sixth model, “Public provision of medical care: the Soviet model,” which now ensues.

The health sector is an integral part of the command economy. It does not differ in the least from the other sectors in its economic mechanism. All the sector's activity is centrally controlled. At the peak is the health minister, who is in turn directed by his superiors in the communist party and the state. Orders filter down from him through the bureaucratic hierarchy to the functionaries controlling the lowest-level organizations: hospitals, outpatient clinics, and district doctors' offices providing primary health care.