BackgroundThe objective of this international comparative study is to describe and compare the mental health policies in seven countries of Eastern Europe that share their common communist history: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania, and Slovakia.MethodsThe health policy questionnaire was developed and the country-specific information was gathered by local experts. The questionnaire includes both qualitative and quantitative information on various aspects of mental health policy: (1) basic country information (demography, health, and economic indicators), (2) health care financing, (3) mental health services (capacities and utilisation, ownership), (4) health service purchasing (purchasing organisations, contracting, reimbursement of services), and (5) mental health policy (policy documents, legislation, civic society).ResultsThe social and economic transition in the 1990s initiated the process of new mental health policy formulation, adoption of mental health legislation stressing human rights of patients, and a strong call for a pragmatic balance of community and hospital services. In contrast to the development in the Western Europe, the civic society was suppressed and NGOs and similar organizations were practically non-existent or under governmental control. Mental health services are financed from the public health insurance as any other health services. There is no separate budget for mental health. We can observe that the know-how about modern mental health care and about direction of needed reforms is available in documents, policies and programmes. However, this does not mean real implementation.ConclusionsThe burden of totalitarian history still influences many areas of social and economic life, which also has to be taken into account in mental health policy. We may observe that after twenty years of health reforms and reforms of health reforms, the transition of the mental health systems still continues. In spite of many reform efforts in the past, a balance of community and hospital mental health services has not been achieved in this part of the world yet.
The objective of this study is to investigate the relationship between the type of urban spatial structure, population density and the selected types of capital and current municipal expenditures. Seven types of urban spatial structures at the level of city blocks are defined. Different types of municipal expenditure (urban green, pavement, roadway and public lighting) are estimated by the data from 22 Czech cities and six city districts. The capital and current municipal expenditures are calculated for each urban structure per hectare and per capita. The most expensive urban structure per hectare is the urban structure of estates and high rises, which is caused by the large proportion of public space. On the other hand, single detached houses are the least costly. If the population density is taken into account and municipal expenditures are calculated per capita, the least costly urban structure is the urban block structure followed by the organic urban structure (historical centre), which is given by high population density and lower size of public space. The urban structure of single detached houses is the most costly urban structure per capita.
The existence of geographic differences in health resources, health expenditures, the utilization of health services, and health outcomes have been documented by a lot of studies from various countries of the world. In a publicly financed health system, equal access is one of the main objectives of the national health policy. That is why inequalities in the geographic allocation of health resources are an important health policy issue. Measures of inequality express the complexity of variation in the observed variable by a single number, and there is a variety of inequality measures available. The objective of this study is to develop a measure of the geographic inequality in the case of multiple health resources. The measure uses data envelopment analysis (DEA), which is a non-parametric method of production function estimation, to transform multiple resources into a single virtual health resource. The study shows that the DEA originally developed for measuring efficiency can be used successfully to measure inequality. For the illustrative purpose, the inequality measure is calculated for the Czech Republic. The values of separate Robin Hood Indexes (RHIs) are 6.64% for physicians and 3.96% for nurses. In the next step, we use combined RHI for both health resources. Its value 5.06% takes into account that the combinations of two health resources serve regional populations.
Keywords data en vel op ment anal y sis, ef fi ciency, health ser vices, hos pi tals JEL Clas si fi ca tion C10, D24, I10PO LI TIC KÁ EKO NO
Health expenditure estimates present the most detailed information on resource allocation in the mental health system of the Czech Republic. The application of the standardized framework in other countries can improve the quality of international comparisons. On the national level, especially if the time series are available, mental health accounts can serve as a useful tool for strategic resource allocation decisions. This is particularly useful for the countries that plan changes in resource allocation directed from institutional to community-based care.
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