Résumé :
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The focus of this article is changes in Slovak health-care policy 1990-97. To place these changes in a comparative perspective we also examine recent Czech, Polish and Hingarian experiences. In the Slovak case we show that although there has been official support for privatization, decentralisation, mixed sources of provision, accountability and individual choice, practice progress towards these goals has been very slow. This relative immobility has been caused by public preferences ; chronic political instability ; the legacy of planning ; a policy-making process dominated by a small number of politicians and a politicized bureaucracy. In addition we argue that the variety of health-care policies we observe in Central Europe reflects the general lack of a clear vision of social policy during transition. The article has six main sections. In the first we use public choice theory to explain why the results have occured. In the second we sketch the health-care system under communism. There follows a description of policy changes since 1989. This topic is split into three parts. First the political background to change is described, then the finance of health care is discussed, and finally issues of organization, control and delivery are raised. A concluding section has a summary and discussion of the arguments.
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