Reforming hospital systems in turbulent times

The countries of central and eastern Europe and central Asia have embarked, to varying extents over the last decade, on a process of restructuring their hospitaldominated health care systems. In doing so, they have, however, encountered considerable barriers. Hospitals are, literally, large immovable objects, frequently designed to meet the needs of a long-gone era. Their cultures are often equally rigid, dominated by powerful medical specialists who resist challenges to their dominance. Even under the best of circumstances implementing change is difficult, but some of these countries have been doing so under the worst of circumstances: near economic collapse; social upheaval; in the midst of re-building their political and civil institutions; while facing war or civil conflict; and the reduction of health budgets.