WORLD BANK TECHNICAL PAPER NO. 348 '~p 3q in progress bllc diacummlocm(g Dec . lI-9C%- Trends in Health Status, Services, and Finance The Transition in Central and Eastern Europe V0lume II, Statistical A nnex 4w-- G;uiaara Chie//araj O/soji Adei Alexander S. Preker E//en Goldsteii RECENT WORLD BANK TECHNICAL PAPERS No. 272 Greaney and Kellaghan, Equity Issues in Public Examinations in Developing Countries No. 273 Grimshaw and Helfer, editors, Vetiver Grass for Soil and Water Conservation, Land Rehabilitation, and Embankment Stabilization: A Collection of Papers and Newsletters Compiled by the Vetiver Network No. 274 Govindaraj, Murray, and Chellaraj, Health Expenditures in Latin America No. 275 Heggie, Management and Financing of Roads: An Agenda for Reform No. 276 Johnson, Quality Review Schemes for Auditors: Their Potential for Sub-Saharan Africa No. 277 Convery, Applying Environmental Economics in Afica No. 278 Wijetilleke and Karunaratne, Air Quality Management: Considerations for Developing Countries No. 279 Anderson and Ahmed, The Case for Solar Energy Investments No. 280 Rowat, Malik, and Dakolias, Judicial Reform in Latin America and the Caribbean: Proceedings of a World Bank Conference No. 281 Shen and Contreras-Hermosilla, Environmental and Economic Issues in Forestry: Selected Case Studies in Asia No. 282 Kim and Benton, Cost-Benefit Analysis of the Onchocerciasis Control Program (OCP) No. 283 Jacobsen, Scobie and Duncan, Statutory Intervention in Agricultural Marketing: A New Zealand Perspective No. 284 Vald6s and Schaeffer in collaboration with Roldos and Chiara, Surveillance of Agricultural Price and Trade Policies: A Handbookfor Uruguay No. 285 Brehm and Castro, The Market for Water Rights in Chile: Major Issues No. 286 Tavoulareas and Charpentier, Clean Coal Technologies for Developing Countries No. 287 Gillham, Bell, Arin, Matthews, Rumeur, and Hearn, Cotton Production Prospects for the Next Decade No. 288 Biggs, Shaw, and Srivastiva, Technological Capabilities and Learning in Afican Enterprises No. 289 Dinar, Seidl, Olem, Jorden, Duda, and Johnson, Restoring and Protecting the World's Lakes and Reservoirs No. 290 Weijenberg, Dagg, Kampen Kalunda, Mailu, Ketema, Navarro, and Abdi Noor, Strengthening National Agricultual Research Systems in Eastern and Central Africa: A Framework for Action No. 291 Vald6s and Schaeffer in collaboration with Errazuriz and Francisco, Surveillance of Agricultural Price and Trade Policies: A Handbook for Chile No. 292 Gorriz, Subramanian, and Simas, Irrigation Management Transfer in Mexico: Process and Progress No. 293 Preker and Feachem, Market Mechanisms and the Health Sector in Central and Eastern Europe No. 294 Valdds and Schaeffer in collaboration with Sturzenegger and Bebczuk, Surveillance of Agricultural Price and Trade Policies: A Handbook for Argentina No. 295 Pohl, Jedrzejczak, and Anderson, Creating Capital Markets in Central and Eastern Europe No. 296 Stassen, Small-Scale Biomass Gasifiers for Heat and Power: A Global Review No. 297 Bulatao, Key Indicators for Family Planning Projects No. 298 Odaga and Heneveld, Girls and Schools in Sub-Saharan Afica: From Analysis to Action No. 299 Tamale, Jones, and Pswarayi-Riddihough, Technologies Related to Participatory Forestry in Tropical and Subtropical Countries No. 300 Oram and de Haan, Technologies for Rainfed Agriculture in Mediterranean Climates: A Review of World Bank Experiences No. 301 Mohan, editor, Bibliography of Publications: Technical Department, Afica Region, July 1987 to April 1995 No. 302 Baldry, Calamari, and Yamdogo, Environmental Impact Assessment of Settlement and Development in the Upper Lraba Basin No. 303 Heneveld and Craig, Schools Count: World Bank Project Designs and the Quality of Primary Education in Sub-Saharan Afica No. 304 Foley, Photovoltaic Applications in Rural Areas of the Developing World No. 305 Johnson, Education and Training of Accountants in Sub-Saharan Anglophone Africa No. 306 Muir and Saba, Improving State Enterprise Performance: The Role of Internal and External Incentives (List continues on the inside back cover) WORLD BANK TECHNICAL PAPER NO. 348 Social Challenges of Transition Series Trends in Health Status, Services, and Finance The Transition in Central and Eastern Europe Volume II, StatisticalAnnex Gnanaraj Chellaraj Olusoji Adeyi Alexander S. Preker Ellen Goldstein The World Bank Washington, D.C. Copyright @ 1996 The International Bank for Reconstruction and Development/THE WORLD BANK 1818 H Street, N.W. Washington, D.C. 20433, U.S.A. All rights reserved Manufactured in the United States of America First printing December 1996 Technical Papers are published to communicate the results of the Bank's work to the development community with the least possible delay. The typescript of this paper therefore has not been prepared in accordance with the procedures appropriate to formal printed texts, and the World Bank accepts no responsibility for errors. Some sources cited in this paper may be informal documents that are not readily available. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the countries they represent. The World Bank does not guarantee the accuracy of the data included in this publication and accepts no responsibility whatsoever for any consequence of their use. The boundaries, colors, denominations, and other information shown on any map in this volume do not imply.on the part of the World Bank Group any judgment on the legal status of any territory or the endorsement or acceptance of such boundaries. The material in this publication is copyrighted. Requests for permission to reproduce portions of it should be sent to the Office of the Publisher at the address shown in the copyright notice above. The World Bank encourages dissemination of its work and will normally give permission promptly and, when the reproduction is for noncommercial purposes, without asking a fee. Permission to copy portions for classroom use is granted through the Copyright Clearance Center, Inc., Suite 910, 222 Rosewood Drive, Danvers, Massachusetts 01923, U.S.A. For a copy of Update describing new publications, contact the Distribution Unit, Office of the Publisher, The World Bank, 1818 H Street, N.W., Washington, D.C. 20433, U.S.A., or Publications, The World Bank, 66, avenue d'I6na, 75116 Paris, France. A catalog and ordering information are also available on the Internet at http://www.worldbank.org. All of the authors work for the World Bank. Gnanaraj Chellaraj is a consultant to the Bank. Olusoji Adeyi is a health specialist in the Human Resources Operations Division of the Europe and Central Asia Department. Alexander S. Preker is senior health economist in the Human Development Department. At the time of writing, Ellen Goldstein was senior human resources economist in the Human Resources Operations Division of the Europe and Central Asia Department. ISSN: 0253-7494 Cover montage by Joyce C. Petruzzelli Photos by Nelson Ryland. Library of Congress Cataloging-in-Publication Data Trends in health status, services, and finance : the transition in Central and Eastern Europe / Ellen Goldstein ... [et al.]. p. cm. - (World Bank technical paper, ISSN 0253-7494 ; no. 341. Social challenges of transition series) Includes bibliographical references. Contents: v. 1. [without special title] - v. 2. Statistical annex. ISBN 0-8213-3751-3 (v. 1) - ISBN 0-8213-3828-5 (v. 2) 1. Medical care-Europe, Eastern. 2. Medical care-Europe, Central. 3. Health status indicators-Europe, Eastern. 4. Health status indicators-Europe, Central. 5. Medical care-Europe, Eastern-Finance. 6. Medical care-Europe, Central-Finance. I. Goldstein, Ellen, 1960- . II. Series: World Bank technical paper ; no. 341. III. Series: World Bank technical paper. Social challenges of transition series. RA407.5.E852T74 1996 96-40968 362.1'0943-dc2O CIP -iii- TABLE OF CONTENTS FOREW ORD ................................................................................................................................................. v ACKN OW LEDGM EN TS .......................................................................................................................... vii ABSTRACT ...... ........................................................................................................................................... ix INTRODUCTION ........................................................................................................................................xi LIST OF ACRONYM S ............................................................................................................................. xii CHAPTER I: Data Sources and Lim itations................................................................................................. CHAPTER II: Statistical Tem plates .............................................................................................................7 CHAPTER III: Figures.............................................................................................................................. 101 GLOSSARY..............................................................................................................................................29 BIBLIOGRAPHY .....................................................................................................................................131 1 1 1 e -v- FOREWORD Transition from central planning in Central and Eastern Europe has led to dramatic and rapid changes in the lives of millions of people. Democratic liberalization has empowered citizens through the provision of basic rights and freedoms and the development of civil society, while economic liberalization has brought the promise of improved living standards, and granted individuals increased choice in consumption, education, health and employment. Despite remarkable expansion of opportunity, transformation has not come without great pain. Poverty has risen throughout the region, real incomes have declined, and crude death rates have climbed in many countries. Equality among households has suffered as a result of increasing income disparity and the erosion of access to basic social services. While the widening income gap is an expected side effect of transition, accompanying the liberalization of prices and wages, heightened social dissatisfaction threatens political stability and the success of economic reforms. On the most basic level, economic recovery and growth in transition depend upon the capacity of individuals to respond and adapt to the changing requirements of market society. The socialist economies embarked upon reform with strong legacies of state commitment to the development of human capital. However, rigidities of central planning and bureaucratic control limited the quality and efficiency of social services. Transition has exacerbated these trends, as unprecedented collapses in output and consequent fiscal crises have undermined the abilities of governments to sustain pre-transition levels of access to social programs and services. At the same time, the introduction of market forces has opened up an array of opportunities for innovation in the provision and financing of health, education and social insurance, and for addressing increases in poverty and unemployment. This paper is one in a series of reports based upon the Social Challenges of Transition (SCT) database. Developed by the Human Resources Operations Division of the Central and Southern Europe Departments of the World Bank, SCT was initiated in order to document empirically the evolving effects of transition on individuals and families. The project examines the social risks facing people and the policy responses taken by governments since 1989, by monitoring indicators of health, earnings, education, labor markets, pensions, social assistance and poverty. The findings contained in this initial set of thematic cross- country papers make a valuable contribution to our understanding of social developments in Central and Eastern Europe five years into the transition. They provide a basis for further improvements in the content and quality of our support to the countries in the region. Kenneth G. Lay Jean-Michel Severino Director Director Country Department I Country Department II Europe and Central Asia Region Europe and Central Asia Region -vii- ACKNOWLEDGMENTS The material reported in this paper was prepared as a part of a larger, multi-sectoral study on the Social Challenges of the Transition in the Central and Eastern Europe, undertaken by the World Bank's Human Resources Operations Division, Central and Southern Europe Departments under the direction of Ralph W. Harbison, Human Resources Division Chief for Central and Southern Europe (ECl/2HR). Much of this study would not have been possible without the close collaboration of the European Office of the World Health Organization in Copenhagen and its Health For All (HFA) monitoring network throughout Central and Eastern Europe. The authors are particularly indebted to Mr. Nanda Arun (European Regional Office of the World Health Organization in Copenhagen) and Dr. Jean-Pierre Poullier (OECD) for their early contributions to the methodological design of the study. Invaluable cooperation and contributions, especially the time-consuming process of compiling the data, were received from the staff of the Ministries of Health, Ministries of Finance, Cerial Statistical Offices and other counterpart agencies throughout Central and Eastern Europe. The authors would also like to thank Mr. Kemal Dervis (Vice President, MNA Region) and Mr. Andrew Rogerson (Director of Africa 3 Department) for their continued enthusiasm and support during the early phases of the study. Peer reviewers, Mr. George Schieber and Dr. Prab at Jha (Human Development Department), Dr. Jose-Luis Bobadilla (Principal Health Speciali Inter-American Development Bank), Dr. David Peters (West Central Africa Department) and Dr.., artin McKee (Senior Lecturer, London School of Hygiene and Tropical Medicine) provided valuable comments during the final revision of the document. Ms. Dena Ringold (Research Assistant) and Mr. Brandon Cline (Staff Assistant) made substantial editorial improvements to the text. Technical support for the SCT data collection exercise was provided by Mr. Jan Rutkowski and Ms. Dorota Holzer (Consultants, World Bank Resident Mission Warsaw), Stephen Heyneman and Verdon Staines, (EMTHR) who provided technical and partial financial support for the study, and Mr. Ross Pavis (Staff Assistant, EC1/2HR). _iXw ABSTRACT This paper is the Statistical Annex to the report, "Trends in Health Status, Services and Finance: The Transition in Central and Eastern Europe," and is part of a cross-national study of trends in health and health care during economic transition to a market economy. It describes the data analyzed in the main report, and contains comprehensive charts and tables of epidemiological, demographic and health financing indicators for the period 1987-1995. The annex also describes the data sources and discusses data quality. As is the case in many developing countries, information on health, health care and financing in the transition economies has been scarce and unreliable. The quality and comparability of much of the data obtained for this study is limited by changes in collection methodologies, discrepancies in definitions, and outdated information technologies and accounting systems. This study makes a useful contribution to an understanding of the impact of transition on the health sector in Central and Eastern Europe, and highlights the need for a more systematic approach to data collection and operational research in the region, supported by the World Bank and the various international agencies. -xi- INTRODUCTION Lack of information on demographic, epidemiological and health financing indicators has been a persistent problem in developing countries. Many developing countries lack detailed breakdowns of health status and service data, and data on private services and expenditures are almost non-existent. At a time when declines in GDP have resulted in increasing poverty (World Bank, 1995, 1996) and reduced access to basic health care needs (Preker and Feachem, 1996), the availability of health related data is vital for identifying critical issues in health at the country and regional level. Furthermore, comprehensive data are essential for the development of viable health care projects and policies (Segall, 1991; Hammer, 1996). This paper is the Statistical Annex to the main report, "Trends in Health Status, Services and Finance: The Transition in Central and Eastern Europe, Volume I." It contains the data analyzed in the report as well as charts on epidemiological, demographic and health financing indicators for the period 1987-1995. It represents part of the Social Challenges of Transition (SCT) project, a broader effort by the World Bank to compile and analyze social sector data in Central and East Europe (CEE). Relative to the established market economies (EME), the availability of health expenditure data in developing countries is poor. Abel-Smith standardized cross-national data by defining categories of health services, listing the sources of finance for the countries of Western Europe and North America (Abel Smith, 1963, 1967). During the past two decades several studies have been undertaken mostly in industrialized countries, regarding the trends in health expenditures (Schieber and Poullier, 1993, 1991a, 1991b, 1987; Schieber, 1990, 1987; Newhouse, 1987; 1977; Parkin et al., 1987; McGuire et al., 1996; Hitiris and Posnett, 1992; Murillo et al., 1993; Gerdtham et al., 1992; Gerdtham and Jonsson, 1994; 1992; 1991; Pfaff, 1990; Culyer, 1988; Wolfe, 1986). In addition, methodologies for tracking and comparing both public and private health care expenditures in industrialized countries have also been developed (Getzen and Poullier, 1991; Poullier, 1989; Getzen, 1990; OECD 1985, 1989). The World Development Report (WDR) 1993 was one of the first comprehensive attempts to gather health-related data across developing countries and transition economies. Since the early 1990s, several attempts have been made to gather and analyze health-related data across regions such as Latin America (McGreevey, 1992; Lee and Bobadilla, 1994; Govindaraj et al., 1995, 1996; Musgrove, 1983), Africa (Vogel, 1992; 1989; Gbesemete and Gerdtham, 1992) and Asia (Griffin, 1992), and in individual countries such as Barbados (Chellaraj, 1992), Mexico (Chellaraj, 1994), Hong Kong (Chu, 1994), Ivory Coast and Peru (Gertler and van der Gaag, 1990), Egypt (Rannan-Eliya, 1995), Sri Lanka (Rannan-Eliya, 1996), Zambia (Berman et al., 1995) and South Africa (McIntyre, 1995), as well as data on international assistance (Michaud and Murray, 1993). However, the data collected during most of these studies were rather limited in scope, and detailed breakdowns of health expenditures were rarely presented. The World Bank is currently developing a methodology for National Health Accounting schemes in developing countries (World Bank, 1996) which will facilitate the collection and analysis of health related data. For Central and Eastern Europe, the only available data on health expenditures were empirical estimates based on the statistical model developed for the 1993 WDR (Murray et al., 1993, 1994), while the 1996 WDR addresses additional health related issues in the former socialist economies (FSE). Furthermore, the 1993 WDR model forecast only total expenditures for individual countries as a whole, and did not provide information on categories of expenditures including wages and drugs, or on levels of services such as public health, or personal health services such as hospitals and polyclinics. Finally, the relationship between epidemiological and demographic indicators and trends in health expenditures was not analyzed in most of the studies discussed above. In an attempt to address these drawbacks in the -xii- Central Asian transition economies, a detailed analysis was recently undertaken on health expenditures in Central Asia, which took into consideration the health status of the population and delivery of health services (Klugman et al., 1996). The present study is an improvement over the previous attempts, as it compiles detailed data on health expenditures by categories and levels such as personal health services, and demographic, epidemiological and health service delivery indicators in selected CEE countries. This Annex is structured as follows: Chapter I provides a brief review of data sources, and the problems associated with data availability and the existing accounting systems and MIS in individual countries; Chapter II presents and discusses the statistical templates; Chapter III presents the various figures and charts (these are discussed in the main report, Volume I, to which the reader is referred); and Chapter IV is a glossary which provides the definitions of the terms used in the report. -xiii- LIST OF ACRONYMS CEE Central and Eastern Europe. EME Established market economies. FSE Former socialist economies. FYR Former Yugoslav Republic. GDP Gross Domestic Product. GHIC General Health Insurance Company. HFA Health For All (database maintained by the WHO). IMF International Monetary Fund. IMR Infant Mortality Rate. MIS Management Information System. MOF Ministry of Finance. MOH Ministry of Health. MOL Ministry of Labor. NHI National Health Insurance Fund. NIA National Income Accounts. OECD Organization for Economic Cooperation and Development. SDR Standardized Death Rate. UNDP United Nations Development Program. WDR World Development Report. WHO World Health Organization. -1- CHAPTER I: DATA SOURCES AND LIMITATIONS Data Sources Data for this study were collected from both primary and secondary sources, based on a standardized template. The health status module included well-known indicators of life expectancy, mortality, morbidity, natality and fertility, as well as data on nutrition, sanitation and lifestyle behaviors. The health services module focused on health personnel, infrastructure, utilization rates, quality of care, public health activities, privatization and private sector development. These two sets of indicators were based on standard definitions, used internationally by the World Health Organization (WHO). The health finance module outlined sources of funds (e.g. central budget, national health insurance, households) from both the public and private sectors. Uses of funds were examined according to broad expenditure categories (e.g. personnel expenditures, drug expenditures, utilities) and level of health care. The latter module also sought information on average salaries for health personnel. In designing the health finance module, reference was made to the Organization for Economic Cooperation and Development's (OECD) Resource Accounting System, which includes a standardized health finance and expenditure database for its 24 OECD member countries. Efforts were made to ensure consistency in definitions and comparability of data with the OECD database, although the disaggregated data set was much more limited. Much of the data on health status, and a portion of the data on health services, were obtained from the WHO Health for All (HFA) database for Europe region, which includes Western Europe as well as Central and Eastern Europe and the countries of the former Soviet Union. The HFA database, consisting of approximately 270 health indicators in the European region, was initiated in 1985 to track international progress in meeting the targets of Health for All by the Year 2000. For countries in arrears on their reporting, or for those with no past reporting to the WHO (e.g. the independent countries of the former Yugoslav federation), the authors worked with ministries of health and national statistical offices in the field to gather the data needed to complete the time series, according to standard WHO definitions. More recent data on life expectancy and age-standardized death rates were obtained from the World Health Statistics Annual for 1993 and 1994. Collecting data on the sources and uses of funds and average wages for the health finance module required extensive field work, and often involved laborious reclassification and/or aggregation of data to ensure cross-national comparability. The problem was aggravated by the lack of up-to-date Management Information Systems (MIS) and accounting systems in a number of countries. In some cases, data requested were hand-written by government officials due to the lack of computers and other technological know-how. Most data were collected directly from Ministries of Finance (MOF) and/or national health insurance offices. The only exception was in the former Yugoslav Republics where the data were collected from the Ministries of Health (MOH), the Statistical Offices and the National Health Insurance Funds (HIF). Financial data were collected in nominal local currency units. Macroeconomic data neededfor trenf analysis (e.g. GDP, public expenditures) are those contained in World Bank economic reports. It should be emphasized that the macroeconomic data used in this study were those available at the time of analysis, and may be subject to change. Real trends in revenues and expenditures 'For information on, and access to, the WHO Health for All database for Europe, contact WHO Regional Office for Europe, Copenhagen, Denmark. 2 World Health Organization, 1995. World Health Statistics Annual 1994. Geneva. 3 World Health Organization, 1994. World Health Statistics Annual 1993. Geneva. -2- were derived by deflating nominal time series data with GDP deflators. In addition to the health finance data obtained in the field, up-to-date information on privatization, private sector development, utilization of health services and quality of care was only available -- if available at all -- through field work. The various data sources by country are discussed below. Albania: Government budgets provided information on health expenditures, by categories such as personnel expenditures and drugs. Administrative expenditures were included under the "other" expenditure category. However, the existing MIS does not provide data on expenditures regarding public health activities. Very little data on health status and health service indicators were available. Bulgaria: The expenditures are classified into two categories: Municipal and Republican budgets. The Municipal budgets are responsible for personal health services in the various municipalities and the Sofia region. However, only the Republican budget, which is directly under the jurisdiction of the MOH, allocates resources for public health related activities. The data on personal health services were generated by subtracting the consolidated budget from the public health budget of the Republican budget. Limited information was available on medical education and research. The data on expenditures were provided by the MOF, while the data on salaries, number of employees and epidemiological indicators were provided by the MOH. Only the administrative budget for the MOH at the Republican level was available. At the Municipal level, the administrative units cover a number of sectors ranging from agriculture to health and education and were not disaggregated by sectors. Croatia: Personal health services in Croatia are financed through the NHI and the private out-of-pocket expenditures of individuals and corporations. Since 1993, the balance sheets of all public hospitals and health centers have been sent to the MOH where they are compiled and their total annual expenditures calculated. Thus, for 1993 and 1994, detailed breakdowns of personal health services were made available. Before 1993, the data were compiled and reported by the National Statistical Institute in its annual Statistical Yearbooks. The MOH budget provides for public health services and administrative expenses, the latter included under the "other" expenditures category. Limited data on medical education were provided by the Ministry of Science and Technology. Data on salaries and medical personnel were compiled from the Statistical Yearbooks, and the epidemiological data from the National Public Health Institute. Until 1991, the expenditures were expressed in thousands of Croatian denars and since 1992 in thousands of kunas. The currency units were not normalized, due to the magnitude of the change in units. However, the various indicators were adjusted to account for this change. Czech Republic: The MOF provided data on health expenditures by category until 1991. Since 1992, the data by categories have been obtained from the National Income Accounts (NIA), prepared by the Central Statistical Office. The MOH expenditures cover only public health and administrative activities. Although information on total capital expenditures was provided by the MOF, the existing MIS cannot disaggregate them by various categories such as vehicles and equipment. The data on NHI were obtained from the MOF and the General Health Insurance Company (GHIC). The GHIC also provided information on its reimbursement to the private sector doctors, both at home and abroad. The Institute of Health Information and Statistics provided the epidemiological indicators and health services data to the WHO for its Health for All database. The data on average levels of salaries for doctors and nurses were provided by the Ministry of Labor (MOL). The financial data for 1993 and 1994 derived from the NIA are tentative, and subject to change. FYR Macedonia: Personal health services in FYR Macedonia are financed mostly through the NHI and private out-of-pocket expenditures of individuals and corporations. Beginning in 1992, the balance sheets of all public hospitals and health centers have been sent to the Health Insurance Fund (HIF) where they are compiled and total annual expenditures are calculated. However, the current MIS only provides for the breakdowns of certain categories of personal health services. These data were compiled and -3- reported by the country's Statistical Office in its annual Statistical Yearbooks. The MOH budget provides for public health services and its administrative expenditures. Data on education and research and development were not provided. Data on salaries and medical personnel were compiled from the Statistical Yearbooks, and the epidemiological data from the National Public Health Institute. Hungary: The data on expenditures and revenue were obtained from the MOH and the NHI. The administrative expenditures of the MOH are included under "other" expenditures. The MOH also provided information on hospital and non-hospital expenditures and limited information on salaries. The data on the number of employees were obtained from the MOH, and epidemiological indicators from the Institute for Public Health. Lithuania: The MOF provided data on public expenditures. However, the accounting system and the MIS have changed twice during the transition. Under the old Soviet system, energy and utilities and maintenance were classified under "other" expenditures. Soon after independence in 1991, the system was changed, and transportation and consumables/other materials were included under "other" expenditures. Since 1993, the categories were split further into energy/utilities, maintenance, transportation, consumables/supplies and "other" expenditures. For 1993 and 1994, "other" categories include only such items as stipends and MOH administrative expenditures. Currency changes have also complicated matters. For 1987-1991, the expenditure data were expressed in rubles, and for 1992 in talonas. In 1993, litas became the unit of measure. Rubles and talonas were converted into litas using the appropriate conversion rate provided by the International Monetary Fund (IMF). The epidemiological data were provided by the Statistical Institute, along with limited information on private expenditures. Poland: At the time of the analysis, data were available only up to 1993. Furthermore, a detailed breakdown was only available for the period 1991-1993. Moreover, for 1987 and 1988, only data on MOH expenditures were available. Direct charges were obtained from the Household Surveys and were compiled by World Bank poverty specialists. Health expenditures, provided by the MOH, include information on employees of the railways and health-related expenditures of other ministries for the period 1989-1993. The MIS at the MOH provided limited information on wages and salaries of medical personnel. The Central Statistical Office compiled epidemiological data for Poland. Romania: Information on health expenditures for all ministries and localities, by all categories with the exception of energy, was made available by the MOF for the period 1990-1994 and budgets were provided for 1995. However, the existing MIS and accounting systems do not account for expenditures on public health, medical education and research and development. "Other" expenditures include administrative expenditures of the MOH. For 1990-1995, the MIS also provided information by hospital and non-hospital categories. The information on average wages and benefits, along with epidemiological information was provided by the MOH. Slovakia: The MOF provided data on health expenditures by categories until 1991. Since 1992, the data were obtained from the NHI Office. The epidemiological data were provided by the MOH. Slovakia lacks disaggregated data, both on recurrent and capital expenditures. Although information on salaries was available from the MOF, at the time of data collection the MIS aggregated all other categories into consumables/other supplies. This category includes a number of items ranging from heating and lighting, to drug supplies for personal health services. Information on capital expenditures, or on the administrative expenditures of the MOH were not included. Finally, no data were available on reimbursement by public insurance schemes to doctors in the private sector, although the NHI provides reimbursements for a variety of services ranging from visits to private sector doctors, both at home and abroad. -4- Slovenia: The MOF provided data on revenues and expenditures for 1993-95, while the MOH provided data for the years prior to 1993. However, the administrative expenditures of the MOH were not included. The Institute of Macroeconomic Analysis and Development provided data on private insurance and the MOL provided salary data. Until 1990, health revenues were contributions collected by special funds within the state budget. The distinction between the state budget and insurance was made only after the implementation of the NHI. Epidemiological indicators were gathered from the Institute of Public Health of the MOH. Turkmenistan: Data on health revenues and expenditures were made available by the Ministry of Economy and Finance, while the data on epidemiological indicators and health services were available from the MOH, for the period 1991-1994. The existing MIS did not account for expenditures before 1991 or for any administrative expenditures. The situation was similar for health expenditures after 1992. Data Limitations Several problems were encountered during data collection which were more severe in some countries than others. These issues are discussed below by country. Albania: The existing MIS does not provide data on allocations between hospitals and non-hospitals and salaries of employees. Data on immunization and number of doctors were scant. However, a complete set of data on personal health services were made available, although these did not include any information on public health expenditures. No data on wages and salaries of health personnel were available. Bulgaria: Detailed breakdowns by sub-categories of personal expenditures were available for 1989- 1994. The existing MIS does not break down capital expenditures by various categories such as equipment and vehicles. Although a cost accounting system has been established, allocations between hospitals and non-hospitals were not provided. Data on average salaries were available for both doctors and nurses only for the period, 1993-1995. There were significant gaps in the salary data prior to this period. Furthermore, only the Republican part of the administrative expenditures was provided. As several sectors are under the jurisdiction of the municipal level administration, the administrative expenditures at that level could not be included in the data. Another gap was the lack of data on medical education and research and development. The epidemiological information in Bulgaria was strong, although information on 1994 was unavailable at the time of the study. Croatia: Although financial and epidemiological data for Croatia were readily available, there were limitations with the total expenditure information. The data included only the central government budget, and not the extra-budgetary items, such as funds for pensions and health insurance. Thus, the figure relating health expenditures to total expenditures is likely to be significantly over-estimated. Furthermore, a detailed breakdown of personal health services was not compiled prior to 1993. Czech Republic: Lack of disaggregated data on capital expenditures was the major gap in the Czech data set. The disaggregated recurrent expenditure data for 1993 and 1994 are preliminary. While financial data for 1994 were available, epidemiological indicators and health services data were unavailable. FYR Macedonia: At the time of writing, both financial and epidemiological data for 1994 were scant. Furthermore, no information on medical education and research and development expenditures were available. Capital expenditure data were available only after 1991. Data on expenditure allocations by hospitals and non-hospitals were limited. Moreover, the Statistical Office only calculated the salary levels for the sector as a whole, and for individual categories such as hospitals and health centers. A significant amount of epidemiological data was made available by the Statistical Office. -5- Hungary: A large amount of information on recurrent health expenditures and health revenues were available, including information on research and development and medical education for 1991-1994. However, the existing MIS was unable to provide a detailed breakdown of capital expenditures. Data on salaries of medical personnel were limited. Furthermore, there were significant gaps in the epidemiological and health services data, especially aftert992. Lithuania: Frequent changes in budget methodology make comparisons across years and with other countries difficult. Expenditures could not be categorized as hospital or non-hospital expenditures. Private expenditures were unreliable due to sampling bias. Only 450 households were surveyed and rural areas of the country were not adequately covered in the sample. No information on wages and salaries of health professionals were available. Poland: Data for 1994 were not available at the time of analysis. Detailed breakdowns of capital expenditures, and salaries and expenditure allocations by hospitals were unavailable. The situation was similar for epidemiological and health personnel data. Romania: Data on research, public health and medical education expenditures were not provided. No disaggregated capital expenditures were available. Sloyakia: The existing MIS provides very little data on disaggregated recurrent expenditures and reimbursement by the public sector to private doctors. Little or no information on capital expenditures or the administrative expenditures of the MOH was available. Epidemiological data and information on health services were available for the period 1987-1992. However, there were significant gaps for both 1993 and 1994. Furthermore, expenditures could not be allocated by hospital and non-hospital categories, and no information on wages and salaries of health professionals was accessible. Slovenia: Detailed breakdowns of personal health services were available, although no information was provided for medical training, public health services and research and development, or administrative expenditures of the MOH or the Health Insurance Fund. Capital expenditures were mostly concentrated on equipment. Expenditure allocations by hospitals and non-hospitals were provided for the period 1987-1993 and information on salaries were also provided for the same period. Epidemiological data and information on the number of medical personnel were available for most categories for the period 1987-1993, but corresponding data for 1994 were not available. Turkmenistan: The MIS did not provide health financing data before 1991, or epidemiological and health services data since 1992. Little, or no, disaggregated data regarding capital expenditures were available. Furthermore, no data on the administrative expenditures of the MOH were available. Expenditures could not be allocated by hospital and non-hospital categories, and no information on wages and salaries of health professionals was available. For all of the countries, information on the emerging private sector was rare or non-existent. Although for some countries, such as Bulgaria, data were available regarding the number of private doctors and nurses. Information on revenues earned by the private sector was not available for any country. Finally, it should be emphasized that it was difficult to obtain a comprehensive overview of foreign assistance. Technical assistance and loans have become an important category in recent years, especially since the onset of major reforms. In most developing countries, particularly Africa and South Asia, the United Nations Development Program (UNDP) keeps track of this information, both according to the project and year, in the publication "Development Cooperation." This document greatly assists in donor coordination, and helps in avoiding overlap and duplication of project-related activities. However, accurate total estimates of donor grants and loans are not available. -7- CHAPTER H: STATISTICAL TEMPLATES Table of Contents Section I: G eneral In dicators..................................................................................................................... 8 Table 1. General Indicators: Albania, Bulgaria, Croatia, Czech, Hungary, Lithuania, FYR Macedonia, Poland, Romania, Slovakia, Slovenia, Turkmenistan. Section H: Sources of Health Financing and Expenditures ..................................................................13 Sources of Financing and Expenditure: A. Health Financing; B. Health Financing (Deflated Expenditures, 1990=100); C. Health Financing (% GDP); D. Health Financing (% Total Expenditures) Table 2. Albania Table 3. Bulgaria Table 4. Croatia Table 5. Czech Republic Table 6. FYR Macedonia Table 7. Hungary Table 8. Lithuania Table 9. Poland Table 10. Romania Table 11. Slovakia Table 12. Slovenia Table 13. Turkmenistan Section III: H ealth Status and Services...................................................................................................63 Health Status and Services: A. Lifestyles and Healthy Environment; B. Appropriate Care; C. Health Status. Table 14. Albania Table 15. Bulgaria Table 16. Croatia Table 17. Czech Republic Table 18. FYR Macedonia Table 19. Hungary -8- Table 20. Lithuania Table 21. Poland Table 22. Romania Table 23. Slovakia Table 24. Slovenia Table 25. Turkmenistan This chapter discusses the data which were analyzed in the main report. The first section discusses the macroeconomic indicators used in the analysis, and the second provides general information on the financial data and indicators. The third section contains general information on epidemiological and demographic indicators, and delivery of health services. Further definitions are available in the Glossary (Chapter IV). The discussions in each section are accompanied by a corresponding data set. Section I: General Indicators Indicators for this study were derived using selected macroeconomic variables including the Gross Domestic Product (GDP), total expenditures and the GDP deflators (1990=100). The GDP (nominal) was used to calculate health expenditures as a proportion of GDP. Total expenditures (nominal) are the sum of total government expenditures at the central, state and local levels. These expenditures were also used to calculate health expenditures as a proportion of total government expenditures. The population is the total estimated mid-year population for each individual country. All expenditure and GDP data are expressed in local currency. The GDP index for each country was calculated based on the GDP deflator, with 1990 as the base year for all countries except Turkmenistan, where 1991 was used as the base year. For example, the GDP index for 1994 is the deflated GDP for 1994 divided by the deflated GDP for 1990, multiplied by 100. The macroeconomic variables used in these calculations were current at the time of analysis, and may differ from more recent World Bank figures. TABLE 1. CEE COUNTRIES: GENERAL INDICATORS Indicators 1987 1988 1989 1990 1991 1992 1993 1994 1995 Albania GDP Million Leks 17,253 17,008 18,681 16,813 16,474 48,477 113,041 166,297 204,500 Total Expenditures Million Leks 10,449 10,202 22,910 45,515 57,332 58,962 Population Millions 3.08 3.14 3.20 3.26 3.32 3.38 3.43 3.48 3.26 GDP Deflator 1990=100 1.00 1.00 1.00 1.00 1.36 3.67 15.23 19.92 14.00 Deflated GDP Index 17,253 17,008 18,681 16,813 12,158 13,227 7,425 8,350 14,607 GDP Index Index 102.62 101.16 111.11 100.00 72.31 78.67 44.16 49.67 86.88 Total Exp. Deflated Million Leks 10,449 7,529 6,251 2,989 2,879 4,212 Bulgaria GDP Million Levas 36,531 38,345 39,579 45,391 131,058 202,956 286,134 543,474 831,515 Total Expenditures Million Levas 22,000 22,400 23,200 26,200 60,947 92,404 150,233 239,844 375,133 Population Millions 8.72 8.69 8.64 8.61 8.57 8.52 8.47 8.43 GDP Deflator 1990=100 0.79 1.00 3.25 5.54 9.14 12.07 14.66 Deflated GDP Index 50,266 45,391 40,301 36,613 31,300 45,024 56,720 GDP Index Index 110.74 100.00 88.79 80.66 68.96 99.19 124.96 Total Exp. Deflated Million Levas 29,464 26,200 18,741 16,669 16,434 19,870 25,589 Croada GDP 000 HRDIKuna 1,221,800 3,663,800 47,253,900 276,158,400 451,436,100 3,366,729 52,436,541 82,600,000 94,560,000 Total Expenditures 000 HRDIKuna 173,720,000 1,406,800 15,263,630 38,032,590 46,255,000 Population 000 4,674 4,681 4,685 4,770 4,789 4,782 4,779 4,775 4,778 GDP Deflator 1990=100 1.00 2.04 15.81 252.91 490.31 584.30 GDP Deflated Index 276,158 221,292 212,949 207,333 168,465 180,365 GDP Index Index 100.00 80.13 77.11 75.08 61.00 65.31 Total Exp. Deflated 000 HRD/Kuna 85,156,863 88,982 60,352 77,568 88,2Z2 Czech Republic , GDP Million Kc 495,100 513,400 524,600 567,300 716,600 791,000 910,600 1,037,500 1,260,070 Total Expenditures Million Kc 385,100 447,300 511,800 590,300 Population Millions 10.28 10.29 10.30 10.31 10.31 10.33 10.34 10.36 10.37 GDP Deflator 1990=100 1.00 1.47 1.73 2.01 2.23 2.50 GDP Deflated Index 567,300 487,483 457,225 453,035 465,247 504,028 GDP index Index 100.00 85.93 80.60 79.86 82.01 88.85 Total Exp. Deflated Million Kc 222,601 222,537 229,507 236,120 TABLE 1. CEE COUNTRIES: GENERAL INDICATORS Indicators 1987 1988 1989 1990 1991 1992 1993 1994 1995 FYR Macedonia GDP 000 Denars 585,000 904,000 11,685,000 60,256,000 128,517,000 136,455,000 Total Expenditures 000 Denars 459,000 5,792,000 31,690,000 67,348,000 67,890,000 Population Thousands 1,995 2,007 2,018 2,028 2,039 2,056 2,073 2,215 2,119 GDP Deflator 1990=100 1.00 1.71 25.24 148.71 334.68 371.90 Deflated GDP Index 585,000 528,655 462,956 405,191 384,000 366,913 GDP Index Index 100.00 90.37 79.14 69.26 65.64 62.72 Total Exp. Deflated 000 Denars 268,421 229,477 213,099 201,231 182,549 Hungary GDP Million HUF 1,226,400 1,440,400 1,722,800 2,089,300 2,347,600 2,885,600 3,502,600 4,314,100 5,617,300 Total Expenditures Million HUF 738,700 892,300 1,041,500 1,194,500 1,345,600 1,778,100 2,004,900 3,103,700 Population Millions 10.62 10.60 10.58 10.55 10.48 10.41 10.34 10.23 10.23 GDP Deflator 1990=100 0.61 0.73 0.80 1.00 1.35 1.64 2.04 2.44 GDP Deflated Index 2,010,492 1,973,151 2,153,500 2,089,300 1,738,963 1,759,512 1,716,961 1,768,074 GDP Index Index 96.23 94.44 103.07 100.00 83.23 84.22 82.18 84.63 Total Exp. Deflated Million HUF 1,210,984 1,222,329 1,301,875 1,194,500 996,741 1,084,207 982,794 Lithuania GDP Million Litas 110.00 118.00 127.00 133.00 382.00 3386.70 11107.90 16980.70 24000.00 Total Expenditures Million Litas 41.00 45.00 48.00 47.00 149.00 1070.00 3910.00 6950.00 10000.00 Population Millions 3.64 3.67 3.70 3.72 3.74 3.74 3.73 3.72 3.71 GDP Deflator 1990=100 0.85 0.84 0.89 1.00 4.31 53.35 249.89 377.33 490.50 Deflated GDP Index 129.56 140.81 142.86 133.00 88.63 63.48 44.45 45.00 48.93 GDP Index Index 97.42 105.87 107.41 100.00 66.64 47.73 33.42 33.84 36.79 Total Exp. Deflated Million Litas 48.29 53.70 53.99 47.00 34.57 20.06 15.65 18.42 20.39 Poland GDP Billion Zlotys 16,940 29,629 118,319 560,271 808,829 1,149,442 1,557,800 2,077,000 2,900,000 Total Expenditures Billion Zlotys 6,389 10,610 47,157 244,243 395,832 595,105 777,999 1,044,136 1,473,473 Population Billions 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.04 GDP Deflator 1990=100 0.03 0.04 0.19 1.00 1.55 2.15 2.81 3.61 4.58 GDP Deflated Index 564,663 740,718 622,730 560,271 521,825 534,624 554,377 575,346 633,188 GDP Index Index 100.78 132.21 111.15 100.00 93.14 95.42 98.95 110.26 118.44 Total Exp. Deflated Billion Zlotys 212,967 265,250 248,195 244,243 255,375 276,793 276,868 289,234 321,719 TABLE 1. CEE COUNTRIES: GENERAL INDICATORS Indicators 1987 1988 1989 1990 1991 1992 1993 1994 1995 Romania GDP Million Lei 845,200 857,000 800,000 857,900 2,203,900 6,083,500 19,737,500 46,607,500 64,861,000 Total expenditures Million Lei 281,426 286,686 288,426 310,863 537,874 1,626,908 6,798,200 16,952,000 24,912,000 Population Millions 22.94 23.05 23.15 23.21 23.19 22.79 22.76 22.73 22.70 GDP Deflator (1990= 1990=100 0.87 0.87 0.87 1.00 2.95 9.29 28.95 67.37 88.25 Deflated GDP Index 971,494 985,057 919,540 857,900 747,085 654,844 681,779 691,814 734,969 GDP Index Index 113.24 114.82 107.19 100.00 87.08 76.33 79.47 80.64 85.67 Total Exp. Deflated Million Lei 323,478 329,524 331,524 310,863 182,330 175,125 234,826 251,625 282,289 Slovakia GDP Million Sk 216,900 237,500 237,500 257,100 295,700 301,800 340,800 396,600 458,200 Total Expenditures Million Sk 192,600 189,500 208,800 237,767 Population Millions 5.23 5.26 5.28 5.30 5.33 5.35 5.37 5.39 5.40 GDP Deflator 1990=100 0.93 1.00 1.34 1.49 1.72 1.92 2.14 GDP Deflated Index 255,376 257,100 220,672 202,550 198,140 206,563 214,112 GDP Index Index 99.33 100.00 85.83 78.78 77.07 80.34 83.28 Total Exp. Deflated Million Sk 129,262 110,174 108,750 111,106 Slovenia GDP Million Tolars 248,221 349,558 1,005,261 1,434,974 1,808,100 2,162,500 Total Expenditures Million Tolars 93,486 143,553 464,159 671,110 855,273 1,002,422 Population Millions 2.00 2.00 2.01 2.01 2.01 2.01 GDP Deflator 1990=100 0.76 1.00 1.97 5.99 8.01 10.17 12.33 Deflated GDP Index 248,221 177,441 167,823 179,148 177,788 175,385 GDP Index Index 100.00 71.48 67.61 72.17 71.62 70.66 Total Exp. Deflated Million Tolars 93,486 72,870 77,489 83,784 84,098 81,299 Turkmenistan GDP 000 Manats 34,000 653,000 11,051,000 205,312,000 674,852,000 Total Expenditures 000 Manats 20,000 378,000 2,172,000 15,287,000 128,200,000 Population 000 3,800 3,950 4,200 4,406 4,650 GDP Deflator Index 1.00 20.22 360.14 7434.80 30550.11 Deflated GDP 000 Manats 34,000 32,300 30,685 27,615 22,090 GDP Index Index 100.00 95.00 90.25 81.22 64.97 Total Exp. Deflated 000 Manats 20,000 18,697 6,031 2,056 4,196 h -13- Section II: Sources of Health Financing and Expenditures This section discusses the indicators associated with health care financing. Health financing data were divided into health revenues and health expenditures for both private and public categories. Similarly, government health expenditures (public) are categorized into recurrent and capital expenditures. The following briefly discusses these indicators: (i) Health revenues in the public sector, In the public sector, health revenues include the state budget, which is a sum of all expenditures by the central, provincial and local budgets. The data do not include budgets (or actual expenditures incurred) of the NI in countries such as Slovenia. The NHI is essentially the budget for the state-run insurance organizations for the given year. In most cases, direct charges are the revenues from user fees in public hospitals. Borrowing by public sector organizations including the MOH is included under this category. (ii Health revenues in the private sector. Private sector revenues include the revenues or budgets of private sector health insurance organizations -- which are still in their infancy in most CEE countries -- as well as direct charges levied by private hospitals, doctors and health centers. (iii) Recurrent Expenditures. This category is comprised of personal health services, public health activities, medical education and research and development. Personal health services include any services dealing directly with a patient. In most countries, activities such as immunization, and others related to primary and ambulatory health care, are provided by hospitals. Hence, it was difficult to separate primary, secondary and tertiary health care activities. The personal health care activities are classified into personnel (wages and social security), drugs, other consumable/supplies, energy/utilities, maintenance, transportation and "other" categories. Public health activities have a significant but indirect impact on the health status of the population. Medical education includes all education related to health professional training, including training of auxiliaries and midwives. Research and development activities include those that are directly connected to improving the health of the population. (iv) Capital expenditures. These include construction of new health facilities and renovation of older ones, as well as equipment and vehicles purchased. (v) Public reimbursements to private sector. This category is the payments made by the public insurance agencies to private facilities including individual private physicians. It captures the amount publicly financed by the government through health insurance schemes and provided by private facilities. Such a category illustrates the main reasons for escalating costs in countries with NHI. (vi) Private sector expenditures. These include reimbursements by private insurance organizations for services provided and direct private out-of-pocket expenditures. (vii) Hospital and non-hospital expenditures. Attempts were also made to allocate expenditures according to hospitals and non-hospitals, separating curative from non-curative activities. Hospital expenditures were further classified into expenditures on in-patients and out-patients. (viii) Average salaries (wages and benefits). This category includes the average salary for the sector, specifically for doctors and nurses. TABLE 2A. ALBANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues Million Leks 509.70 528.30 544.50 558.90 793.80 1,630.00 3,412.00 4,720.00 5,300.00 Public 509.70 528.30 544.50 558.90 793.80 1,630.00 3,412.00 4,720.00 5,300.00 State Budget 509.70 528.30 544.50 558.90 793.80 1,630.00 3,412.00 4,720.00 5,300.00 National Health Insurance - - - - - - - - - Direct Charges (Public) - Borrowing - Foreign Assistance (Loans/Grants) - - - - - Pnvate - - - - - - - - - Private Insurance - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure Million Leks 508.70 527.30 543.50 562.90 722.80 1,619.10 3,397.00 4,700.00 5,550.00 Public 508.70 527.30 543.50 562.90 722.80 1,619.10 3,397.00 4,700.00 5,550.00 Recurrent Expenditure 469.50 486.80 503.50 527.20 680.00 1,543.60 3,112.00 4,377.00 5,170.00 Personal Health Services 465.30 481.80 498.50 522.20 670.00 1,528.60 3,092.00 4,354.00 5,140.00 Personnel (Wage/Benetits) 222.50 230.40 240.00 251.00 330.00 571.00 960.00 2,233.00 2,650.00 Drugs 50.00 54.60 61.30 60.00 80.00 240.00 567.00 724.00 1,000.00 Other Consumables/Supplies 59.00 62.80 80.50 81.00 70.00 250.00 450.00 520.00 700.00 Energy/Utilities 3.00 3.00 3.50 3.50 5.00 10.00 15.00 20.00 30.00 Maintenance 58.00 60.70 64.00 67.00 95.00 302.00 530.00 560.00 650.00 Transportation 20.00 21.00 22.00 22.00 40.00 40.00 60.00 87.00 110.00 Other 52.80 49.30 27.20 37.70 50.00 115.80 510.00 210.00 - Public Health Activities - - - - - - - - - Medical Education 1.00 1.00 1.00 1.00 2.00 5.00 5.00 5.00 5.00 Research And Development 3.20 4.00 4.00 4.00 8.00 10.00 15.00 18.00 25.00 Capital Expenditures 39.20 40.50 40.00 35.70 42.80 75.50 285.00 323.00 380.00 Construction 3.20 3.20 2.50 3.00 4.00 10.50 20.00 25.00 90.00 New 23.00 24.00 25.60 22.70 28.80 30.00 95.00 88.00 100.00 Rehabilitation 4.00 4.30 4.90 5.00 5.00 25.00 70.00 90.00 90.00 Equipment 9.00 9.00 7.00 5.00 5.00 10.00 100.00 120.00 100.00 Vehicles 1.00 1.00 1.00 1.00 1.00 10.00 15.00 20.00 20.00 Public Reimbumements to Private Sector Million Lae - - - - - - - - - Private Sector - - - Private Insurance Reimbursement - - - Private Expenditures - - - Expenditure Allocation Million Leks - - - Hospitals - - In-patient - - Out-patient-- Non-Hospitals - - Average salary (Wages + Benefits) Leks/Month - - Average For Sector - - Doctors - - Nurses - - .. TABLE 2B. ALBANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues Million Leks 509.70 528.30 544.50 558.90 585.83 444.75 224.11 237.01 -- Public 509.70 528.30 544.50 558.90 585.83 444.75 224.11 237.01 State Budget 509.70 528.30 544.50 558.90 585.83 444.75 224.11 237.01 National Health Insurance -- - - - - - -- -- - Direct Charges (Public) Borrowing Foreign Assistance (LoanslGrants) - -- - -- -- - - - -- Private Private Insurance - - -- - -- - - -- Direct Charges (Private) Health Expenditure Million Leks 508.70 527.30 543.50 562.90 533.43 441.77 223.12 236.00 -- Public 508.70 527.30 543.50 562.90 533.43 441.77 223.12 236.00 -- Recurrent Expenditure 469.50 486.80 503.50 527.20 501.85 421.17 204.40 219.78 -- Personal Health Services 465.30 481.80 498.50 522.20 494.46 417.08 203.09 218.63 -- Personnel (Wage/Benefits) 222.50 230.40 240.00 251.00 243.54 155.80 63.05 112.13 Drugs 50.00 54.60 61.30 60.00 59.04 65.48 37.24 36.35 Other Consumables/Supplies 59.00 62.80 80.50 81.00 51.66 68.21 29.56 26.11 - Energy/Utilities 3.00 3.00 3.50 3.50 3.69 2.73 0.99 1.00 -- Maintenance 58.00 60.70 64.00 67.00 70.11 82.40 34.81 28.12 -- Transportation 20.00 21.00 22.00 22.00 29.52 10.91 3.94 4.37 -- Other 52.80 49.30 27.20 37.70 36.90 31.54 33.50 10.54 -- Public Health Activities - -- - - -- - - - Medical Education 1.00 1.00 1.00 1.00 1.48 1.36 0.33 0.25 -- Research And Development 3.20 4.00 4.00 4.00 5.90 2.73 0.99 0.90 Capital Expenditures 39.20 40.50 40.00 35.70 31.59 20.60 18.72 16.22 -- Construction 3.20 3.20 2.50 3.00 2.95 2.86 1.31 1.26 New 23.00 24.00 25.60 22.70 21.25 8.19 6.24 4.42 -- Rehabilitation 4.00 4.30 4.90 5.00 3.69 6.82 4.60 4.52 -- Equipment 9.00 9.00 7.00 5.00 3.69 2.73 6.57 6.03 - Vehicles 1.00 1.00 1.00 1.00 0.74 2.73 0.99 1.00 - Public Reimbursements to Private Sector - -- -- -- -- -- -- - -- Private Sector Private Insurance Reimbursement - - - - - - - - Private Expenditures Expenditure Allocation Million Leks - -- -- - - - - - Hospitals In-patient Out-patient Non-Hospitals Average salary (Wages + Benefits) Leks/Month -- - -- - - Average For Sector Doctors Nurses -d- d _- - _ - - - TABLE 2C. ALBANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% GDP) Health Revenues % 2.95% 3.11% 2.91% 3.32% 4.82% 3.36% 3.02% 2.84% - Public 2.95% 3.11% 2.91% 3.32% 4.82% 3.36% 3.02% 2.84% - State Budget 2.95% . 3.11% 2.91% 3.32% 4.82% 3.36% 3.02% 2.84% - National Health Insurance - - - - - - - - Direct Charges (Public) - - - - Borrowing - - - - Foreign Assistance (Loans/Grants) - - - - Private Private Insurance Direct Charges (Private) - - - - Health Expenditure % 2.95% 3.10% 2.91% 3.35% 4.39% 3.34% 3.01% 2.83% - Public 2.95% 3.10% 2.91% 3.35% 4.39% 3.34% 3.01% 2.83% - Recurrent Expenditure 2.72% 2.86% 2.70% 3.14% 4.13% 3.18% 2.75% 2.63% - Personal Health Services 2.70% 2.83% 2.67% 3.11% 4.07% 3.15% 2.74% 2.62% - Personnel (Wage/Benefits) 1.29% 1.35% 1.28% 1.49% 2.00% 1.18% 0.85% 1.34% - Drugs 0.29% 0.32% 0.33% 0.36% 0.49% 0.50% 0.50% 0.44% - Other Consumables/Supplies 0.34% 0.37% 0.43% 0.48% 0.42% 0.52% 0.40% 0.31% - EnergyItilities 0.02% 0.02% 0.02% 0.02% 0.03% 0.02% 0.01% 0.01% - Maintenance 0.34% 0.36% 0.34% 0.40% 0.58% 0.62% 0.47% 0.34% - Transportation 0.12% 0.12% 0.12% 0.13% 0.24% 0.08% 0.05% 0.05% - Other 0.31% 0.29% 0.15% 0.22% 0.30% 0.24% 0.45% 0.13% - Public Health Activities - - - - - - - - - Medical Education 0.01% 0.01% 0.01% 0.01% 0.01% 0.01% 0.00% 0.00% - Research And Development 0.02% 0.02% 0.02% 0.02% 0.05% 0.02% 0.01% 0.01% - Capital Expenditures 0.23% 0.24% 0.21% 0.21% 0.26% 0.16% 0.25% 0.19% - Construction 0.02% 0.02% 0.01% 0.02% 0.02% 0.02% 0.02% 0.02% - New 0.13% 0.14% 0.14% 0.14% 0.17% 0.06% 0.08% 0.05% - Rehabilitation 0.02% 0.03% 0.03% 0.03% 0.03% 0.05% 0.06% 0.05% - Equipment 0.05% 0.05% 0.04% 0.03% 0.03% 0.02% 0.09% 0.07% - Vehicles 0.01% 0.01% 0.01% 0.01% 0.01% 0.02% 0.01% 0.01% - Public Reimbursements to Private Sector - - - - - - - - - Private Sector----- --- Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - - - -_- TABLE 2D. ALBANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % -- -- - 5.35% 7.78% 7.11% 7.50% 8.23% - Public - - - 5.35% 7.78% 7.11% 7.50% 8.23% State Budget - - - 5.35% 7.78% 7.11% 7.50% 8.23% National Health Insurance - - - - - Direct Charges (Public) Borrowing Foreign Assistance (Loans/Grants) - - - -- - - - - - Private Private Insurance Direct Charges (Private) Health Expenditure % - -- - 5.39% 7.08% 7.07% 7.46% 8.20% - Public - -- - 5.39% 7.08% 7.07% 7.46% 8.20% - Recurrent Expenditure -- - - 5.05% 6.67% 6.74% 6.84% 7.63% - Personal Health Services -- - -- 5.00% 6.57% 6.67% 6.79% 7.59% - Personnel (Wage/Benefits) - - - 2.40% 3.23% 2.49% 2.11% 3.89% -- Drugs - -- - 0.57% 0.78% 1.05% 1.25% 1.26% Other Consumables/Supplies - -- -- 0.78% 0.69% 1.09% 0.99% 0.91% -- Energy/Utilities -- - - 0.03% 0.05% 0.04% 0.03% 0.03% -- Maintenance - -- -- 0.64% 0.93% 1.32% 1.16% 0.98% Transportation - - -- 0.21% 0.39% 0.17% 0.13% 0.15% -- Other -- -- - 0.36% 0.49% 0.50% 1.12% 0.37% Public Health Activities - -- - - -- Medical Education - - - 0.01% 0.02% 0.02% 0.01% 0.01% -- Research And Development -- -- -- 0.04% 0.08% 0.04% 0.03% 0.03% - Capital Expenditures -- -- - 0.34% 0.42% 0.33% 0.63% 0.56% - Construction -- -- - 0.03% 0.04% 0.05% 0.04% 0.04% -- New -- -- -- 0.22% 0.28% 0.13% 0.21% 0.15% - Rehabilitation - -- -- 0.05% 0.05% 0.11% 0.15% 0.16% Equipment - - -- 0.05% 0.05% 0.04% 0.22% 0.21% -- Vehicles - - -- 0.01% 0.01% 0.04% 0.03% 0.03% -- Public Reimbursements to Private Sector -- - - -- - -- -- - - Private Sector Private Insurance Reimbursement -- -- - - - - - Private Expenditures -_-_- - - TABLE 3A. BULGARIA: SOURCES OF FINANCING AND HEALTH EXPENDITURES, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues Million Levas - 1,620.26 1,780.01 2,356.62 7,124.40 13,815.13 14,723.40 21,943.10 33,214.50 Public - 1,620.26 1,780.01 2,356.62 7,124.40 13,815.13 14,723.40 21,943.10 33,214.50 State Budget - 1,245.30 1,354.20 1,855.50 5,919.00 10,995.60 14,723.40 21,943.10 33,214.50 National Health Insurance - - - - - - - - - Direct Charges (Public) - 374.96 425.81 501.12 1,205.40 2,819.53 - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - Private - - - - - - - Private Insurance - - - - - - - - Direct Charges (Private) - - - - - - - Health Expenditure Million Levas - 1,195.30 1,276.20 1,778.00 5,627.90 10,514.40 14,180.40 21,183.70 31,851.50 Public - 1,195.30 1,276.20 1,778.00 5,627.90 10,514.40 14,180.40 21,183.70 31,851.50 Recurrent Expenditure - 1,166.30 1,247.20 1,749.00 5,598.90 10,485.40 14,151.40 21,154.70 31,822.50 Personal Health Services - - 1,230.50 1,730.40 5,413.60 10,179.80 13,071.90 19,582.30 29,798.70 Personnel (Wage/Benefits) - - 606.70 984.10 2,662.50 4,783.30 6,969.20 10,387.70 16,267.40 Drugs - - 196.30 212.20 837.60 2,089.60 2,197.70 3,629.90 5,151.00 Other Consumables/Supplies - - 311.90 350.60 1,479.60 2,305.60 2,642.50 3,964.50 6,020.30 Energy/Utilities - - - - - - - - - Maintenance - - 115.30 182.60 432.00 999.50 1,243.20 1,541.30 2,256.50 Transportation - - - - - - 16.90 17.80 32.90 Other - - 0.30 0.90 1.90 1.80 2.40 41.10 70.60 Public Health Activities - - - - - - 764.60 1,158.40 1,505.10 Medical Education - - - - 136.50 229.10 234.70 299.60 350.50 Research And Development - 15.30 16.70 18.60 48.80 76.50 80.20 114.40 168.20 Capital Expenditures - 79.00 107.00 106.50 320.10 510.20 572.00 788.40 1,392.00 Construction - - - - - - - - - New - - - - - - - - - Rehabilitation - - - - Equipment - - - - - - - - - Vehicles - - - - - - - - - Public Reimbursements to Private Sector - - - - - - - - - Private Sector - - - - - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - - - - Expenditure Allocation Million Levas - - - - - - - - - Hospitals .- - - - - - - In-patient .- - - - - - - - Out-patient - - - - - - - - Non-Hospitals - - - - - Average salary (Wages + Benefits) Levas/Month - - - - - - Average For Sector - - - 432.00 1,207.00 2,257.00 3,805.00 7,419.00 - Doctors - - - 531.00 - - 6,692.00 10,140.00 12,123.00 Nurses - - - 312.00 - - 2,934.00 6,487.00 10,945.00 TABLE 3B. BULGARIA: SOURCES OF FINANCING AND HEALTH EXPENDITURES, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues Million Levas - - 2,260.61 2,356.62 2,190.80 2,492.22 1,610.57 1,817.86 2,265.65 Public - - 2,260.61 2,356.62 2,190.80 2,492.22 1,610.57 1,817.86 2,265.65 State Budget - - 1,719.83 1,855.50 1,820.13 1,983.58 1,610.57 1,817.86 2,265.65 National Health Insurance - - - - - - - - - Direct Charges (Public) - - 540.78 501.12 370.67 508.64 - - - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - - - - Private Insurance - - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure Million Levas - - 1,719.83 1,855.50 1,820.13 1,983.58 1,610.57 1,817.86 2,265.65 Public - - 1,719.83 1,855.50 1,820.13 1,983.58 1,610.57 1,817.86 2,265.65 Recurrent Expenditure - - 1,583.94 1,749.00 1,721.70 1,891.54 1,548.00 1,752.54 2,170.70 Personal Health Services - - 1,562.74 1,730.40 1,664.71 1,836.41 1,429.91 1,622.28 2,032.65 Personnel (Wage/Benefits) - - 770.51 984.10 818.73 862.90 762.35 860.56 1,109.65 Drugs - - 249.30 212.20 257.57 376.96 240.40 300.72 351.36 Other Consumables/Supplies - - 396.11 350.60 454.99 415.93 289.06 328.44 410.66 Energy/Utilities - - - - - - - - - Maintenance - - 146.43 182.60 132.84 180.31 135.99 127.69 153.92 Transportation - - - - - - 1.85 1.47 2.24 Other - - 0.38 0.90 0.58 0.32 0.26 3.40 4.82 t Public Health Activities - - - - - - 83.64 95.97 102.67 Medical Education - - - - 41.97 41.33 25.67 24.82 23.91 Research And Development - - 21.21 18.60 15.01 13.80 8.77 9.48 11.47 Capital Expenditures - 135.89 106.50 98.43 92.04 62.57 65.31 94.95 Construction - - - - - - - - - New - - - - - - - - - Rehabilitation - - - - - - - - - Equipment - - - - - - - - - Vehicles - - - - - - - - - Public Reimbursements to Private Sector - - - - - - - - - Private Sector - - - - - - - - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - - - - - Expenditure Allocation Million Levas - - - - - - - - - Hospitals - - - - - - - - - In-patient Out-patlent - Non-Hospitals - Average salary (Wages + Benefits) Levas/Month - - - - - - - - - Average For Sector - - - 432.00 371.16 407.16 416.22 614.62 - Doctors - - - 531.00 - - 732.03 840.04 826.94 Nurses - - - 312.00 - - 320.95 537.41 748.59 TABLE 3C. BULGARIA: SOURCES OF FINANCING AND HEALTH EXPENDITURES, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% GDP) Health Revenues % -- 4.23% 4.50% 5.19% 5.44% 6.81% 5.15% 4.04% 3.99% Public - 4.23% 4.50% 5.19% 5.44% 6.81% 5.15% 4.04% 3.99% State Budget - 3.25% 3.42% 4.09% 4.52% 5.42% 5.15% 4.04% 3.99% National Health Insurance - - - - - - - - - Direct Charges (Public) - 0.98% 1.08% 1.10% 0.92% 1.39% - Borrowing - - Foreign Assistance (Loans/Grants) - - Private - - Private Insurance - - Direct.Charges (Private) - - Health Expenditure % - 3.25% 3.42% 4.09% 4.52% 5.42% 5.15% 4.04% 3.99% Public - 3.25% 3.42% 4.09% 4.52% 5.42% 5.15% 4.04% 3.99% Recurrent Expenditure - 3.04% 3.15% 3.85% 4.27% 5.17% 4.95% 3.89% 3.83% Personal Health Services - - 3.11% 3.81% 4.13% 5.02% 4.57% 3.60% 3.58% Personnel (Wage/Benefits) - - 1.53% 2.17% 2.03% 2.36% 2.44% 1.91% 1.96% Drugs - - 0.50% 0.47% 0.64% 1.03% 0.77% 0.67% 0.62% Other Consumables/Supplies - - 0.79% 0.77% 1.13% 1.14% 0.92% 0.73% 0.72% Energy/Utilities - - - - - - - Maintenance - - 0.29% 0.40% 0.33% 0.49% 0.43% 0.28% 0.27% Transportation - - Other - - - - - - - 0.01% 0.01% Public Health Activities - -- 0.27% 0.21% 0.18% Medical Education - - - - 0.10% 0.11% 0.08% 0.06% 0.04% Research And Development - 0.04% 0.04% 0.04% 0.04% 0.04% 0.03% 0.02% 0.02% Capital Expenditures - 0.21% 0.27% 0.23% 0.24% 0.25% 0.20% 0.15% 0.17% Construction New Rehabilitation Equipment Vehicles Public Reimbursements to Private Sector Private Sector Private Insurance Reimbursement Private Expenditures TABLE 3D. BULGARIA: SOURCES OF FINANCING AND HEALTH EXPENDITURES, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % -- 7.23% 7.67% 8.99% 11.69% 14.95% 9.80% 9.15% 8.85% Public - 7.23% 7.67% 8.99% 11.69% 14.95% 9.80% 9.15% 8.85% State Budget - 5.56% 5.84% 7.08% 9.71% 11.90% 9.80% 9.15% 8.85% National Health Insurance - - - - - - - - - Direct Charges (Public) - 1.67% 1.84% 1.91% 1.98% 3.05% - - - Borrowing - - - - - - Foreign Assistance (Loans/Grants) -- - - - - - - -- -- Private Private Insurance Direct Charges (Private) - - -- - -- - -- Health Expenditure % - 5.56% 5.84% 7.08% 9.71% 11.90% 9.80% 9.15% 8.85% Public -- 5.56% 5.84% 7.08% 9.71% 11.90% 9.80% 9.15% 8.85% Recurrent Expenditure - 5.21% 5.38% 6.68% 9.19% 11.35% 9.42% 8.82% 8.48% Personal Health Services - 0.00% 5.30% 6.60% 8.88% 11.02% 8.70% 8.16% 7.94% Personnel (Wage/Benefits) - -- 2.62% 3.76% 4.37% 5.18% 4.64% 4.33% 4.34% Drugs - -- 0.85% 0.81% 1.37% 2.26% 1.46% 1.51% 1.37% Other Consumables/Supplies - -- 1.34% 1.34% 2.43% 2.50% 1.76% 1.65% 1.60% Energy/Utilities - - - -- - -- - Maintenance -- - 0.50% 0.70% 0.71% 1.08% 0.83% 0.64% 0.60% Transportation -- -- - -- -- -- 0.01% 0.01% 0.01% Other - - -- - -- -- -- 0.02% 0.02% Public Health Activities - -- -- -- 0.51% 0.48% 0.40% Medical Education - -- 0.22% 0.25% 0.16% 0.12% 0.09% Research And Development - 0.07% 0.07% 0.07% 0.08% 0.08% 0.05% 0.05% 0.04% Capital Expenditures -- 0.35% 0.46% 0.41% 0.53% 0.55% 0.38% 0.33% 0.37% Construction -- - - - -- - - New Rehabilitation Equipment Vehicles Public Reimbursements to Private Sector -- -- - - - -- -- -- - Private Sector Private Insurance Reimbursement - - -- - - - - -- - Private Expenditures -_--_- --_- - - -_ -- TABLE 4A. CROATIA: SOURCES OF FINANCING AND HEALTH EXPENDITURES, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues 000 HRDIKuna 54,442 152,531 4,073,311 28,987,956 47,892,625 287,371 3,900,813 7,469,096 7,081,832 Public 54,442 152,531 4,073,311 28,987,956 47,892,625 287,371 3,900,813 7,489,096 7,081,832 State Budget - - 253,336 1,445,910 4,724,300 20,196 148,279 301,904 315,505 National Health Insurance 54,442 152,531 2,793,523 21,494,083 33,670,000 222,540 2,552,534 5,767,192 6,704,377 Direct Charges (Public) - - 1,026,452 6,047,963 9,498,325 44,635 1,200,000 1,400,000 - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - 61,950 Private - - - - - - - - - Private insurance - - - - - - - - - Direct Charges (Private) - - - - 7 - - - - Health Expenditure 000 HRD/Kuna - - 3,981,001 26,696,068 44,427,175 260,497 3,904,701 7,215,178 - Public - - 3,981,001 26,696,058 44,427,175 260,497 3,904,701 7,215,178 106,183 Recurrent Expenditure - - 3,981,001 25,558,503 43,053,904 253,596 3,891.405 7.163,738 - Personal Health Services 5,308 18,362 3,981,001 25,526,619 42,934,634 253,295 3,883,126 6,781,621 - Personnel (Wage/Benefits) - - 1,489,194 10,426,843 14,832,058 52,877 807,870 1,810,730 - Drugs 5,308 18,362 281,717 1,713,073 3,850,000 37,025 978,270 1,832,135 - Other Consumables/Supplies - - 692,447 5,343,587 8,552,498 61,697 483,619 744,400 - Energy/Utilities - - - - - - 99,062 150,129 - Maintenance - - - - - - 40,399 78,889 - Transportation - - Other - - 1,517,643 8,043,116 15,700,078 101,696 1,473,906 2,165,338 - Public Health Activities - - - 31,884 119,270 301 6,146 194,388 266,733 Medical Education - - - 2,133 67,476 - Research And Development - - - - - - - 120,253 - Capital Expenditures - - - 1,137,555 1,373,271 6,901 13,296 51,440 106,183 Construction - - - 586,388 559,223 3,022 7,832 22,451 52,410 New - - - - - - - - 7,400 Rehabilitation - - - - - - - - 45,010 Equipment - - - 551,167 814,048 3,879 5,464 28,989 1,279 Vehicles - - - - 84 Public Reimbursements to Private Sector Private Sector Private Insurance Reimbursement Private Expenditures Expenditure Allocation 000 HRD/Kuna - - - - - 3,904,701 7,215,178 - Hospitals - 1,732,055 3,107,834 - In-patient Out-patient -- Non-Hospitals - - - - - - 2,172,646 4,107,344 - Average salary (Wages + Benefits) HRDIKuna/Month - - - - - - - - Average For Sector - - - 144,000 228,000 780 2,200 3,800 - Doctors - - - 252,000 360,000 1,200 3,300 5,400 - Nurses - - - 132,000 216,000 720 2,000 3,200 - TABLE 4B. CROATIA: SOURCES OF FINANCING AND HEALTH EXPENDITURES, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues 000 HRDIKuna - - - 28,987,956 23,476,777 18,177 15,424 15,233 - Public - - - 28,987,956 23,476,777 18,177 15,424 15,233 - State Budget - - - 1,445,910 2,315,833 1,277 586 616 - National Health Insurance - - - 21,494,083 16,504,902 14,076 10,093 11,762 -- Direct Charges (Public) - - - 6,047,963 4,656,042 2,823 4,745 2,855 - Borrowing - - - -- Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - - - - Private Insurance - - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure 000 HRDIKuna - - - 26,696,058 21,778,027 16,477 15,439 14,716 - Public - - - 26,696,058 21,778,027 16,477 15,439 14,716 - Recurrent Expenditure - - - 25,558,503 21,104,855 16,040 15,387 14,611 - Personal Health Services - - - 25,526,619 21,046,389 16,021 15,354 13,831 - Personnel (Wage/Benefits) - - - 10,426,843 7,270,617 3,345 3,194 3,693 - Drugs - - - 1,713,073 1,887,255 2,342 3,868 3,737 - Other Consumables/Supplies - - - 5,343,587 4,192,401 3,902 1,912 1,518 - Energy/Utilities - - - - - - 392 306 - Maintenance - - - - - - 160 161 - Transportation - - - -- - - - - Other - - - 8,043,116 7,696,117 6,432 5,828 4,416 - A Public Health Activities - - - 31,884 58,466 19 24 396 - Medical Education - - - - - - 8 138 - Research And Development - - - - - - - 245 - Capital Expenditures - - - 1,137,555 673,172 436 53 105 - Construction - - - 586,388 274,129 191 31 46 - New - - - - - Rehabilitation - - - - - - - - Equipment - - - 551,167 399,043 245 22 59 - Vehicles - - - - - - - Pubilc Reimbursements to Private Sector - - - - - - - - - Private Sector - - - - - - - - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - - - - - Expenditure Allocation 000 HRDIKuna - - - - -- - 15,439 14,716 -- Hospitals - - - - - - 6,849 6,339 - In-patient - - - - - - Out-patient - - - - -- Non-Hospitals -- - - - - - 8,591 8,377 - Average salary (Wages + Benefits) HRDIKuna/Month - - - - - -- - - - Average For Sector -- - - 144,000 111,765 49 9 8 - Doctors - - - 252,000 176,471 76 13 11 Nurses - - - 132,000 105,882 46 8 7 - TABLE 4C. CROATIA: SOURCES OF FINANCING AND HEALTH EXPENDITURES, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% GDP) Health Revenues % 4.46% 4.16% 8.62% 10.50% 10.61% 8.54% 7.44% 9.04% - Public 4.46% 4.16% 8.62% 10.50% 10.61% 8.54% 7.44% 9.04% - State Budget - - 0.54% 0.52% 1.05% 0.60% 0.28% 0.37% - National Health Insurance 4.46% 4.16% 5.91% 7.78% 7.46% 6.61% 4.87% 6.98% - Direct Charges (Public) - - 2.17% 2.19% 2.10% 1.33% 2.29% 1.69% - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - Private - - Private Insurance - Direct Charges (Private) - Health Expenditure % - - 8.42% 9.67% 9.84% 7.74% 7.45% 8.74% - Public - - 8.42% 9.67% 9.84% 7.74% 7.45% 8.74% - Recurrent Expenditure - - 8.42% 9.26% 9.54% 7.53% 7.42% 8.67% - Personal Health Services 0.43% 0.50% 8.42% 9.24% 9.51% 7.52% 7.41% 8.21% - Personnel (Wage/Benefits) - - 3.15% 3.78% 3.29% 1.57% 1.54% 2.19% - Drugs 0.43% 0.50% 0.60% 0.62% 0.85% 1.10% 1.87% 2.22% - Other ConsumablesSupplies - - 1.47% 1.93% 1.89% 1.83% 0.92% 0.90% - EnergyUtilities - - - - - - 0.19% 0.18% - Maintenance - - - - - - 0.08% 0.10% - Transportation - - - - Other - - 3.21% 2.91% 3.48% 3.02% 2.81% 2.62% - Public Health Activities - - 0.01% 0.03% 0.01% 0.01% 0.24% - Medical Education - - - - 0.08% - Research And Development - - - - - 0.15% - Capital Expenditures - - - 0.41% 0.30% 0.20% 0.03% 0.06% - Construction - - - 0.21% 0.12% 0.09% 0.01% 0.03% - New ---- - - - - Rehabilitation - - - - - Equipment - - 0.20% 0.18% 0.12% 0.01% 0-04% Vehicles Public Reimbursements to Private Sector Private Sector Private Insurance Reimbursement Private Expenditures TABLE 4D. CROATIA: SOURCES OF FINANCING AND HEALTH EXPENDITURES, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % -- -- - -- 27.57% 20.43% 25.56% 19.64% - Public -- -- - -- 27.57% 20.43% 25.56% 19.64% - State Budget -- -- -- -- 2.72% 1 44% 0.97% 0.79% - National Health Insurance -- - -- - 19.38% 15.82% 16.72% 15.16% - Direct Charges (Public) - -- -- -- 5.47% 3.17% 7.86% 3.68% -- Borrowing - - - - Foreign Assistance (Loans/Grants) - - - - - - -- - - Private - - - - Private Insurance - - - - Direct Charges (Private) - - - - - - -- -- Health Expenditure % - - - - 25.57% 18.52% 25.58% 18.97% - Public -- - - -- 25.57% 18.52% 25.58% 18.97% Recurrent Expenditure -- -- - - 24.78% 18.03% 25.49% 18.84% - Personal Health Services - -- - - 24.71% 18.01% 25.44% 17.83% - Personnel (Wage/Benefits) - -- - -- 8.54% 3.76% 5.29% 4.76% - Drugs -- - -- -- 2.22% 2.63% 6.41% 4.82% - Other Consumables/Supplies -- - - -- 4.92% 4.390% 3.17% 1.96% -- Energy/Utilities - - -- -- - -- 0.65% 0.39% -- Maintenance - - -- - - -- 0.26% 0.21% -- Transportation - - Other - -- -- -- 9.04% 7.23% 9.66% 5.69% - Public Health Activities - -- - - 0.07% 0.02% 0.04% 0.51% - Medical Education -- -- - -- - -- 0.01% 0.18% - Research And Development -- -- - - Capital Expenditures - - - -- 0.79% 0.49% 0.09% 0.14% - Construction -- -- -- -- 0.32% 0.21% 0.05% 0.06% - New -- -- - -- Rehabilitation -- -- - Equipment - -- -- - 0.47% 0.28% 0.04% 0.08% Vehicles -- - -- -- Public Reimbursements to Private Sector - -- -- - -- - -- -- -- Private Sector Private Insurance Reimbursement Private Expenditures -- -- -- - -- - -- -- -- TABLE 5A. CZECH REPUBLIC: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues Million Kc 22,881 24,748 26,305 31,114 46,678 54,918 69,262 81,136 92,060 Public 22,881 24,748 26,305 31,114 46,678 54,918 69,262 81,136 92,060 State Budget 22,881 24,748 26,305 31,114 38,459 42,857 18,645 22,614 14,060 National Health Insurance -- - 50,617 58,522 78,000 Direct Charges (Public) -- - -- -- 8,219 12,061 - - - Borrowing - - Foreign Assistance (Loans/Grants) - - -- -- Private Private Insurance Direct Charges (Private) - - . Health Expenditure Million Kc 22,881 24,748 26,305 31,114 46,678 54,918 69,262 81,136 92,060 Public 22,881 24,748 26,305 31,114 38,459 42,857 69,262 81,136 92,060 Recurrent Expenditure 20,871 22,116 23,597 28,759 36,039 40,411 47,617 56,002 66,500 Personal Health Services 19,272 20,408 21,734 26,757 33,882 38,078 44,784 52,459 62,000 Personnel (Wage/Benefits) 8,938 9,255 9,616 11,622 13,460 15,585 19,341 23,864 - Drugs 4,281 4,629 5,024 6,294 7,171 7,908 9,537 10,461 - Other Consumables/Supplies 3,017 3,118 3,216 4,183 5,060 6,970 7,624 8,537 - Energy/Utilities - - - - - - - - Maintenance 1,924 2,236 2,524 3,022 3,538 4,720 5,301 6,591 Transportation - - - - - - - Other 1,112 1,170 1,354 1,636 4,653 2,895 2,981 3,006 4,500 Public Health Activities 1,599 1,708 1,863 2,002 2,157 2,333 2,833 3,543 4,500 Medical Education - - - - - - - - Research And Development - - - - - - - - - Capital Expenditures 2,010 2,632 2,708 2,355 2,420 2,446 2,894 3,509 3,197 Construction - - - - - - - - New - Rehabilitation - Equipment - Vehicles - - Public Reimbursements to Private Sector - - - - - - 18,751 21,625 22,363 Private Sector - -- - - 8,219 12,061 - - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - -- - - 8,219 12,061 - - - Expenditure Allocation Million Kc -- -- - - - - - - - Hospitals In-patient Out-patient Non-Hospitals - - - - - - Average salary (Wages + Benefits) Kc/Month 3,026 3,095 3,170 3,286 3,792 4,644 5,817 6,600 -- Average For Sector 2,948 3,000 3069 3,287 3,954 4,802 6,061 7,632 -- Doctors 4,805 4,865 5,072 5,444 6,303 7,801 10,347 13,652 - Nurses 2,732 2,770 2,838 3,109 3,722 4,545 5,899 7,144 - TABLE 5B. CZECH REPUBLIC: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues Million Kc - - - 31,114 31,754 31,744 34,459 36,384 36,824 Public - - - 31,114 31,754 31,744 34,459 36,384 36,824 State Budget - - - 31,114 26,163 24,773 9,276 10,141 5,624 National Health Insurance - - - - - - 25,183 26,243 31,200 Direct Charges (Public) - - - - 5,591 6,972 - Borrowing - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - Private Insurance - - - - - Direct Charges (Private) - - - - - Health Expenditure Million Kc - - - 31,114 31,754 31,744 34,459 36,384 36,824 Public - - - 31,114 26,163 24,773 34,459 36,384 36,824 Recurrent Expenditure - - - 28,759 24,516 23,359 23,690 25,113 26,600 Personal Health Services - - - 26,757 23,049 22,010 22,281 23,524 24,800 Personnel (Wage/Benefits) - - - 11,622 9,156 9,009 9,622 10,701 - Drugs - - - 6,294 4,878 4,571 4,745 4,691 - Other Consumables/Supplies - - - 4,183 3,442 4,029 3,793 3,828 - Energy/Utilities - - - - - - - - Maintenance - - - 3,022 2,407 2,728 2,637 2,956 - Transportation - - - - - - Other - - - 1,636 3,165 1,673 1,483 1,348 1,800 Public Health Activities - - - 2,002 1,467 1,349 1,409 1,589 1,800 Medical Education - - - - - - - Research And Development - - - - - - - Capital Expenditures - - - 2,355 1,646 1,414 1,440 1,574 1,279 Construction - - - - - - - New - - - - - - - - - Rehabilitation - - - - - - - - - Equipment - - - - - - - - - Vehicles - - - - - - - - - Public Reimbursements to Private Sector - - - - - - 9,329 9,697 8,945 Private Sector - - - - 5,591 6,972 - -- Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - 5,591 6,972 - - - Expenditure Allocation Million Kc - - - - - - - - Hospitals - - - - - - - In-patient - - - - - - - Out-patient - - - - - - - Non-Hospitals - - - - - - - - Average salary (Wages + Benefits) KclMonth - - - 3,286 2,580 2,684 2,894 2,960 - Average For Sector - - - 3,287 2,690 2,776 3,015 3,422 - Doctors - - - 5,444 4,288 4,509 5,148 6,122 - Nurses - - - 3,109 2,532 2,627 2,935 3,204 - TABLE 5C. CZECH REPUBLIC: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% GDP) Health Revenues % 4.62% 4.82% 5.01% 5.48% 6.51% 6.94% 7.61% 7.82% 7.31% Public 4.62% 4.82% 5.01% 5.48% 6.51% 6.94% 7.61% 7.82% 7.31% State Budget 4.62% 4.82% 5.01% 5.48% 5.37% 5.42% 2.05% 2.18% 1.12% National Health Insurance - - - - - - 5.56% 5.64% 6.19% Direct Charges (Public) - - - - 1.15% 1.52% - - - Borrowing - - - - - - Foreign Assistance (Loans/Grants) - - - - Private - - - - Private Insurance - - - - - Direct Charges (Private) - - - - - - Health Expenditure % 4.62% 4.82% 5.01% 5.48% 6.51% 6.94% 7.61% 7.82% 7.31% Public 4.62% 4.82% 5.01% 5.48% 5.37% 5.42% 7.61% 7.82% 7.31% Recurrent Expenditure 4.22% 4.31% 4.50% 5.07% 5.03% 5.11% 5.23% 5.40% 5.28% Personal Health Services 3.89% 3.98% 4.14% 4.72% 4.73% 4.81% 4.92% 5.06% 4.92% Personnel (Wage/Benefits) 1.81% 1.80% 1.83% 2.05% 1.88% 1.97% 2.12% 2.30% - Drugs 0.86% 0.90% 0.96% 1.11% 1.00% 1.00% 1.05% 1.01% - Other Consumables/Supplies 0.61% 0.61% 0.61% 0.74% 0.71% 0.88% 0.84% 0.82% - Energy/Utilities - - - - - - - Maintenance 0.39% 0.44% 0.48% 0.53% 0.49% 0.60% 058% 0.64% - Transportation - - - Other 0.22% 0.23% 0.26% 0.29% 0.65% 0.37% 0.33% 0.29% 0.36% Public Health Activities 0.32% 0.33% 0.36% 0.35% 0.30% 0.29% -0.31% 0.34% 0.36% Medical Education - - - - Research And Development - - - - - - - Capital Expenditures 0.41% 0.51% 0.52% 0.42% 0.34% 0.31% 0.32% 0.34% 0.25% Construction - - New Rehabilitation Equipment - - Vehicles - - Public Reimbursements to Private Sector - - - - - - 2.06% 2.08% 1.77% Private Sector - - - - 1.15% 1.52% - - - Private Insurance Reimbursement - - - - Private Expenditures - - - - 1.15% 1.52% - - - TABLE 5D. CZECH REPUBLIC: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % - - - - - 14.26% 15.48% 15.85% 15.60% Public - - - - - 14.26% 15.48% 15.85% 15.60% State Budget - - - - - 11.13% 4.17% 4.42% 2.38% National Health Insurance - - - - - - 11.32% 11.43% 13.21% Direct Charges (Public) - - - - - 3.13% - - - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - - - - Private Insurance - - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure % - - - - - 14.26% 15.48% 15.85% 15.60% Public - - - - - 11.13% 15.48% 15.85% 15.60% Recurrent Expenditure - - - - - 10.49% 10.65% 10.94% 11.27% Personal Health Services - - - - - 9.89% 10.01% 10.25% 10.50% Personnel (Wage/Benefits) - - - - - 4.05% 4.32% 4.66% - Drugs - - - - - 2.05% 2.13% 2.04% - Other Consumables/Supplies - - - - - 1.81% 1.70% 1.67% - Energy/Utilities - - - - - - - - Maintenance - - - - - 1.23% 1.19% 1.29% - Transportation - - - - - - -- - - Other - - - -- - 0.75% 0.67% 0.59% 0.76% Public Health Activities - - - - - 0.61% 0.63% 0.69% 0.76% Medical Education - - - -- - - - Research And Development - - - - -- Capital Expenditures -- - - - - 0.64% 0.65% 0.69% 0.54% Construction - - - - New Rehabilitation Equipment Vehicles - - Public Reimbursements to Private Sector - - - - - - 4.19% 4.23% 3.79% Private Sector - - Private Insurance Reimbursement - - - - - .. .. Private Expenditures - - - - TABLE 6A. FYR MACEDONIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues 000 Denars - - - 39,080 79,620 711,758 3,789,906 8,112,598 208,898 Public - - - 39,080 79,620 711,758 3,789,906 8,112,598 208,898 State Budget - - - 444 865 73,247 380,760 970,848 208,898 National Health Insurance - - - 38,636 78,755 638,511 3,409,146 7,141,750 - Direct Charges (Public) - - - - - - - - - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - - - - Private Insurance - - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure 000 Denars 134 353 6,012 46,511 103,397 917,988 4,651,227 847,270 208,898 Public 134 353 6,012 46,511 103,397 917,988 4,651,227 847,270 208,898 Recurrent Expenditure 134 353 6,012 46,511 102,217 907,876 4,610,605 770,249 208,898 Personal Health Services 134 353 6,012 46,511 101,352 898,080 4,523,257 622,546 - Personnel (Wage/Benefits) 71 193 3,677 23,173 48,496 422,345 2,164,327 - - Drugs - - - 4,955 10,805 88,340 328,016 622,546 - Other Consumables/Supplies 48 122 1,216 10,011 21,517 188,644 1,043,263 - - Energy/Utilities - - - - Maintenance Transportation - - - Other 15 38 1,119 8,372 20,534 198,751 987,651 - - Public Health Activities - - - - 865 9,796 87,348 147,703 208,898 Medical Education - - - Research And Development - - - - - .. Capital Expenditures - - - - 1,180 10,112 40,622 77,021 - Construction - - - - 0 0 5 23 - New -- - - - - Rehabilitation - - - - - Equipment - - - 1,180 10,112 40,617 76,998 - Vehicles -- - - - - Public Reimbursements to Private Sector - - - - - - - - - Private Sector - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - - - - Expenditure Allocation 000 Denars - - - - - - - - - Hospitals In-patient - - Out-patient - - Non-Hospitals - - - - - Average salary (Wages + Benefits) Denars/Month - - - - - - - - - Average For Sector - - - 960 2,040 9,684 42,000 - - Doctors - - Nurses - - TABLE 6B. FYR MACEDONIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues 000 Denars - -- -- 39,080 46,561 28,200 25,485 24,240 -- Public - - - 39,080 46,561 28,200 25,485 24,240 - State Budget - - - 444 506 2,902 2,560 2,901 - National Health Insurance - - - 38,636 46,056 25,298 22,925 21.339 - Direct Charges (Public) - - - - - - - - - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - - - - Private Insurance - - - - - - - - Direct Charges (Private) - - - - - - - - Health Expenditure 000 Denars - - - 46,511 60,466 36,370 31,277 -- -- Public - - - 46,511 60,466 36,370 31,277 -- -- Recurrent Expenditure - - - 46,511 59,776 35,970 31,004 - - Personal Health Services - - -- 46,511 59,270 35,582 30,417 - - Personnel (Wage/Benefits) - -- -- 23,173 28,360 16,733 14,554 - - Drugs - - - 4,955 6,319 3,500 2,206 -- - Other Consumables/Supplies - -- - 10,011 12,583 7,474 7,015 - - Energy/Utilities - - - .. - .. Maintenance -- - - Transportation - .. -. .. .. .. Other - - -- 8,372 12,008 7,874 6,641 - Public Health Activities - - - -- 506 388 587 - Medical Education - - Research And Development -- -- -- -. . -. .. .. .. Capital Expenditures - -- - -- 690 401 273 - - Construction - - - -- 0 0 0 -- -- New - - - .. .. .. .. Rehabilitation - . Equipment - - -- - 690 401 273 -- -- Vehicles - - - .. Public Reimbursements to Private Sector - -- .. .. .. Private Sector -- - .. -. Private Insurance Reimbursement - - . .. .. Private Expenditures - Expenditure Allocation 000 Denars- - - -- .. .. Hospitals - - - -- .. In-patient Out-patient Non-Hospitals Average salary (Wages + Benefits) Denars/Month -- - - -- -- -. .. Average For Sector - -- -- 960 1,193 384 282 -- -- Doctors Nurses TABLE 6C: FYR MACEDONIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% GDP) Health Revenues % - - - 6.68% 8.81% 6.09% 6.29% 6.31% - Public - - - 6.68% 8.81% 6.09% 6.29% 6.31% - State Budget - - - 0.08% 0.10% 0.63% 0.63% 0.76% - National Health Insurance - - - 6.60% 8.71% 5.46% 5.66% 5.56% - Direct Charges (Public) - - - - - - - - - Borrowing Foreign Assistance (LoansiGrants) - - - - - - private - - - - - --- Private Insurance - - - - - - Direct Charges (Private) - - - - - - Health Expenditure %- - - 7.95% 11.44% 7.86% 7.72% - - Public - - - 7.95% 11.44% 7.86% 7.72% - - Recurrent Expenditure - - - 7.95% 11.31% 7.77% 7.65% - - Personal Health Services - - - 7.95% 11.21% 7.69% 7.51% - - Personnel (WageBenefits) - - - 3.96% 5.36% 3.61% 3.59% - - Drugs - - - 0.85% 1.20% 0.76% 0.64% - - Other Consumables/Supplies - - - 1.71% 2.38% 1.61% 1.73% - - EnergyUtilities - - - - Maintenance - - - - - Transportation - - - - Other - - - 1.43% 2.27% 1.70% 1.64% - Public Health Activities - - - - 0.10% 0.08% 0.14% - Medical Education - - - - - - - Research And Development - - - - - - - Capital Expenditures - - - - 0.13% 0.09% 0.07% - Construction - - - - - - - New - Rehabilitation - - - Equipment - - - 0.13% 0.09% 0.07% - Vehicles - - - Public Reimbursements to Private Sector Private Sector Private insurance Reimbursement Private Expenditures TABLE 6D. FYR MACEDONIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % - - - - 17.35% 12.29% 11.96% 12.05% - Public - - - - 17.35% 12.29% 11.96% 12.05% - State Budget - - - - 0.19% 1.26% 1.20% 1.44% - National Health Insurance - - - - 17.16% 11.02% 10.76% 10.60% - Direct Charges (Public) - - - - - - - Borrowing - - - - Foreign Assistance (Loans/Grants) - - - - Private - - - - Private Insurance - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure % - - - - 22.53% 15.85% 14.68% - - Public - - - - 22.53% 15.85% 14.68% - - Recurrent Expenditure - - - - 22.27% 15.67% 14.55% - - Personal Health Services - - - - 22.08% 15.51% 14.27% - - Personnel (Wage/Benefits) - - - - 10.57% 7.29% 6.83% - - Drugs - - - - 2.35% 1.53% 1.04% - - Other Consumables/Supplies - - - - 4.69% 3.26% 3.29% - - Energy/Utilities - - - - - - - - Maintenance - - - - .. Transportation - - - - - - - 4L Other - - - - 4.47% 3.43% 3.12% - - Public Health Activities - - - - 0.19% 0.17% 0.28% - - Medical Education - - - - - - Research And Development - - - - - - - Capital Expenditures - - - - 0.26% 0.17% 0.13% - - Construction - - - ..- - - New - - - - Rehabilitation - - - Equipment - - - - 0.26% 0.17% 0.13% - Vehicles - - - Public Reimbursements to Private Sector - - - - - .. Private Sector - - - - Private Insurance Reimbursement - - - - - .. .. Private Expenditures - - - - - - - .. TABLE 7A. HUNGARY: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues Million HUF 57,679 70,407 89,833 119,153 166,391 206,773 241,648 296,359 - Public 57,679 70,407 89,833 119,153 166,391 206,773 241,648 296,359 - State Budget 53,979 66,907 65,669 17,194 28,502 43,014 50,214 51,379 - National Health Insurance 800 1,000 19,664 96,819 130,159 151,741 175,605 223,440 - Direct Charges (Public) 2,900 2,500 4,500 5,140 7,730 12,018 15,829 21,540 - Borrowing - - - - - - - Foreign Assistance (Loans/Grants) -- - - Private - - -- Private Insurance - - - Direct Charges (Private) - - - - - - - - - Health Expenditure Million HUF 57,679 70,407 89,833 119,153 166,391 193,306 241,641 296,359 - Public 57,679 70,407 89,833 119,153 166,391 193,306 241,641 296,359 - Recurrent Expenditure 52,078 63,006 82,252 108,778 151,347 174,092 224,130 278,181 - Personal Health Services 49,399 59,330 77,452 102,542 142,584 163,372 214,834 268,460 - Personnel (Wage/Benefits) - 18,858 22,730 32,240 42,969 63,912 76,433 93,852 - Drugs 18,901 25,321 23,764 32,709 47,133 74,248 69,500 89,800 - Other Consumables/Supplies - - - - - - - - - Energy/Utilities - 4,329 - - - - - - - Maintenance - 1,490 - - - - - -- - Transportation 350 400 400 509 800 1,118 1,069 1,580 - Other 30,148 8,932 30,558 37,084 51,682 24,094 67,832 83,228 - Public Health Activities 1,080 1,318 1,754 2,373 3,547 4,625 4,448 4,006 - Medical Education 902 1,645 2,151 2,854 3,911 4,403 3,902 4,450 - Research And Development 697 713 895 1,009 1,305 1,692 946 1,265 - Capital Expenditures 5,601 7,401 7,581 10,375 15,044 19,214 17,511 18,178 - Construction - - - - - - . New Rehabilitation Equipment Vehicles Public Reimbursements to Private Sector -- - - - - - Private Sector Private Insurance Reimbursement - - - - Private Expenditures - - - - - Expenditure Allocation Million HUF 30,148 38,229 53,288 69,324 94,651 121,111 144,265 177,080 - Hospitals 19,150 23,827 33,950 41,967 56,161 70,751 85,108 108,801 - In-patient - - - - - - Out-patient - - - - - Non-Hospitals 10,998 14,402 19,338 27,357 38,490 50,360 59,157 68,279 - Average salary (Wages + Benefits) HUF/Month - - - - - - - - -- Average For Sector - - Doctors - - 16,816 - - 36,557 37,800 - - Nurses - - 7,968 - - 17,008 18,200 - - TABLE 7B. HUNGARY: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) 1 Health Revenues Million HUF 94,666 96,448 112,291 119,163 123,253 126,081 118,455 121,459 - Public 94,566 96,448 112,291 119,153 123,253 126,081 118,486 121,469 - State Budget 88,490 91,653 82,086 17,194 21,113 26,228 24,615 21,057 - National Health Insurance 1,311 1,370 24,580 96,810 96,414 92,525 86,081 91,574 - Direct Charges (Public) 4,754 3,425 5,625 5,140 5,726 7,328 7,759 8,828 - Borrowing - - - - - - - - Foreign Assistance (Loans/Grants) Private Private Insurance Direct Charges (Private) - - - - - - - - Health Expenditure Million HUF 94,566 96,448 112,291 119,153 123,253 117,870 118,451 121,459 - Public 94,566 96,448 112,291 119,153 123,263 147,870 118,481 121,459 - Recurrent Expenditure 85,374 86,310 102,815 108,778 112,109 106,154 109,868 114,009 - Personal Health Services 80,982 81,274 96,815 102,542 105,618 99,617 105,311 110,025 - Personnel (Wage/Benefits) - 25,833 28,413 32,240 31,829 38,971 37,467 38,464 - Drugs 30,985 34,686 29,705 32,709 34,913 45,273 34,069 36,803 - Other Consumables/Supplies - - - - - - - - - Energy/Utilities - 5,930 - - - - - Maintenance - 2,041 - - - - - - - Transportation 574 548 500 509 593 682 524 648 - Other 49,423 12,236 38,198 37,084 38,283 14,691 33,251 34,110 - Public Health Activities 1,770 1,805 2,193 2,373 2,627 2,820 2,180 1,642 - Medical Education 1,479 2,253 2,689 2,854 2,897 2,685 1,913 1,824 - Research And Development 1,143 977 1,119 1,009 967 1,032 464 518 - Capital Expenditures 9,182 10,138 9,476 10,375 11,144 11,716 8,584 7,450 - Construction - - - New - - - - - - - Rehabilitation - - - Equipment - - - Vehicles - - - - - - - - Public Reimbursements to Private Sector - - - - - - - - Private Sector - - - - Private Insurance Reimbursement - - - - Private Expenditures - - - - Expenditure Allocation Million HUF 49,423 52,368 66,610 69,324 70,112 73,848 70,718 72,574 - Hospitals 31,393 32,640 42,438 41,967 41,601 43,141 41,720 44,591 - In-patient - - - - - Out-patient - - - - - Non-Hospitals 18,030 19,729 24,173 27,357 28,511 30,707 28,999 27,983 - Average salary (Wages + Benefits) HUF/Month - - - - - - - - - Average For Sector - Doctors - - 21,020 - - 22,291 18,529 - - Nurses - - 9,960 - - 10,371 8,922 - - TABLE 7C. HUNGARY: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1996 (% GDP) Health Revenues % 4.70% 4.89% 5.21% 5.70% 7.09% 7.17% 6.90% 6.87% - Public 4.70% 4.89% 5.21% 5.70% 7.09% 7.17% 6.90% 6.87% - State Budget 4.40% 4.65% 3.81% 0.82% 1.21% 1.49% 1.43% 1.19% - National Health Insurance 0.07% 0.07% 1.14% 4.63% 5.54% 5.26% 5.01% 5.18% - Direct Charges (Public) 0.24% 0.17% 0.26% 0.25% 0.33% 0.42% 0.45% 0.50% - Borrowing - - - - - - - - Foreign Assistance (LoanslGrants) - - - - - - - - - Private - - - Private Insurance - - - Direct Charges (Private) - - - - - - - - Health Expenditure % 4.70% 4.89% 5.21% 5.70% 7.09% 6.70% 6.90% 6.87% - Public 4.70% 4.89% 5.21% 5.70% 7.09% 6.70% 6.90% 6.87% - Recurrent Expenditure 4.25% 4.37% 4.77% 5.21% 6.45% 6.03% 6.40% 6.45% - Personal Health Services 4.03% 4.12% 4.50% 4.91% 6.07% 5.66% 6.13% 6.22% - Personnel (Wage/Benefits) - 1.31% 1.32% 1.54% 1.83% 2.21% 2.18% 2.18% - Drugs 1.54% 1.76% 1.38% 1.57% 2.01% 2.57% 1.98% 2.08% - Other Consumables/Supplies - - - - - - - - - Energy/Utilities - 0.30% - - - - - - - Maintenance - 0.10% - - - - - - - Transportation 0.03% 0.03% 0.02% 0.02% 0.03% 0.04% 0.03% 0.04% - Other 2.46% 0.62% 1.77% 1.77% 2.20% 0.83% 1.94% 1.93% - Public Health Activities 0.09% 0.09% 0.10% 0.11% 0.15% 0.16% 0.13% 0.09% - Medical Education 0.07% 0.11% 0.12% 0.14% 0.17% 0.15% 0.11% 0.10% - Research And Development 0.06% 0.05% 0.05% 0.05% 0.06% 0.06% 0.03% 0.03% - Capital Expenditures 0.46% 0.51% 0.44% 0.50% 0.64% 0.67% 0.50% 0.42% - Construction - - - - - - - - - New Rehabilitation Equipment Vehicles Public Reimbursements to Private Sector - - - - - - - - - Private Sector Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - - -_-_- TABLE 7D. HUNGARY: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % 7.81% 7.89% 8.63% 9.98% 12.37% 11.63% 12.05% - - Public 7.81% 7.89% 8.63% 9.98% 12.37% 11.63% 12.05% - - State Budget 7.31% 7.50% 6.31% 1.44% 2.12% 2.42% 2.50% - - National Health Insurance 0.11% 0.11% 1.89% 8.11% 9.67% 8.53% 8.76% - - Direct Charges (Public) 0.39% 0.28% 0.43% 0.43% 0.57% 0.68% 0.79% - - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - -- - Private Insurance - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure % 7.81% 7.89% 8.63% 9.98% 12.37% 10.87% 12.05% - - Public 7.81% 7.89% 8.63% 9.98% 12.37% 10.87% 12.05% - - Recurrent Expenditure 7.05% 7.06% 7.90% 9.11% 11.25% 9.79% 11.18% - - Personal Health Services 6.69% 6.65% 7.44% 8.58% 10.60% 9.19% 10.72% - - Personnel (WagelBenefits) 2.11% 2.18% 2.70% 3.19% 3.59% 3.81% - - Drugs 2.56% 2.84% 2.28% 2.74% 3.50% 4.18% 3.47% - - Other Consumables/Supplies - - - - - - - - - Energy/Utilities - 0.49% - - - Maintenance - 0.17% - - - - - - Transportation 0.05% 0.04% 0.04% 0.04% 0.06% 0.06% 0.05% - - Other 4.08% 1.00% 2.93% 3.10% 3.84% 1.36% 3.38% - - Public Health Activities 0.15% 0.15% 0.17% 0.20% 0.26% 0.26% 0.22% - - Medical Education 0.12% 0.18% 0.21% 0.24% 0.29% 0.25% 0.19% - - Research And Development 0.09% 0.08% 0.09% 0.08% 0.10% 0.10% 0.05% - - Capital Expenditures 0.76% 0.83% 0.73% 0.87% 1.12% 1.08% 0.87% - - Construction - - - - - - - New - - - Rehabilitation - - - - - - - Equipment - - - - - - - Vehicles - - - - - - - Public Reimbursements to Private Sector - - - - - - - - Private Sector - - - - Private Insurance Reimbursement - - - - - - - - Private Expenditures J - - - - - -_-_- TABLE 8A. LITHUANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues Million Litas 2.90 3.14 3.49 3.88 114.34 128.36 436.93 823.30 1,133.50 Public 2.90 3.14 3.49 3.88 14.34 127.72 432.34 812.58 1,133.50 State Budget 2.90 3.14 3.49 3.88 13.57 121.50 382.19 689.73 964.00 National Health Insurance - - - - 0.77 6.22 50.15 122.85 169.50 Direct Charges (Public) - - - - - - - Borroing - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - Private - - - - - 0.64 4.59 10.72 - Private Insurance - - - - - - - - Direct Charges (Private) - - - - - 0.64 4.59 10.72 - Health Expenditure Million Litas 2.90 3.14 3.49 3.88 14.34 128.36 436.93 823.30 1,133.50 Public 2.90 3.14 3.49 3.88 14.34 127.73 432.34 812.58 1,133.50 Recurrent Expenditure 2.46 2.70 3.02 3.57 11.65 107.50 340.43 562.95 - Personal Health Services 2.38 2.62 2.93 3.47 11.27 104.76 333.39 549.78 - Personnel (Wage/Benefits) - - - 1.83 7.59 45.01 165.70 320.67 - Drugs - - - 0.36 0.71 4.76 50.42 79.72 - Other Consumables/Supplies - - - 0.75 - - 30.73 50.62 - Energy/Utilities - - - - - - 27.24 24.38 - Maintenance - - - - - - 21.20 31.60 - Transportation - - - 0.01 - - 0.46 0.50 - Other - - - 0.52 2.97 54.99 37.64 42.29 - Public Health Activities 0.08 0.08 0.09 0.10 0.38 2.74 5.01 9.23 - 0 Medical Education - - - - - - 1.63 2.90 - Research And Development - - - - - - 0.40 1.04 - Capital Expenditures 0.44 0.44 0.47 0.31 1.92 14.00 41.76 126.79 - Construction - - - 0.16 1.07 6.95 10.55 47.59 - New - - - 0.15 0.81 5.06 7.39 30.95 - Rehabilitation - - - 0.01 0.26 1.90 3.16 16.65 - Equipr.nt - - - 0.15 0.85 7.05 12.44 23.77 - Vehicles - - - - - - - - - Public Reimbursements to Private Sector - - - - 0.77 6.23 50.15 122.85 169.50 Private Sector - - - - - 0.64 4.59 10.72 - Private Insurance Reimbursement - - - - - - - Private Expenditures - - - - - 0.64 4.59 10.72 Expenditure Allocation Million Litas 2.90 3.14 3.49 3.87 13.57 121.50 382.19 676.57 - Hospitals 2.21 2.48 2.69 3.23 11.11 99.88 307.66 541.49 - In-patient - - - - - - - - Out-patient - - - - - - Non-Hospitals 0.69 0.66 0.80 0.64 2.46 21.62 74.53 135.08 - Average salary (Wages + Benefits) Litas/Month - - Average For Sector - Doctors - - Nurses - - TABLE 8B. LITHUANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues Million Litas 3.42 3.75 3.93 3.88 3.33 2.41 1.75 2.18 2.31 Public 3.42 3.75 3.93 3.88 3.33 2.39 1.73 2.15 2.31 State Budget 3.42 3.75 3.93 3.88 3.15 2.28 1.53 1.83 1.97 National Health Insurance - - - - 0.18 0.12 0.20 0.33 0.35 Direct Charges (Public) - - - - - - - - Borrowing - - - - - - - Foreign Assistance (Loans/Grants) - - - - - Private - - - - - 0.01 0.02 0.03 - Private Insurance - - - - - - - Direct Charges (Private) - - - - - 0.01 0.02 0.03 - Health Expenditure Million Litas 3.41 3.75 3.92 3.88 3.33 2.41 1.75 2.18 2.31 Public 3.41 3.75 3.92 3.88 3.33 2.39 1.73 2.15 2.31 Recurrent Expenditure 2.89 3.22 3.39 3.57 2.70 2.01 1.36 1.49 - Personal Health Services 2.80 3.13 3.30 3.47 2.61 1.96 1.33 1.46 - Personnel (Wage/Benefits) - - - 1.83 1.76 0.84 0.66 0.85 - Drugs - - - 0.36 0.16 0.09 0.20 0.21 - Other Consumables/Supplies - - - 0.75 - - 0.12 0.13 - Energy/Utilities - - - - - 0.11 0.06 - Maintenance - - - - - - 0.08 0.08 - Transportation - - - 0.01 - - - - - Other - - - 0.52 0.69 1.03 0.15 0.11 - Public Health Activities - - - 0.10 0.09 0.05 0.02 0.02 - Medical Education - - - - - - 0.01 0.01 - Research And Development - - - - - - - - Capital Expenditures 0.52 0.53 0.53 0.31 0.45 0.26 0.17 0.34 - Construction - - - 0.16 0.25 0.13 0.04 0.13 - New - - - 0.15 0.19 0.09 0.03 0.08 - Rehabilitation - - - 0.01 0.06 0.04 0.01 0.04 - Equipment - - - 0.15 0.20 0.13 0.05 0.06 - Vehicles - - - - - - - - - Public Reimbursements to Private Sector - - - - 0.18 0.12 0.20 0.33 0.35 Private Sector - - - - - 0.01 0.02 0.03 - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - 0.01 0.02 0.03 - Expenditure Allocation Million Litas 3.42 3.75 3.93 3.87 3.15 2.28 1.53 1.79 - Hospitals 2.60 2.96 3.03 3.23 2.58 1.87 1.23 1.44 - In-patient - - - - - - - - Out-patient - - - - - - - Non-Hospitals 0.81 0.79 0.90 0.64 0.57 0.41 0.30 0.36 - Average salary (Wages + Benefits) Litas/Month - - - - - - - - - Average For Sector - - - - - - Doctors Nurses--------- TABLE 8C. LITHUANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (%GDP) Health Revenues % 2.64% 2.66% 2.75% 2.92% 3.75% 3.79% 3.93% 4.85% 4.72% Public 2.64% 2.66% 2.75% 2.92% 3.75% 3.77% 3.89% 4.79% 4.72% State Budget 2.64% 2.66% 2.75% 2.92% 3.55% 3.59% 3.44% 4.06% 4.02% National Health Insurance - - - - 0.20% 0.18% 0.45% 0.72% 0.71% Direct Charges (Public) - - - - - - - - Borrowing - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - Private - - - - - 0.02% 0.04% 0.06% - Private Insurance - - - Direct Charges (Private) - - - - - 0.02% 0.04% 0.06% - Health Expenditure % 2.63% 2.66% 2.75% 2.92% 3.75% 3.79% 3.93% 4.85% 4.72% Public 2.63% 2.66% 2.75% 2.92% 3.75% 3.77% 3.89% 4.79% 4.72% Recurrent Expenditure 2.23% 2.29% 2.38% 2.69% 3.05% 3.17% 3.06% 3.32% 0.00% Personal Health Services 2.16% 2.22% 2.31% 2.61% 2.95% 3.09% 3.00% 3.24% - Personnel (Vage/Benefits) - - - 1.38% 1.99% 1.33% 1.49% 1.89% - Drugs - - - 0.27% 0.19% 0.14% 0.45% 0.47% - Other Consumables/Supplies - - - 0.56% - - 0.28% 0.30% - Energy/Utilities - - - - - - 0.25% 0.14% - Maintenance - - - - - - 0.19% 0.19% - Transportation - - - 0.01% - - - - - Other - - - 0.39% 0.78% 1.62% 0.34% 0.25% - Public Health Activities 0.07% 0.07% 0.07% 0.08% 0.10% 0.08% 0.05% 0.05% - Medical Education - - - - - - 0.01% 0.02% - Research And Development - - - - - - - 0.01% - Capital Expenditures 0.40% 0.37% 0.37% 0.23% 0.50% 0.41% 0.38% 0.75% - Construction - - - 0.12% 0.28% 0.21% 0.09% 0.28% - New - - - 0.11% 0.21% 0.15% 0.07% 0.18% - Rehabilitation - - - 0.01% 0.07% 0.06% 0.03% 0.10% - Equipment - - - 0.11% 0.22% 0.21% 0.11% 0.14% - Vehicles - - - - - - Public Reimbursements to Private Sector - - - - 0.20% 0.18% 0.45% 0.72% 0.71% Private Sector - - - - - 0.02% 0.04% 0.06% - Private Insurance Reimbursement Private Expenditures - - - - - 0.02% 0.04% 0.06% - TABLE 8D. LITHUANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % 7.07% 6.98% 7.27% 8.26% 9.62% 12.00% 11.17% 11.85% 11.34% Public 7.07% 6.98% 7.27% 8.26% 9.62% 11.94% 11.06% 11.69% 11.34% State Budget 7.07% 6.98% 7.27% 8.26% 9.11% 11.36% 9.77% 9.92% 9.64% National Health Insurance - - - - 0.52% 0.58% 1.28% 1.77% 1.70% Direct Charges (Public) - - - - - - - - - Borrowing - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - 0.06% 0.12% 0.15% - Private Insurance - - - - - - - - Direct Charges (Private) - - - - - 0.06% 0.12% 0.15% - Health Expenditure % 7.07% 6.98% 7.27% 8.26% 9.62% 12.00% 11.17% 11.85% 11.34% Public 7.07% 6.98% 7.27% 8.26% 9.62% 11.94% 11.06% 11.69% 11.34% Recurrent Expenditure 5.99% 6.00% 6.29% 7.60% 7.82% 10.05% 8.71% 8.10% - Personal Health Services 5.80% 5.82% 6.10% 7.38% 7.56% 9.79% 8.53% 7.91% - Personnel (Wage/Benefits) -- - - 3.89% 5.09% 4.21% 4.24% 4.61% - Drugs - - - 0.77% 0.47% 0.44% 1.29% 1.15% - Other Consumables/Supplies - - - 1.59% - - 0.79% 0.73% - Energy/Utilities - - - - - - 0.70% 0.35% - Maintenance - - - - - - 0.54% 0.45% - Transportation - - - 0.02% - - 0.01% 0.01% - Other - - - 1.10% 1.99% 5.14% 0.96% 0.61% - Public Health Activities 0.19% 0.18% 0.18% 0.22% 0.26% 0.26% 0.13% 0.13% - Medical Education - - - - - - 0.04% 0.04% - Research And Development - - - - - - 0.01% 0.01% - Capital Expenditures 1.07% 0.98% 0.98% 0.66% 1.29% 1.31% 1.07% 1.82% - Construction - - - 0.34% 0.72% 0.65% 0.27% 0.68% - New - - - 0.32% 0.55% 0.47% 0.19% 0.45% - Rehabilitation - - - 0.02% 0.17% 0.18% 0.08% 0.24% - Equipment - - - 0.32% 0.57% 0.66% 0.32% 0.34% - Vehicles - - - - - - - Public Reimbursements to Private Sector - - - - 0.52% 0.58% 1.28% 1.77% 1.70% Private Sector - - - - - 0.06% 0.12% 0.15% - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - 0.06% 0.12% 0.15% - TABLE 9A. POLAND: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues Billion Zloty 734 1,225 5,882 28,497 46,910 72,582 75,892 - - Public 734 1,225 5,882 28,497 46,910 72,582 75,892 - - State Budget 686 1,152 5,645 26,647 41,297 60,433 75,892 - - National Health Insurance - - - - - - - Direct Charges (Public) 48 73 237 1,850 5,613 12,149 - - Borrowing - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - Private - - - - - - - Private Insurance - - - - - - Direct Charges (Private) - - - - - - - Health Expenditure Billion Zloty 686 1,152 4,084 24,453 41,297 60,410 75,892 - Public 686 1,152 4,084 24,453 41,297 60,410 75,892 - - Recurrent Expenditure 583 984 3,614 22,555 39,241 56,374 73,099 - - Personal Health Services - - - - 36,651 52,526 68,096 - - Personnel (Wage/Benefits) - - - - 19,223 29,511 38,409 - - Drugs - - - - 7,978 9,865 11,573 - - Other Consumables/Supplies - - - - 2,136 2,582 3,290 - - Energy/Utilities - - - - 981 1,448 1,484 - - Maintenance - - - - 2,765 3.389 4,320 - - Transportation - - - Other - - 1,381 2,194 3,570 5,731 9,020 - - Public Health Activities - - - - 897 1,351 1,808 - - Medical Education -- - - 1,423 2,142 2,781 - - Research And Development - - - - 270 356 414 - - Capital Expenditures 103 168 470 1,898 2,055 4,037 2,793 - - Construction - - - New - - - - Rehabilitation - - - - Equipment - - - - - - - - - Vehicles - - - - - - - - - Public Reimbursements to Private Sector - - - - - - - - - Private Sector - - - - - - - - - Private Insurance Reimbursement - - - - Private Expenditures - - - - Expenditure Allocation Billion Zloty - - - - - - - - Hospitals - - - - 19,504 28,071 36,520 - - In-patient - - - - - -- - - - Out-patient Non-Hospitals - Average salary (Wages + Benefits) 000 ZI/Month - - - - - Average For Sector 22 41 189 1,041 1.604 - Doctors - - - - - Nurses -_-_____ TABLE 9B. POLAND: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues Billion Zloty 29,350 30,631 30,009 28,497 30,265 33,759 27,008 - - Public 29,350 30,631 30,009 28,497 30,265 33,759 27,008 - State Budget 27,440 28,800 28,763 26,647 26,643 28,108 27,008 - - National Health Insurance - - - - - - - Direct Charges (Public) 1,910 1,831 1,245 1,850 3,622 5,651 - - - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - - - - Private Insurance - - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure Billion Zloty 27,440 28,800 21,495 24,453 26,643 28,098 27,008 - - Public 27,440 28,800 21,495 24,453 26,643 28,098 27,008 - - Recurrent Expenditure 23,320 24,600 19,021 22,555 26,317 26,220 26,014 - - Personal Health Services - - - - 23,646 24,431 24,233 - - Personnel (Wage/Benefits) - - - - 12,402 13,726 13,669 - - Drugs - - - - 5,147 4,588 4,119 - - Other Consumables/Supplies - - - - 1,378 1,201 1,171 - - Energy/Utilities - - - - 633 673 528 - - Maintenance - - - - 1,784 1,576 1,537 - - Transportation - - - - - - - - Other - - 7,268 2,194 2,303 2,666 3,210 - - Public Health Activities - - - - 579 628 644 - - Medical Education - - - - 918 996 990 - - Research And Development - - - - 174 165 147 - - Capital Expenditures 4,120 4,200 2,474 1,898 1,326 1,878 994 - - Construction - - - - - - - - New - - - - - Rehabilitation - - - - - Equipment - - - - - Vehicles - - - - - Public Reimbursements to Private Sector - - - - - - - - - Private Sector - - - - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures Expenditure Allocation Billion Zloty - - - - - - - - - Hospitals - - - - 12,583 13,056 12,996 - - In-patient - - - - - - - Out-patient - - - - - - - Non-Hospitals - - - - - - - Average salary (Wages + Benefits) 000 ZI/Month - - - - - - - - - Average For Sector 896 1,015 997 1,041 1,035 - - - - Doctors - - - - - - - Nurses - - - - - - -_-_ TABLE 9C. POLAND: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (1% GDP) HealthRevenues % 4.33% 4.14% 4.82% 5.09% 5.80% 6.31% 4.87% - - Public 4.33% 4.14% 4.82% 5.09% 5.80% 6.31% 4.87% - - State Budget 4.05% 3.89% 4.62% 4.76% 5.11% 5.26% 4.87% - - National Health Insurance - - - - - - - Direct Charges (Public) 0.28% 0.25% 0.20% 0.33% 0.69% 1.06% - - - Borrowing - Foreign Assistance (Loans/Grants) - - - - - - - - - Privat - - - - - - - - - Private Insurance - - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure % 4.05% 3.89% 3.45% 4.36% 5.11% 5.26% 4.87% - - Public 4.05% 3.89% 3.45% 4.36% 5.11% 5.26% 4.87% - - Recurrent Expenditure 3.44% 3.32% 3.05% 4.03% 4.85% 4.90% 4.69% - - Personal Health Services - - - - 4.53% 4.57% 4.37% - - Personnel (WagelBenefits) - - - - 2.38% 2.57% 2.47% - - Drugs - - - - 0.99% 0.86% 0.74% - - Other Consumables/Supplies - - - - 0.26% 0.22% 0.21% - - Energy/Utilities - - - - 0.12% 0.13% QA0% - - Maintenance - - - - 0.34% 0.29% 0.28% - - Transportation - - - - - - - - - Other - - 1.17% 0.39% 0.44% 0.50% 0.58% - - Public Health Activities - - - - 0.11% 0.12% 0.12% - - Medical Education - - - - 0.18% 0.19% 0.18% - - Research And Development - - - - 0.03% 0.03% 0.03% - - Capital Expenditures 0.61% 0.57% 0.40% 0.34% 0.25% 0.35% 0.18% - - Construction - - - - - - - - - New - Rehabilitation - - - - - - - - - Equipment - - - - - - - - - Vehicles - - - - - - - - - Public Reimbursements to Private Sector - - - - - - - - - Private Sector - - - - - - - - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - __-___-_- TABLE 9D. POLAND: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % 11.48% 11.55% 12.09% 11.67% 11.85% 12.20% 9.75% - - Public 11.48% 11.55% 12.09% 11.67% 11.85% 12.20% 9.75% - - State Budget 10.74% 10.86% 11.59% 10.91% 10.43% 10.15% 9.75% - - National Health Insurance - - - - - - - Direct Charges (Public) 0.75% 0.69% 0.50% 0.76% 1.42% 2.04% - - - Borrowing - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - Private Insurance - - - - - Direct Charges (Private) - - - - - - - - Health Expenditure % 10.74% 10.86% 8.66% 10.01% 10.43% 10.15% 9.75% - - Public 10.74% 10.86% 8.66% 10.01% 10.43% 10.15% 9.75% - - Recurrent Expenditure 9.13% 9.27% 7.66% 9.23% 9.91% 9.47% 9.40% - - Personal Health Services - - - - 9.26% 8.83% 8.76% - - Personnel (Wage/Benefits) - - - - 4.86% 4.96% 4.94% - - Drugs - - - - 2.02% 1.66% 1.49% - - Other Consumables/Supplies - - - - 0.54% 0.43% 0.42% - - Energy/Utilities - - - - 0.25% 0.24% 0.19% - - Maintenance - - - - 0.70% 0.57% 0.56% - - Transportation - - - - - - - - - Other - - 2.93% 0.90% 0.90% 0.96% 1.16% - - Public Health Activities - - - - 0.23% 0.23% 0.23% - - Medical Education - - - - 0.36% 0.36% 0.36% - - Research And Development - - - - 0.07% 0.06% 0.05% - - Capital Expenditures 1.61% 1.58% 1.00% 0.78% 0.52% 0.68% 0.36% - - Construction - - - - - - - - - New - Rehabilitation - - - - - - - - - Equipment - - - - - - - - - Vehicles - - - - - - - - - Public Reimbursements to Private Sector - - - - - - - - - Private Sector - - - - - - - - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures --- - -1 -- - - TABLE 10A. ROMANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues Million Le= 17,533 17,824 18,975 24,210 71,730 215,432 604,124 1,62,312 2,620,400 Publtc 17,533 17,824 18,975 24,210 71,730 215,432 604,124 1,662,312 2,620,400 State Budget 17,533 17,824 18,975 24,210 62,680 152,990 468,800 1,273,340 1,852,310 National Health Insurance - - - - - - - - - Direct Charges (Public) - - - - - - - - - Borrowing - - - - - 19,800 43,000 144,700 352,290 Foreign Assistance (Loans/Grants) - - - - - 10,472 25,844 80,682 130,000 Private - - - - - - - - - Private Insurance - - - - - Direct Charges (Private) - - - - - - Health Expenditure Million Lei 17,533 17,824 18,975 24,210 71,730 215,432 604,124 1,662,312 2,620,400 Public 17,533 17,824 18,975 24,210 71,730 215,432 604,124 1,662,312 2,620,400 Recurrent Expenditure - - - 24,170 67,380 199,822 562,574 1,531,162 2,271,010 Personal Health Services - - - 24,170 67,380 199,822 562,574 1,531,162 2,271,010 Personnel (Wage/Benefits) - - - 16,310 43,490 109,540 310,730 765,600 1,139,670 Drugs - - - 3,110 9,310 25,450 73,440 256,590 425,830 Other Consumables/Supplies - - - 2,560 7,570 19,680 56,080 143,860 188,500 Energy/Utilities - - - - - - - - - Maintenance - - - 1,890 6,710 20,250 60,460 167,110 211,040 Transportation - - - 20 50 120 330 950 2,270 Other - - - 280 250 24,782 61,534 197,052 303,700 Public Health Activities - -;- Medical Education - - Research And Development - - Capital Expenditures - - - 40 4,350 15,610 41,550 131,150 349,390 Construction New - - - - - - - - Rehabilitation - - - - - - - - Equipment Vehicles - - - - - - - - Public Reimbursements to Private Sector - - - - - - Private Sector - Private Insurance Reimbursement - Private Expenditures - - - - - - Expenditure Allocation Million Lei - - - 24,210 71,730 185,160 535,280 1,436,930 2,138,110 Hospitals - - - 13,690 44,520 119,030 312,410 851,340 1,371,370 In-patient - - - - - Out-patient - - - - Non-Hospitals - - - 10,520 27,210 66,130 222,870 585,590 766,740 Average salary (Wages + Benefits) Lel/Month - - - - - - - - - Average For Sector 2,675 2,725 2,870 3,262 7,983 19,760 55,067 145,869 - Doctors 3,694 4,029 4,029 4,029 9,396 22,480 102,240 185,560 - Nurses 2,436 2,817 2,817 2,817 6,120 14,600 68,520 124,280 - TABLE 1OB. ROMANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues Million Lei 20,153 20,487 21,811 24,210 24,316 23,190 20,868 24,674 29,693 Public 20,153 20,487 21,811 24,210 24,315 23,190 20,868 24,674 29,693 State Budget 20,153 20,487 21,811 24,210 21,247 16,468 16,193 18,901 20,989 National Health Insurance - - - - - - - - Direct Charges (Public) - - - - - - - - - Borrowing - - - - - 2,131 1,485 2,148 3,992 Foreign Assistance (Loans/Grants) - - - - - 1,127 893 1,198 1,473 Private - - - - - - - - - Private Insurance - - - - - Direct Charges (Private) - - - - - Health Expenditure Million Lei 20,153 20,487 21,811 24,210 24,316 23,190 20,868 24,674 29,693 Public 20,163 20,487 21,811 24,210 24,315 23,190 20,868 24,674 29,693 Recurrent Expenditure - - - 24,170 22,841 21,509 19,433 22,728 25,734 Personal Health Services - - -- 24,170 22,841 21,509 19,433 22,728 25,734 Personnel (Wage/Benefits) - - - 16,310 14,742 11,791 10,733 11,364 12,914 Drugs - - - 3,110 3,156 2,740 2,537 3,809 4,825 Other Consumables/Supplies - - - 2,560 2,566 2,118 1,937 2,135 2,136 Energy/Utilities - - - - - Maintenance - - - 1,890 2,275 2,180 2,088 2,480 2,391 Transportation - - - 20 17 13 11 14 26 Other - - - 280 85 2,668 2,126 2,925 3,441 00 Public Health Activities - - Medical Education Research And Development - Capital Expenditures - - - 40 1,475 1,680 1,435 1,947 3,959 Construction - - - - - New Rehabilitation Equipment Vehicles Public Reimbursements to Private Sector - - - - - - - - -- Private Sector Private Insurance Reimbursement Private Expenditures - - - - - - Expenditure Allocation Million Lei -- - - 24,210 24,315 19,931 18,490 21,329 24,228 Hospitals - - -- 13,690 15,092 12,813 10,791 12,637 15,540 In-patient Out-patient Non-Hospitals - - - 10,520 9,224 7,118 7,698 8,692 8,688 Average salary (Wages + Benefits) LeilMonth - - - - - - - - - Average For Sector 3,075 3,132 3,299 3,262 2,706 2,127 1,902 2,165 - Doctors 4,246 4,631 4,631 4,029 3,185 2,420 3,532 2,754 - Nurses 1 2,800 3,238 3,238 2,817 2,075 1,572 2,367 1,845 - TABLE 10C. ROMANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% GDP) Health Revenues % 2.07% 2.08% 2.37% 2.82% 3.25% 3.54% 3.06% 3.57% 4.04% Public 2.07% 2.08% 2.37% 2.82% 3.25% 3.54% 3.06% 3.57% 4.04% State Budget 2.07% 2.08% 2.37% 2.82% 2.84% 2.51% 2.38% 2.73% 2.86% National Health Insurance - - - - - - - - Direct Charges (Public) - - - - - - - - - Borrowing - - - - - 0.33% 0.22% 0.31% 0.54% Foreign Assistance (Loans/Grants) - - - - - 0.17% 0.13% 0.17% 0.20% Private - - - - - - - - - Private Insurance - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure % 2.07% 2.08% 2.37% 2.82% 3.25% 3.54% 3.06% 3.57% 4.04% Public 2.07% 2.08% 2.37% 2.82% 3.25% 3.54% 3.06% 3.57% 4.04% Recurrent Expenditure - - - 2.82% 3.06% 3.28% 2.85% 3.29% 3.60% Personal Health Services - - - 2.82% 3.06% 3.28% 2.85% 3.29% 3.50% Personnel (Wage/Benefits) - - - 1.90% 1.97% 1.80% 1.57% 1.64% 1.76% Drugs - - - 0.36% 0.42% 0.42% 0.37% 0.55% 0.66% Other Consumables/Supplies - - - 0.30% 0.34% 0.32% 0.28% 0.31% 0.29% Energy/Utilities - - - - - - - - - Maintenance - - - 0.22% 0.30% 0.33% 0.31% 0.36% 0.33% Transportation - - - 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% I Other - - - 0.03% 0.01% 0.41% 0.31% 0.42% 0.47% Public Health Activities - - - - - - - - - Medical Education - - - - Research And Development - - - - - - - - - Capital Expenditures - - - - 0.20% 0.26% 0.21% 0.28% 0.54% Construction - - - - - - - - - New -- - - - - - - - Rehabilitation - - - - - - - - - Equipment - - - - - - - - - Vehicles - - - - - - - - -- Public Reimbursements to Private Sector - - - - - - - - - Private Sector - - - - - - - - - Private Insurance Reimbursement - - - - - - - - Private Expenditures - TABLE 10D. ROMANIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % 6.23% 6.22% 6.58% 7.79% 13.34% 13.24% 8.89% 9.81% 10.52% Public 6.23% 6.22% 6.58% 7.79% 13.34% 13.24% 8.89% 9.81% 10.52% State Budget 6.23% 6.22% 6.58% 7.79% 11.65% 9.40% 6.90% 7.51% 7.44% National Health Insurance - - - - - - - - - Direct Charges (Public) - - - - - - - - - Borrowing - - - - - 1.22% 0.63% 0.85% 1.41% Foreign Assistance (LoanstGrants) - - - - - 0.64% 0.38% 0.48% 0.52% Private - - - - - - - - - Private Insurance - - - - - Direct Charges (Private) - - - - - - - - Health Expenditure % 6.23% 6.22% 6.58% 7.79% 13.34% 13.24% 8.89% 9.81% 10.52% Public 6.23% 6.22% 6.58% 7.79% 13.34% 13.24% 8.89% 9.81% 10.52% Recurrent Expenditure - - - - 12.53% 12.28% 8.28% 9.03% 9.12% Personal Health Services - - - - 12.53% 12.28% 8.28% 9.03% 9.12% Personnel (Wage/Benefits) - - - - 8.09% 6.73% 4.57% 4.52% 4.57% Drugs - - - - 1.73% 1.56% 1.08% 1.51% 1.71% Other Consumables/Supplies - - - - 1.41% 1.21% 0.82% 0.85% 0.76% EnergylUtilities - - - - - - - - Maintenance - - - - 1.25% 1.24% 0.89% 0.99% 0.85% Transportation - - - - 0.01% 0.01% 0.00% 0.01% 0.01% 0 Other - - - - 0.05% 1.52% 0.91% 1.16% 1.22% Public Health Activities - - - - - - - - Medical Education - Research And Development - - - - - - - Capital Expenditures - - - - 0.81% 0.96% 0.61% 0.77% 1.40% Construction - - - -- - - - New - Rehabilitation - - - Equipment - - - Vehicles - - - Public Reimbursements to Private Sector - - - - - - - - Private Sector - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures -___- - -_- - _ - - TABLE 1 1A. SLOVAKIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues IMillion Sk 10,367 10,601 11,964 13,796 14,836 15,324 21,665 27,970 31,240 Public 10,367 10,601 11,964 13,796 14,836 15,324 21,665 27,970 31,240 State Budget 10,367 10,601 11,964 13,796 14,644 15,324 13,655 15,820 16,240 National Health Insurance - - - - - - 8,010 12,150 15,000 Direct Charges (Public) - - - - 192 - - - - Borrowing - Foreign Assistance (Loaris/Grants) - - Private - - Private Insurance Direct Charges (Private) - - Health Expenditure Million Sk 10,367 10,601 11,964 13,796 14,644 15,324 21,665 27,970 31,240 Public 10,367 10,601 11,964 13,796 14,644 15,324 21,665 27,970 31,240 Recurrent Expenditure 10,367 10,601 11,964 13,796 14,644 15,324 21,665 27,970 31,240 Personal Health Services 10,367 10,601 11,964 13,796 14,644 15,324 21,665 27,970 31,240 Personnel (WagelBenefits) 3,244 3,464 3,735 5,345 5,766 5,987 7,104 8,144 - Drugs -------- Other Consumables/Supplies 3,945 4,193 4,336 5,768 5,935 6,234 7,745 8,677 - Energy/Utilities - - - - - - - - Maintenance Transportation - - - - - - - - Other 3,178 2,944 3,893 2,683 2,943 3,103 6,816 11,149 Public Health Activities - - - - - - - - Medical Education - - Research And Development - - - Capital Expenditures - - 1,235 - - - - - Construction - - - - - - - New - - - - - - - Rehabilitation - - - - - - - Equipment - - - - - - - Vehicles - - - - - - - Public Reimbursements to Private Sector - - - - - - - - Private Sector - - - - - - Private Insurance Reimbursement - - - - - - - - Private Expenditures - - - - - - Expenditure Allocation Million Sk - - - - - - - - Hospitals - - - - - - In-patient - - - - - - Out-patient - - - - - - Non-Hospitals Average salary (Wages + Benefits) SkfMonth - - - - - - Average For Sector Doctors Nurses_______________ _____ _____ _____ ___ __ TABLE 11 B. SLOVAKIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues Million Sk - - 12,865 13,796 11,071 10,285 12,696 14,568 14,698 Public - - 12,865 13,796 11,071 10,286 12,696 14,568 14,698 State Budget - - 12,865 13,796 10,928 10,285 7,939 8,240 7,589 National Health Insurance - - - - - - 4,657 6,328 7,009 Direct Charges (Public) - - - - 143 - - - - Borrowing -- Foreign Assistance (Loans/Grants) - - - - - - - - - Private Private Insurance Direct Charges (Private) Health Expenditure Million Sk - - 12,865 13,796 10,928 10,286 12,596 14,668 14,598 Public - - 12,865 13,796 10,928 10,285 12,696 14,668 14,598 Recurrent Expenditure - - 12,865 13,796 10,928 10,285 12,596 14.568 14,598 Personal Health Services - - 12,865 13,796 10,928 10,285 12,596 14,568 14,598 Personnel (Wage/Benefits) - - 4,016 5,345 4,303 4,018 4,130 4,242 - Drugs - - - - - - - - Other Consumables/Supplies - - 4,662 5,768 4,429 4,184 4,503 4,519 Energy/Utilities - - - - - - - - Maintenance - - Transportation - - - - - - - - Other - - 4,186 2,683 2,196 2,083 3,963 5,807 - Public Health Activities - - - - - - - - Medical Education - - Research And Development - - - Capital Expenditures - - 1,328 - - - - - - Construction - - - - - - - - New -------- Rehabilitation - - - - - - - - Equipment - - - - - - - - Vehicles - - - - - - - - Public Reimbursements to Private Sector - - - - - - - - - Private Sector - - - - - - - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - - - - Expenditure Allocation Million Sk - - - - - - - - - Hospitals - - - - - - - - In-patient - - - - - - - - Out-patient - - - - - - - - Non-Hospitals - - - - - - - - Average salary (Wages + Benefits) SklMonth - - - - - - - - - Average For Sector - - - - - - - - Doctors - - - - - - - - Nurses --------- TABLE 11C. SLOVAKIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% GDP) Health Revenues % 4.78% 4.46% 5.04% 5.37% 5.02% 5.08% 6.36% 7.05% 6.82% Public 4.78% 4.46% 5.04% 5.37% 5.02% 5.08% 6.36% 7.05% 6.82% State Budget 4.78% 4.46% 5.04% 5.37% 4.95% 5.08% 4.01% 3.99% 3.54% National Health Insurance - - - - - - 2.35% 3.06% 3.27% Direct Charges (Public) - - - - 0.06% - - - - Borrowing - - - - - Foreign Assistance (Loans/Grants) - - - - - - Private-- ----- Private Insurance - - - - Direct Charges (Private) - - - - Health Expenditure % 4.78% 4.46% 5.04% 5.37% 4.95% 5.08% 6.36% 7.05% 6.82% Public 4.78% 4.46% 5.04% 5.37% 4.95% 5.08% 6.36% 7.05% 6.82% Recurrent Expenditure 4.78% 4.46% 5.04% 5.37% 4.95% 5.08% 6.36% 7.05% 6.82% Personal Health Services 4.78% 4.46% 5.04% 5.37% 4.95% 5.08% 6.36% 7.05% 6.82% Personnel (Wage/Benefits) 1.50% 1.46% 1.57% 2.08% 1.95% 1.98% 2.08% 2.05% - Drugs - - - - - - - - Other Consumables/Supplies 1.82% 1.77% 1.83% 2.24% 2.01% 2.07% 2.27% 2.19% - Energy/Utilities - - - - - - - - Maintenance - - - - Transportation - - - Other - - - - Public Health Activities - - - Medical Education - - Research And Development - - - Capital Expenditures - - 0.52% - - Construction - ----- New - - - Rehabilitation - - - Equient- - -- ----- Vehicles - - - Public Reimbursements to Private Sector - - - Private Sector - Private Insurance Reimbrsement - - - - - PrW ste E)pendtmrs____ TABLE 11D. SLOVAKIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % - - - - - 7.96% 11.43% 13.40% 13.14% Public - - - - - 7.96% 11.43% 13.40% 13.14% State Budget - - - - - 7.96% 7.21% 7.58% 6.83% National Health Insurance - - - - - - 4.23% 5.82% 6.31% Direct Charges (Public) - - - - Borrowing - Foreign Assistance (Loans/Grants) - - - - - - - - Private - Private Insurance - - - - - Direct Charges (Private) - - - - - - - -- - Health Expenditure % - - - - - 7.96% 11.43% 13.40% 13.14% Public - - - - - 7.96% 11.43% 13.40% 13.14% Recurrent Expenditure - - - - - 7.96% 11.43% 13.40% 13.14% Personal Health Services - - - - - 7.96% 11.43% 13.40% 13.14% Personnel (Wage/Benefits) - - - - - 3.11% 3.75% 3.90% - Drugs ----- Other Consumables/Supplies - - - - - 3.24% 4.09% 4.16% Energy/Utilities -- - -- Maintenance - - - - - - - - -- Transportation - -- - - - -- - - - Other - - - -- - 1.61% 3.60% 5.34% - Public Health Activities - - - Medical Education Research And Development - Capital Expenditures - Construction - New - Rehabilitation Equipment Vehicles Public Reimbursements to Private Sector - - - -- - - -- Private Sector Private Insurance Reimbursement -- - - - - - - - - Private Expenditures -- - - - - - - - - TABLE 12A. SLOVENIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues Million Tolars - - - 13,968 18,086 74,590 110,076 135,112 163,521 Public - - - 13,968 18,086 74,590 110,076 135,112 163,521 State Budget - - - 13,968 18,086 1,737 3,510 9,966 4,398 National Health Insurance - - - - - 72,853 106,566 125,147 159,123 Direct Charges (Public) - - - - - - Borrowing - - Foreign Assistance (Loans/Grants) - - Private - - Private Insurance - - Direct Charges (Private) - - - - - - - Health Expenditure Million Tolars - - 13,968 18,086 74,590 110,076 142,056 1,922 Public - - 13,968 18,086 68,812 103,955 126,422 1,922 Recurrent Expenditure - - - 13,900 18,002 68,657 103,228 124,807 - Personal Health Services - - - 13,444 17,481 67,971 102,361 123,770 - Personnel (Wage/Benefits) - - - 7,413 7,825 34.278 53,170 64,809 - Drugs - - - 1,989 2,447 11,871 17.313 23,242 - Other Consumables/Supplies - - - 2,524 3,361 11,346 19,331 20,242 - Energy/Utilities -- - - - - - Maintenance - - - 204 222 1,065 1,122 1,132 - Transportation - - - 261 642 1,663 2,254 2,679 - Other - - - 1,054 2,983 7,748 9,171 11,666 - Public Health Activities - - - 456 521 686 845 1,007 1,514 Medical Education - - - - - - 14 22 29 Research And Development - - - - - - 7 9 14 Capital Expenditures - - - 67 84 154 727 1,615 1,922 Construction - - - - - - New Rehabilitation - - - - Equipment - - - - - 154 727 1,615 1,922 Vehicles - - - - Public Reimbursements to Private Sector - - - - - 5,778 6,121 15,634 - Private Sector - - - Private Insurance Reimbursement Private Expenditures - - - Expenditure Allocation Million Tolars - - 13,968 18,086 74,590 110,076 135,143 - Hospitals - - - 7,585 9,423 34,162 46,892 66,220 - In-patient - - - - - - Out-patient - - - - - - Non-Hospitals - - - 6,383 8,663 40,428 63,184 68,923 - Average salary (Wages + Benefits) Tolars/Month - - - 10,159 16,836 51,056 77,882 - - Average For Sector - - - 13,210 21,280 63,983 97,012 - - Doctors - - - 21,131 31,464 97,885 146,254 - - Nurses - - - 11,571 19,708 59,999 93,730 - - TABLE 12B. SLOVENIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1990=100) Health Revenues Million Tolars - - - 13,968 9,181 12,452 13,742 13,285 12,750 Public - - - 13,968 9,181 12,452 13,742 13,285 12,750 State Budget - - - 13,968 9,181 290 438 980 357 National Health Insurance - - - - - 12,162 13,304 12,305 12,393 Direct Charges (Public) - - - - - - - - - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - - - - Private Insurance - - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure Million Tolars - - - 13,968 9,181 12,452 13,742 13,968 12,750 Public - - - 13,968 9,181 12,452 13,742 13,968 12,750 Recurrent Expenditure - - - 13,900 9,138 11,462 12,887 12,272 - Personal Health Services - - - 13,444 8,873 11,347 12,779 12,170 - Personnel (Wage/Benefits) - - - 7,413 3,972 5,723 6,638 6,373 - Drugs - - - 1,989 1,242 1,982 2,161 2,285 - Other Consumables/Supplies - - - 2,524 1,706 1,894 2,413 1,990 - Energy/Utilities - - - - - - - - - Maintenance - - - 204 113 178 140 111 - Transportation - - - 261 326 278 281 263 - Other - - - 1,054 1,514 1,293 1,145 1,147 - Public Health Activities - - - 456 265 115 106 99 123 Medical Education - - - - - - 2 2 2 Research And Development - - - - - - 1 1 1 Capital Expenditures - - - 67 42 26 91 159 156 Construction - - - - - - - - - New --------- Rehabilitation - - - - - - - - - Equipment - - - - - 26 91 159 156 Vehicles - - - - - - - - - Public Reimbursements to Private Sector - - - - - 965 764 1,537 Private Sector - - - - - - - - Private Insurance Reimbursement - - - - - Private Expenditures - - - - - - - - Expenditure Allocation Million Tolars - - - 13,968 9,181 12,452 13,742 13,288 - Hospitals - - - 7,585 4,783 5,703 5,854 6,511 In-patient - - - - - - - - Out-patient - - - - - - - - Non-Hospitals - - - 6,383 4,397 6,749 7,888 6,777 Average salary (Wages + Benefits) Tolars/Month - -- - 10,159 8,546 8,524 9,723 - - Average For Sector - - - 13,210 10,802 10,682 12,111 - - Doctors - - - 21,131 15,972 16,341 18,259 - - Nurses - - - 11,571 10,003 10,017 11,702 - - TABLE 12C. SLOVENIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% GDP) Health Revenues % - - - 5.63% 6.17% 7.42% 7.67% 7.47% 7.27% Public - - - 5.63% S.17% 7.42% 7.67% 7.47% 7.27% State Budget - - - 5.63% 5.17% 0.17% 0.24% 0.55% 0.20% National Health Insurance - - - - - 7.25% 7.43% 6.92% 7.07% Direct-Charges (Public) - - - - Borrowing - - Foreign Assistance (Loans/Grants) - - - Private - - - Private Insurance - - - Direct Charges (Private) - - - Health Expenditure % - - - 5.63% 5.17% 7.42% 7.67% 7.86% 7.27% Public - - - 5.63% S.17% 7.42% 7.67% 7.86% 7.27% Recurrent Expenditure - - - 5.60% 5.15% 6.83% 7.19% 6.90% - Personal Health Services - - - 5.42% 5.00% 6.76% 7.13% 6.85% - Personnel (WagetBenetits) - - - 2.99% 2.24% 3.41% 3.71% 3.568% - Drugs - - - 0.80% 0.70% 1.18% 1.21% 1.29% - Other Consumables/Supplies - - - 1.02% 0.96% 1.13% 1.35% 1.12% - Energy/Utilities - - - - .. - Maintenance - - - 0.08% 0.06% 0.11% 0.08% 0.06% Transportation - - - 0.10% 0.18% 0.17% 0.16% 0.15% - Other - - - 0.42% 0.85% 0.77% 0.64% 0.65% - Public Health Activities - - - 0.18% 0.15% 0.07% 0.06% 0.06% 0.07% Medical Education - - - - - - Research And Development - - - - - - Capital Expenditures - - - 0.03% 0.02% 0.02% 0.05% 0.09% 0.09% Construction - - - - - New Rehabilitation - - - - Equipment - - - - - 0.02% 0.05% 0.09% 0.09% Vehicles - - - - - - - - - Private insurance Reimbursement - - - - - - Private Expenditures - - - - - - - - - TABLE 12D. SLOVENIA: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % - - - 14.94% 12.60% 16.07% 16.40% 15.80% 15.68% Public - - - 14.94% 12.60% 16.07% 16.40% 15.80% 15.68% State Budget - - - 14.94% 12.60% 0.37% 0.52% 1.17% 0.44% National Health Insurance - - - - - 15.70% 15.88% 14.63% 15.24% Direct Charges (Public) -- - - - Borrowing - Foreign Assistance (Loans/Grants) - - - - - .. Private - - - - Private Insurance - - - . Direct Charges (Private) - - - - Health Expenditure % - - - 14.94% 12.60% 16.07% 16.40% 16.61% 15.68% Public - - - 14.94% 12.60% 16.07% 16.40% 16.61% 15.68% Recurrent Expenditure - - - 14.87% 12.54% 14.79% 15.38% 14.59% - Personal Health Services - - - 14.38% 12.18% 14.64% 15.25% 14.47% -- Personnel (Wage/Benefits) - - - 7.93% 5.45% 7.38% 7.92% 7.58% Drugs - - - 2.13% 1.70% 2.56% 2.58% 2.72% Other Consumables/Supplies - - -- 2.70% 2.34% 2.44% 2.88% 2.37% Energy/Utilities - - -- .. - Maintenance - - -- 0.22% 0.15% 0.23% 0.17% 0.13% Transportation -- - 0.28% 0.45% 0.36% 0.34% 0.31% -- Other - - - 1.13% 2.08% 1.67% 1.37% 1.36% - Public Health Activities - - - 0.49% 0.36% 0.15% 0.13% 0.12% 0.15% Medical Education -- -- -- - -- .. Research And Development -- -- - - -- -- Capital Expenditures -- -- - 0.07% 0.06% 0.03% 0.11% 0.19% 0.19% Construction -- -- - -- -- -- New Rehabilitation -- -- -- - Equipment -- -- -- - -- 0.03% 0.11% 0.19% 0.19% Vehicles -- -- -- - Public Reimbursements to Private Sector - - -- - -- 1.24% 0.91% 1.83% -- Private Sector Private Insurance Reimbursement -- -- -- -- - -- -- -- -- Private Expenditures --'--I- - - -- -- -- - TABLE 13A. TURKMENISTAN: SOURCES OF FINANCING AND HEALTH EXPENDITURE, NOMINAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 Health Revenues 000 Manats - - - - 1,088 11,569 182,508 1,639,496 9,835,189 Public - - - - 1,088 11,569 182,508 1,639,496 9,835,189 State Budget - - - - 1,088 11,569 182,508 1,639,496 9,835,189 National Health Insurance - - - - - - - - Direct Charges (Public) - - - Borrowing - - - Foreign Assistance (Loans/Grants) - - Private - - Private Insurance - - Direct Charges (Private) - - - - - - - Health Expenditure 000 Manats - - - -- 1,088 11,569 182,507 1,639,496 9,835,189 Public - - - - 1,088 11,569 182,507 1,639,496 9,835,189 Recurrent Expenditure - - - 1,004 10,021 161,451 1,395,544 8,286,300 Personal Health Services - - - - 1,004 10,021 152,032 1,320,026 8,286,300 Personnel (wagelbenefits) - - - - 509 5,915 100,536 814,179 3,268,186 Drugs - - - - 73 503 12,123 94,594 1,641,784 Other consumables/supplies - - - - 77 1,001 11,910 130,594 1,388,986 Energy/utilities - - - - 279 1,410 16,032 170,352 1,860,946 Maintenance - - - - 65 1,192 9,443 91,233 126,398 Transportation - - - - - - 346 6,555 - Other - - - - - - 1,642 12,519 - Public Health Activities - - - - - - 9,419 39,055 - Medical Education - - - - - - - - - Research And Development - - - - - - - 36,463 - Capital Expenditures - - - - 84 1,548 21,056 243,952 1,548,889 Construction - - - - - - - - - New - - - - Rehabilitation - - - - - - - - - Equipment - - - - 18 878 7,763 45,766 139,789 Vehicles - - - - - - - - - Public Reimbursement to Private Sector - - - - - - - - - Private Private Insurance Reimbursement - - - - - - - -- -- Private Expenditures - - Expenditure Allocation 000 Manats - - - - - - 182,507 1,639,496 Hospitals - - - - -- - 120,555 1,005,570 - In-patient - - - - - - - - Out-patient - - - - - - Non-Hospitals - - - - - - 61,952 633,926 - Average salary (wages + benefits) Manats/Month - - - - - - - -- -- Average for Sector - - Doctors - - Nurses TABLE 13B. TURKMENISTAN: SOURCES OF FINANCING AND HEALTH EXPENDITURE, REAL VALUES Health Financing LCU 1987 1988 1989 1990 1991 1992 1993 1994 1995 (Deflated Expenditures, 1991=100) Health Revenues 000 Manats - - - - 1,087.79 572.26 506.76 220.52 321.94 Public - - - - 1,087.79 572.26 506.76 220.52 321.94 State Budget - - - - 1,087.79 572.26 506.76 220.52 321.94 National Health Insurance - - - - - - - - - Direct Charges (Public) - - - - - - - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - Private - - - - - - - - - Private Insurance - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure 000 Manats - - - - 1,087.79 572.26 506.76 220.52 321.94 Public - - - - 1,087.79 572.26 506.76 220.52 321.94 Recurrent Expenditure - - - - 1,003.83 495.69 448.30 187.70 271.24 Personal Health Services - - - - 1,003.83 495.69 422.14 177.55 271.24 Personnel (wage/benefits) - - - - 508.70 292.58 279.16 109.51 106.98 Drugs - - - - 73.31 24.88 33.66 12.72 53.74 Other consumables/supplies - - - - 77.14 49.53 33.07 17.57 45.47 Energy/utilities - - - - 279.22 69.76 44.52 22.91 60.91 Maintenance - - - - 65.45 58.94 26.22 12.27 4.14 Transportation - - - - - - 0.96 0.88 - Other - - - - - - 4.56 1.68 - Public Health Activities - - - - - - 26.15 5.25 - Medical Education - - - - - - Research And Development - - - - - - 4.90 - Capital Expenditures - - - - 83.97 76.58 58.47 32.81 50.70 Construction - - - - - - - - - New - - - - Rehabilitation - - - - - - - - Equipment - - - - 18.37 43.43 21.56 6.16 4.58 Vehicles - - - - - - - - - Public Reimbursement to Private Sector - - - - - - - - - Private - - - - - - - - Private Insurance Reimbursement - - - - - - - - - Private Expenditures - - - - - - Expenditure Allocation 000 Manats - - - - - - 506.76 220.52 - Hospitals - - - - - - 334.74 135.25 - In-patient - - - - - - - - Out-patient - - - - - - - - - Non-Hospitals - - - - - - 172.02 85.26 - Average salary (wages + benefits) Manats/Month - - - - - - - - - Average for Sector - - - - - - Doctors Nurses TABLE 13C. TURKMENISTAN: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % GDP Health Financing UNITS 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% GDP) Health Revenues % - - - - 3.20% 1.77% 1.65% 0.80% 1.46% Public - - - - 3.20% 1.77% 1.65% 0.80% 1.46% State Budget - - - - 3.20% 1.77% 1.65% 0.80% 1.46% National Health Insurance - - - - - - - - Direct Charges (Public) - - - - - - - - - Borrowing - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - Private Insurance Direct Charges (Private) - - - - Health Expenditure % - - - - 3.20% 1.77% 1.65% 0.80% 1.46% Public - - - - 3.20% 1.77% 1.65% 0.80% 1.46% Recurrent Expenditure - - - - 2.95% 1.53% 1.46% 0.68% 1.23% Personal Health Services - - - - 2.95% 1.53% 1.38% 0.64% 1.23% Personnel (wagelbenefits) - - - 1.50% 0.91% 0.91% 0.40% 0.48% Drugs - - - - 0.22% 0.08% 0.11% 0.05% 0.24% Other consumablesisupplies - - - - 0.23% 0.15% 0.11% 0.06% 0.21% Energyutilities - - - - 0.82% 0.22% 0.15% 0.08% 0.28% Maintenance - - - - 0.19% 0.18% 0.09% 0.04% 0.02% Transportation - - - - Other - - - - - - 0.01% 0.01% Public Health Activities - - - - - - 0.09% 0.02% - Medical Education - - - - - - - - - Research And Development - - - - - Capital Expenditures - - - - 0.25% 0.24% 0.19% 0.12% 0.23% Construction - - - - - New Rehabilitation - - - - - Equipment - - - - 0.05% 0.13% 0.07% 0.02% 0.02% Vehicles - - - Public Reimbursement to Private Sector - - - - - Private Private Insurance Reimbursement - - - - - Private Expenditures - - - - - TABLE 13D. TURKMENISTAN: SOURCES OF FINANCING AND HEALTH EXPENDITURE, % TOTAL EXPENDITURES Health Financing Units 1987 1988 1989 1990 1991 1992 1993 1994 1995 (% Total Expenditures) Health Revenues % - - - - 5.44% 3.06% 8.40% 10.72%/ 7.67% Public - - - - 5.44% 3.06% 8.40% 10.72% 7.67% State Budget - - - - 5.44% 3.06% 8.40% 10.72% 7.67% National Health Insurance - - - - - - - - - Direct Charges (Public) - - - - - - - - - Borrowing - - - - - - - - - Foreign Assistance (Loans/Grants) - - - - - - - - - Private - - - - - - - - - Private Insurance - - - - - - - - - Direct Charges (Private) - - - - - - - - - Health Expenditure % - - - - 5.44% 3.06% 8.40% 10.72% 7.67% Public - - - - 5.44% 3.06% 8.40% 10.72% 7.67% Recurrent Expenditure - - - - 5.02% 2.65% 7.43% 9.13% 6.46% Personal Health Services - - - - 5.02% 2.65% 7.00% 8.63% 6.46% Personnel (wage/benefits) - - - - 2.54% 1.56% 4.63% 5.33% 2.55% Drugs - - - - 0.37% 0.13% 0.56% 0.62% 1.28% Other consumables/supplies - - - - 0.39% 0.26% 0.55% 0.85% 1.08% Energy/utilities - - - - 1.40% 0.37% 0.74% 1.11% 1.45% Maintenance - - - - 0.33% 0.32% 0.43% 0.60% 0.10% Transportation - - - - - - 0.02% 0.04% - Other - - - - - - 0.08% 0.08% - Public Health Activities - - - - - - 0.43% 0.26% - Medical Education - - - - - - - - Research And Development - - - - - - - 0.24% - Capital Expenditures - - - - 0.42% 0.41% 0.97% 1.60% 1.21% Construction - - - - New - - - - Rehabilitation - - - - - - - Equipment - - - - 0.09% 0.23% 0.36% 0.30% 0.11% Vehicles - - - - - - - - - Public Reimbursement to Private Sector - - - - Private - - - - Private Insurance Reimbursement - - - - Private Expenditures I_ 1_-1 -1 -1 -1 1 _ _ ____1__1 --63- Section III: Health Status and Services Health status and service indicators were generally obtained from the WHO. The following briefly describes the categories of indicators contained in the database. (i) Lifestyles. Indicators such as annual cigarette and alcohol consumption and diseases such as tuberculosis, hepatitis and gonorrhea are included in this category. Other indicators in this category include Standardized Death Rates (SDRs) due to "car accidents," "fatalities-work accidents" and "SDR suicide + self injury" per 100,000 population, nutritional indicators, such as percentage of total energy from fat, protein and alcohol, and percentage of neonates weighing more than 2500 grams. (ii) Healthy Environment. Indicators such as the percentage of the population with access to sewage disposal and the percentage of the population with water supply at home, for both the urban and rural areas, are included in this category. (iii) Appropriate Care. This category deals with the coverage, availability and quality of health services within a given country. The indicators are medical personnel, medical graduates, and number of health units, such as primary health care units, per 100,000 population. Other indicators include child immunization rates, as well as abortions per 100,000 live births, inpatient admissions and average length of stay, and other miscellaneous categories such as SDR for drug reactions. (iv) Health Status. This category includes incidence of specified diseases, such as diphtheria, measles, malaria and tetanus. Other indicators in this category are life expectancy at different ages, infant mortality rate, maternal mortality ratio, crude birth rate, crude death rate, total fertility rates, and SDRs per 100,000 population for groups of diseases. 扩 TABLE 14A. ALBANIA: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Reft 1987 1988 1989 1990 1991 1992 1993 1994 1995 Ufe*los Incidence Tuberculosis/1 00,000 40,301 29.10 23.90 21.70 19.90 - 7.40 8.80 Incidence HepaUW100,000 40,310 - 318.30 297.80 341.40 - 143.40 171.40 Incidence Gonorrhea/100,000 40,322 4.00 - 3.10 4.30 SDR Car Aocklents/100,000 110,201 10.30 10.30 12.60 - - 14.00 - Fatalities-Wbrk Accidents/1 oo,ooo 110,503 - - - - SDR Suicide+Self Injury/100,000 120,101 2.40 2.40 2.50 - - 1.70 Nutrition % Of Total Energy From Fat 160,306 20.10% 20.60% 20.90% 20.80% 21.60% 21.00% % Of Total Energy From Protein 160,107 11.80% 11.90% 11.90% 12.10% 12.90% 12.500A % Of Total Energy From Alcohol 160,308 5.00% 0.60% 0.60% 0.50% - % Neonates Weighing More Than 25009 160,401 92.00% 93.10% 93.10% 93.10% Annual Liters Aloohol/Person 170,101 - - - - - - Annual Cigarette Consumption/Person 170,902 763.10 $12.60 821.50 - 646.40 Nonsmokers In Population (%) 171,001 - - - - 70.00% Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 Urban 200,108 - Rural 200,109 - % Population With Water Supply in Home Total 992,001 - Urban 992,002 - Rural 99ZO03 TABLE 14B. ALBANIA: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 - - 139.60 135.90 140.00 - 140.00 130.00 - Qualified nurses 270,202 - - - - - Dentists 270,203 - - 34.30 33.40 - Pharmacists 270,204 55.70 - - - - Midwives 270,209 - - - - - % Doctors Working In Hospitals 270,321 - - - - - % Nurses Working In Hospitals 270,322 - - - - - Graduating Per 100,000 Population Doctors 360,301 - - 5.40 - - Nurses 360,302 - - - - - Dentists 360,303 - - 1.60 - - Pharmacists 360,304 - - 0.50 - - Midwives 360,305 - - - - - Health Units Primary Care Units/100,000 Population 270,206 - - - - - Hospitals/100,000 Population 270,210 - - 5.00 4.90 - 4.10 - - Inpatient Beds/100,000 population 992,710 - - - 4.00 4.00 4.00 3.60 3.00 Psychiatric Beds/100,000 Population 992,711 - - - - - - Nursing Home Beds/100,000 Population 992,712 - - - - - - Utilization % Children Immunized Against: Diptheria 280,101 - - - - - - - 96.30% - Tetanus 280,102 - - - - - - - 96.30% - Pertussis 280,103 - - - - - - - 96.30% - Measles 280,104 - - - - - - - 81.20% - Polio 280,105 - - - - - - - 87.20% - Tuberculosis 280,106 - - - - - - - 81.20% - Abortions/1,000 Live Births 280,500 - - - - - - - - - Ambulatory Care Contacts/Person 992,801 - - - - - - - - - Inpatient Admissions/1 00 Population 992,902 - - - - - - - - - Average Length Of Stay (Days) 992,901 - - - 13.40 13.70 12.70 9.00 9.00 - Quality SDR Appendicitis/100,000 Population 310,304 0.20 0.30 0.30 - - 0.30 - - - SDR Drug Reactions/100,000 Population 310,306 - 0.00 - - - - - - - Surgical Wound Infection Rate 310,701 - - - - - - - - - TABLE 14C. ALBANIA: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refts 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 0.00 0.00 4251.60 13.00 - 0.00 0.20 0.30 - Malaria 50,112 - 0.00 0.00 0.00 - 0.00 0.00 0.00 - Diphtheria 50,113 0.10 0.10 0.20 0.50 - 1.50 0.50 0.40 - Tetanus 50,114 0.20 0.20 0.10 0.40 - 0.20 0.50 0.40 - Acute Poliomyelitis 50,115 0.00 0.00 0.00 0.00 - 0.00 0.00 0.00 - Neonatal Tetanus 50,118 0.00 0.00 0.00 0.00 - 0.00 0.00 0.00 - Rubella 50,130 0.00 0.00 - 0.00 3.30 - - Mumps 50,131 108.50 56.30 18.70 79.00 - 31.30 123.70 89.40 - Clinically Diagnosed AIDS 50,312 0.00 0.00 0.00 0.00 - 0.00 0.00 - - LIfe Expectancy At Birth. In Years 60,101 72.30 72.60 72.10 72.60 - 73.20 73.70 - - At Age 1, In Years 60,201 73.60 73.70 73.40 73.60 - 74.70 - - - At Age 15, In Years 60,202 61.10 61.10 60.90 61.10 - 62.00 - - - At Age 45, In Years ' 60,203 32.40 32.40 32.30 32.50 - 33.60 - - - At Age 65, In years 60,204 15.40 15.30 15.20 15.30 - 16.50 - - - Probability Of Dying Before 5 yrs /1,000 Population 60,401 46.80 42.70 45.60 42.20 - 45.20 - - - Infant Mortality/1,000 Live Births 70,100 30.90 28.30 30.90 - - 33.80 33.40 35.70 - Maternal Deaths/100,000 Live Births 80,100 38.90 34.90 45.60 31.00 20.70 22.50 22.60 - - Standard Death Rates Per 100,000 Population Circulatory, Ail Ages 90,102 444.90 126.80 118.00 - - 95.30 - Malignant Neoplasms, All Ages 100,102 113.30 126.80 118.00 - - 95.30 - All Causes, All Ages 990,102 - - - - - - - - - Infectious/Parasitic, All Ages 993,002 - - - - - - - - - Respiratory System, All Ages 993,202 - - - - - - - - - Mental/Nervous/Sensory, All Ages 993,702 - - - - - -- - - Crude Birth Rate (Per 1,000 Population) 998,004 25.30 25.30 24.60 25.00 - 23.60 22.44 22.30 - Crude Death Rate (Per 1,000 Population) 998,005 5.50 5.40 5.70 5.50 - 5.40 5.25 - - Total Fertility Rate 998,006 - - - 3.10 - 2.90 2.75 2.60 - TABLE 15A. BULGARIA: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Lifestyles Incidence Tuberculosis/100,000 40,301 26.20 26.60 25.60 25.10 28.60 36.30 38.00 - - Incidence Hepatitis/100,000 40,310 87.90 122.40 107.00 267.60 260.80 143.00 113.90 - - Incidence Gonorrhea/100,000 40.322 - - - - - - - - - SDR Car Accidents/100,000 110,201 12.20 11.70 12.90 15.50 10.10 12.30 - - - Fatalities-Work Accidents/100,000 110,503 - - - - - - - - - SDR Suicide+Self Injury/100,000 120.101 16.00 15.60 15.60 14.10 14.60 16.60 - - - Nutrition % Of Total Energy From Fat 160,306 29.90% 30.10% 30.60% 3.13% 30.60% 32.30% - - - % Of Total Energy From Protein 160,307 12.00% 12.00% 11.90% 12.00% 12.10% 11.90% - - - % Of Total Energy From Alcohol 160,308 6.10% 6.20% 6.10% 6.00% - - - - - % Neonates Weighing More Than 2500g 160,401 - - 93.70% - - - - - - Annual Liters Alcohol/Person 170,101 8.90 9.10 9.30 9.30 7.80 - - - Annual Cigarette Consumption/Person 170,902 1783.40 1532.90 1557.40 1356.90 1750.80 3729.80 2341.90 - - Nonsmokers In Population (%) 171,001 - - 67.00% - - - - - - Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 - - 98.60% - - - - - - Urban 200,108 - - 100.00% - - - - - - Rural 200,109 - - 96.00% - - - - - - % Population With Water Supply In Home Total 992,001 - - - - - - - - - Urban 992.002 - - - - - - - - - Rural 992,003 - - - - - - - - - TABLE 15B. BULGARIA: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 302.10 309.00 313.90 317.00 298.00 319.00 336.00 335.00 - Qualified nurses 270,202 584.20 592.40 591.00 598.50 563.00 593.00 615.00 590.00 - Dentists 270,203 66.00 66.30 67.30 67.90 66.00 67.00 68.00 65.00 - Pharmacists 270,204 46.20 47.80 47.40 48.60 36.00 31.00 28.00 25.00 - Midwives 270,209 85.20 86.30 83.10 84.00 81.00 83.00 82.00 75.00 - % Doctors Working In Hospitals 270,321 - - - - - - - - - % Nurses Working In Hospitals 270,322 - - - - - - Graduating Per 100,000 Population Doctors 360,301 7.10 - 14.60 - - - 12.50 - - Nurses 360,302 - - 15.90 24.30 26.60 34.20 22.70 36.50 Dentists 360,303 2.20 - 2.00 - - - - - Pharmacists 360,304 0.80 - 1.20 - - - - - - Midwives 360,305 - - 2.50 - - - - - - Health Units Primary Care Units/100,000 Population 270,206 75.40 76.30 77.10 77.60 78.20 78.80 79.50 80.10 - Hospitals1100,000 Population 270,210 2.10 2.20 2.20 2.30 2.30 2.50 2.70 2.60 - Inpatient Beds/100,000 population 992,710 - - - 978.00 981.00 1022.00 0.54 1022.00 - Psychiatric Beds/100,000 Population 992,711 87.00 86.00 87.00 90.00 88.00 90.00 94.00 96.00 - Nursing Home Bedsl100,000 Population 992,712 - - - - - - - - Utilization % Children Immunized Against: Diptheria 280,101 100.00% 99.00% 99.00% 99.00% 99.30% 98.30% - - - Tetanus 280,102 100.00% 99.00% 99.00% 99.00% 99.30% 98.30% - - - Pertussis 280,103 100.00% 99.00% 99.00% 99.00% 99.30% 97.10% - - - Measles 280,104 100.00% 99.00% 99.00% 98.00% 97.80% 92.20% - - - Polio 280,105 100.00% 99.00% 99.00% 99.00% 98.90% 98.70% - - - Tuberculosis 280,106 100.00% 99.00% 99.00% 99.00% 99.60% 99.30% - - - Abortions/1,000 Live Births 280,500 1149.30 1133.70 988.90 1367.20 1434.20 1480.00 1264.00 1336.00 - Ambulatory Care Contacts/Person 992,801 7.50 7.40 7.20 6.60 5.60 5.80 5.50 5.50 - Inpatient Admissions/100 Population 992,902 20.40 20.50 19.80 19.60 18.70 19.10 18.60 18.20 - Average Length Of Stay (Days) 992,901 14.00 13.90 13.80 13.70 13.90 13.80 13.80 14.10 - Quality SDR Appendicitial100,000 Population 310,304 - - - - - - - - SDR Drug Reactions/100,000 Population 310,306 - - - - - -- Surgical Wound Infection Rate 310,701 - - - - - - - - TABLE 15C. BULGARIA: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 17.40 4.50 1.20 1.70 22.60 237.20 4.20 - - Malaria 50,112 - 0.00 0.00 - - - - - - Diphtheria 50,113 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - - Tetanus 50,114 0.10 0.00 0.10 0.10 0.10 0.10 0.10 - - Acute Poliomyelitis 50,115 0.00 0.00 0.00 0.00 0.50 0.00 0.00 - - Neonatal Tetanus 50,118 0.00 0.00 0.00 0.00 0.00 0.00 - - Rubella 50,130 159.90 275.20 137.80 142.40 103.50 127.50 138.70 - - Mumps 50,131 374.80 5.00 1.20 1.50 1.40 3.20 2.30 - - Clinically Diagnosed AIDS 50,312 0.00 0.00 0.10 0.00 0.00 0.10 0.10 - - Life Expectancy At Birth, In Years 60,101 71.30 71.40 71.30 71.30 71.20 70.90 71.20 70.90 - At Age 1, In Years 60,201 71.40 71.30 71.50 71.50 71.60 71.30 - - - At Age 15, In Years 60,202 57.90 57.90 58.00 58.00 58.10 57.80 - - - At Age 45, In Years 60,203 29.70 29.70 29.80 29.90 29.90 29.80 - - - At Age 65, In years 60,204 13.80 13.90 14.00 14.10 14.10 14.20 - - - Probability Of Dying Before 5 yrs 11,000 Population 60,401 18.60 17.70 18.10 18.30 20.70 20.00 - - - Infant Mortality/1,000 Live Births 70,100 14.70 13.60 14.40 14.80 16.90 15.90 15.50 16.30 - Maternal Deaths/100,000 Live Births 80,100 19.70 9.40 18.70 20.90 10.40 21.30 20.10 - - Standard Death Rates Per 100,000 Population Circulatory, All Ages 90.102 714.30 702.40 694.30 691.40 699.20 677.90 - - - Malignant Neoplasms, All Ages 100,102 156.10 155.40 156.40 152.40 155.40 158.40 - - - All Causes, All Ages 990,102 - - - - - - - - - Infectious/Parasitic, All Ages 993,002 - - - - - - - - - Respiratory System, All Ages 993,202 - - - - - - - - - Mental/Nervous/Sensory, All Ages 993,702 - - - - - - - - - Crude Birth Rate (Per 1,000 Population) 998,004 13.00 13.10 12.50 11.70 10.70 10.40 10.00 9.40 - Crude Death Rate (Per 1,000 Population) 998,005 12.00 12.00 11.90 12.10 12.30 12.60 12.90 13.20 - Total Fertility Rate 998,006 - - 1.90 1.90 1.80 1.50 1.50 1.40 - TABLE 16A. CROATIA: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Ref 1987 1988 1989 1990 1991 1992 1993 1994 1995 Lifestyles Incidence Tuberculosis/100,000 40,301 70.90 63.20 60.70 54.50 45.10 46.10 43.20 - - Incidence Hepatitis/100,000 40,310 94.01 73.16 41.07 33.92 38.28 22.96 25.19 - - Incidence Gonorrhea/100,000 40,322 15.83 11.09 9.52 8.30 6.68 4.41 3.39 - - SDR Car Accidents/100,000 110,201 39.02 38.92 38.04 41.15 38.31 36.31 30.34 - - Fatalities-Work Accidents/100,000 110,503 2.70 2.20 1.80 1.40 4.10 4.20 1.50 - - SDR Suicide+Self Injury/100,000 120,101 - - - - - - - - - Nutrition % Of Total Energy From Fat 160,306 39.00% 41.00% 36.00% 38.00% 38.00% - - - - % Of Total Energy From Protein 160,307 12.00% 12.00% 12.00% 12.00% - - - - - % Of Total Energy From Alcohol 160,308 - - - - - - - - - % Neonates Weighing More Than 2500g 160,401 - - - 93.90% - 92.50% - - - Annual Liters Alcohol/Person 170,101 - - - - - - - - - Annual Cigarette Consumption/Person 170,902 - - - - - - - - - Nonsmokers In Population (%) 171,001 - - - - - - - - - Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 67.50% 67.70% 67.90% 68.10% 68.10% 68.10% 68.70% - - Urban 200,108 71.80% 71.90% 72.00% 72.10% 72.10% 72.10% 73.30% - - Rural 200,109 27.50% 27.70% 28.00% 28.30% 28.30% 28.30% 29.10% - % Population With Water Supply in Home Total 992,001 - - - - - - - - - Urban 992,002 - - - - - - - - Rural 992,003 - - - - - - - - - TABLE 16B. CROTIA: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 209.50 212.67 217.14 212.83 194.26 197.53 194.18 200.00 - Qualified nurses 270,202 485.20 494.30 504.50 511.10 454.20 447.80 441.20 - - Dentists 270,203 47.69 48.77 48.79 47.42 42.43 42.49 40.59 - - Pharmacists 270,204 39.58 40.33 40.26 38.93 36.10 36.53 35.59 - - Midwives 270,209 51.75 48.49 45.14 40.94 29.46 23.55 18.60 - - % Doctors Working In Hospitals 270,321 43.70% 43.54% 44.25% 44.10% 40.71% 41.88% 42.23% - - % Nurses Working In Hospitals 270,322 - - - - - - - - - Graduating Per 100,000 Population Doctors 360,301 - - - 11.80 7.37 11.33 8.52 - - Nurses 360,302 - - - - - - - - - Dentists 360,303 - - - 1.97 2.23 2.74 2.34 - - Pharmacists 360,304 - - - 1.80 1.55 1.55 1.74 - - Midwives 360,305 - - - - - - - - - Health Units Primary Care Units/100,000 Population 270,206 - - - - - - - - Hospitals/100,000 Population 270.210 2.35 2.31 2.31 2.18 2.11 2.05 1.99 - - Inpatient Beds/100,000 population 992,710 - - - 740.00 650.00 630.00 610.00 590 - Psychiatric Beds/100,000 Population 992.711 82.48 82.35 81.77 80.02 79.22 78.00 78.15 - - Nursing Home Beds/100,000 Population 992,712 - - - - - - - - - Utilization % Children Immunized Against Diptheria 280,101 80.70% 83.70% 86.40% 87.90% 84.90% 82.80% 83.50% - - Tetanus 280,102 - - - - 85.00% 86.40% 88.30% - - Pertussis 280,103 - - - - 85.00% 86.40% 88.30% - - Measles 280,104 90.00% 91.40% 92.80% 91.50% 88.70% 89.80% 90.10% - - Polio 280,105 82.30% 84.20% 85.20% 86.60% 85.50% 84.90% 85.30% - - Tuberculosis 280,106 93.30% 94.90% 94.70% 93.50% 92.70% 92.00% 92.10% - - Abortions/1,000 Live Births 280,500 - - - - - - - - - Ambulatory Care Contacts/Person 992,801 - - - - - - - - - Inpatient Admissions/100 Population 992,902 15.48 15.62 15.45 15.37 14.40 15.20 14.50 13.83 - Average Length Of Stay (Days) 992,901 - - - - - - - - - Quality SDR Appendicitis/100,000 Population 310,304 - - - - - - - - - SDR Drug Reactions/100,000 Population 310,306 - - - - - - - - - Surgical Wound Infection Rate 310,701 - - - - - - - - - TABLE 16C. CROATIA: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refts 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 18.60 22.60 24.00 2.50 2.40 3.40 1.90 - - Malaria 50,112 0.21 0.32 0.34 0.29 0.29 0.17 0.38 - - Diphtheria 50,113 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - - Tetanus 50,114 0.49 0.51 0.28 0.46 0.35 0.17 0.23 - - Acute Poliomyelitis 50,015 0.00 0.00 0.02 0.00 0.00 0.02 0.02 - - Neonatal Tetanus 50,118 - - - 0.00 0.00 0.00 0.00 - - Rubella 50,130 23.80 22.40 171.55 12.81 4.07 2.05 1.95 - - Mumps 50,131 41.20 39.30 117.00 37.80 8.10 6.50 6.30 - - Clinically Diagnosed AIDS 50,312 0.20 0.20 0.10 0.20 0.20 0.20 0.30 - - Life Expectancy At Birth. In Years 60,101 71.60 71.80 72.20 72.50 71.00 71.70 72.60 73.1 - At Age 1, In Years 60,201 - - - - - - - - - At Age 1S, In Years 60,202 - - - - - - - At Age 45, In Years 60,203 - - - - - - - At Age 65, In years 60,204 - - - - - - - ProbabiltyOfDigBefoe5yrsI,00Population 60,401 - - - - - - - Infant Mortality/1,000 Live Births 70,100 14.00 13.10 11.70 10.70 11.10 11.60 9.90 10.19 - Matemal Deaths/100,000 Live Births 80,100 - - 12.36 10.83 8.61 4.26 10.30 10.29 - Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 - - - 571.84 551.91 518.34 463.57 - - Malignant Neoplasms, All Ages 100,102 226.60 210.10 221.70 226.06 219.52 213.17 206.65 - - Al Causes, All Ages 990,102 - - - 1094.17 1144.96 1083.23 1084.52 - - Infectious/Parasitic, All Ages 993,002 - - - 10.75 9.31 9.49 8.43 - - Respiratory System, All Ages 993,202 - - - 29.48 39.36 47.07 51.29 - - Mental/Nervous/Sensory, AJl Ages 993,702 - - - 8.16 7.14 5.54 4.39 - - Crude Birth Rate (Per 1,000 Population) 998,004 12.67 12.50 11.88 11.62 10.82 9.82 9.27 10.17 - Crude Death Rate (Per 1,000 Population) 998,005 11.36 11.26 11.25 10.73 11.45 10.82 10.20 10.36 - Total Fertility Rate 998,006 - - - 1.69 1.5 1.7 - - - TABLE 17A. CZECH REPUBLIC: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Ufestyles Incidence Tuberculosis/100,000 40,301 21.20 19.80 18.40 18.70 20.20 19.30 18.00 - - Incidence Hepatitis/100,000 40,310 34.20 47.00 41.80 28.30 20.70 20.90 18.00 - - Incidence Gonorrhea/100,000 40,322 57.00 61.70 58.60 61.10 69.10 70.80 44.40 - - SDR Car Accidents/100,000 110,201 - - - - - 13.90 13.60 - - Fatalities-Work Accidents/100,000 110,503 - - - - - - - - - SDR Suicide+Self Injury/100,000 120,101 17.90 18.10 17.60 18.40 18.80 18.10 - - Nutrition % Of Total Energy From Fat 160,306 - - 37.50% 37.50% - - - - - % Of Total Energy From Protein 160,307 - - - - 12.40% - - - - % Of Total Energy From Alcohol 160,308 - - - - - - - - - % Neonates Weighing More Than 2500g 160,401 94.59% 94.56% 94.82% 94.51% 94.13% 94.29% 94.38% - - Annual Liters Alcohol/Person 170,101 8.00 8.10 8.20 8.90 9.10 9.40 - - - Annual Cigarette Consumption/Person 170,902 1832.00 1750.00 1776.00 2808.50 2025.00 2825.20 2824.60 - - Nonsmokers In Population (%) 171,001 62.00% 63.00% 64.00% 61.00% 60.00% 59.00% - - - Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 71.60% 72.10% 72.40% 72.60% 72.30% - - - - Urban 200,108 - - - - - - - - - Rural 200,109 - - - - - - - - - % Population With Water Supply In Home Total 992,001 80.90% 81.50% 82.40% 83.20% 84.00% - - - - Urban 992,002 - - - - - - - - - Rural 992,003 - - - - - - - - - TABLE 17B. CZECH REPUBLIC: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 - - - 270.00 - - 320.00 290.00 - Qualified nurses 270,202 787.34 798.76 808.35 809.15 793.16 760.98 760.25 - - Dentists 270,203 53.08 53.46 53.95 54.60 54.59 50.69 57.02 - - Pharmacists 270,204 - - - 43.00 41.00 40.00 37.00 - - Midwives 270,209 - - - - - - - - - % Doctors Working In Hospitals 270.321 28.78% 28.77% 29.00% 29.68% 31.48% 48.35% 41,09% - - % Nurses.Wbrking In Hospitals 270,322 40.39% 40.49% 40.63% 42.30% 46.11% 56.80% 67.74% - - Graduating Per 100,000 Population Doctors 360,301 1068.00 1101.00 1120.00 1049.00 1237.00 1255.00 1347.00 - - Nurses 360,302 3786.00 3476.00 4023.00 4039.00 4586.00 5394.00 5755.00 - - Dentists 360,303 143.00 93.00 122.00 119.00 88.00 85.00 136.00 - - Pharmacists 360,304 192.00 181.00 202.00 196.00 133.00 259.00 146.00 - - Midwives 360,305 - - - - - 266.00 267.00 - - Health Units Primary Care Units/100,000 Population 270,206 - - - - - - - - Hospitals/100,000 Population 270,210 1.50 1.50 1.50 1.60 1.60 1.70 1.80 - - Inpatient Beds/100,000 population 992,710 - - - 1090.00 - - 1220.00 980.00 - Psychiatric Beds/100,000 Population 992,711 147.83 147.43 146.88 140.00 132.78 126.68 120.78 120.08 - Nursing Home Beds1100,000 Population 992,712 - - - - - - - - - Utilization % Children Immunized Against Diptheria 280,101 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% - - Tetanus 280,102 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% - - - Pertussis 280,103 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% - - Measles 280,104 98.00% 97.00% 97.00% 97.00% 98.00% 97.00% - - - Polio 280,105 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% - - Tuberculosis 280,106 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% - - Abortions/l,000 Live Births 280,500 952.00 963.00 987.00 965.00 918.00 891.00 694.00 - - Ambulatory Care Contacts/Person 992,801 15.05 15.05 14.86 13.90 13.70 13.21 13.40 14.76 - Inpatient Admissionsl100 Population 992,902 17.90 17.70 18.70 17.90 18.10 18.40 18.70 - - Average Length Of Stay (Days) 992,901 13.20 13.00 12.40 12.00 11.90 11.60 11.20 - Quality SDR Appendicitis/100,000 Population 310,304 - - - - - 0.40 - - - SDR Drug Reactionsl00,000 Population 310,306 - - - - - 0.40 - - - Surgical Wound Infection Rate 310,701 - 5.80 5.90 6.60 - - - - - TABLE 17C. CZECH REPUBLIC: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 0.00 0.10 0.00 2340 8.10 4.00 0.20 - - Malaria 50,112 - - - - - - - - - Diphtheria 50,113 - - - - 0.00 0.00 0.00 - - Tetanus 50,114 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - - Acute Poliomyelitis 50,115 0.00 0.00 - - - 0.00 0.00 - - Neonatal Tetanus 50,118 - - - - - 0.00 0.00 - - Rubella 50,130 170.00 71.50 20.00 12.60 106.80 21.50 5.30 - - Mumps 50,131 374.30 739.80 210.90 37.80 11.60 11.60 14.80 - - Clinically Diagnosed AIDS 50,312 0.10 0.10 0.10 0.10 0.10 0.10 0.10 - - Life Expectancy At Birth, In Years 60,101 71.46 71.70 71.80 71.70 72.00 72.30 72.90 - - At Age 1, In Years 60,201 71.50 71.60 71.60 71.60 71.90 72.20 72.60 - - At Age 15, In Years 60,202 57.80 57.90 57.90 57.90 58.10 58.50 58.80 - - At Age 45, In Years 60,203 29.30 29.40 29.30 29.40 29.70 29.50 30.30 - - At Age 65, In years 60,204 13.60 13.70 13.60 13.70 14.00 14.30 14.40 - - Probability Of Dying Before 5 yrs /1,000 Population 60,401 - - - - - - - - - Infant Mortalityll,000 Live Births 70,100 12.00 11.00 10.00 10.80 10.40 9.90 8.50 - - Maternal Deathsl100,000 Live Births 80,100 15.00 19.00 13.00 19.00 18.00 12.00 12.00 - - Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 656.50 634.20 645.50 647.00 615.50 591.50 576.40 - - Malignant Neoplasms, All Ages 100,102 256.80 262.00 259.70 262.50 - 254.50 254.10 - - All Causes, All Ages 990,102 - - - - - 1082.40 1052.60 - - InfectiouslParasitic, All Ages 993,002 - - - - - 3.40 2.90 - - Respiratory System, All Ages 993,202 - - - - - 45.50 42.50 - - Mental/Nervous/Sensory, All Ages 993,702 - - - - - 10.10 10.20 - - Crude Birth Rate (Per 1,000 Population) 998,004 12.70 12.90 12.40 12.70 12.60 11.80 11.80 - Crude Death Rate (Per 1,000 Population) 998,005 12.30 12.10 12.30 12.50 12.10 11.70 11.40 - - Total Fertility Rate 998,006 1.90 1.90 1.90 1.90 1.80 1.90 1.70 - - TABLE 18A. FYR MACEDONIA: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs . 1987 1988 1989 1990 1991 1992 1993 1994 1995 Lffestyles incidence Tuberculosish100,000 40,301 34.84 42.55 37.61 37.23 33.06 30.06 34.35 - - Incidence Hepatitis/100,000 40,310 137.04 228.60 166.70 132.35 81.41 88.81 149.73 2763.00 - Incidence Gonorrheal00,000 40,322 7.72 5.63 4.81 7.15 5.89 3.99 1.40 35.00 - SDR'CarAccidents/100,000 110,201 11.08 11.01 0.10 10.75 7.36 6.61 5.79 - - Fatalities-Work Accidents/100,000 110,503 - - - - - - - - - SDR Suicide+Self Injury/100,000 120,101 6.47 6.98 7.43 6.85 7.16 7.00 7.24 - - Nutrition % Of Total Energy From Fat 160,306 25.80% 27.70% 22.00% 23.70% 22.70% 24.70% 23.50% - - % Of Total Energy From Protein 160,307 11.90% 13.80% 14.90% 11.70% 12.30% 12.10% 10.70% - - % Of Total Energy From Alcohol 160,308 - - - - - - - - - % Neonates Weighing More Than 2500g 160,401 - - - - - -- - Annual Liters Alcohol/Person 170,701 - - - - - - - Annual Cigarette Consumption/Person 170,902 - - - - - - - - - Nonsmokers In Population (%) 171,001 - - - - - - - - - Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 - - - - 71.00% - - - - Urban 200,108 - - - - - - - - - Rural 200,109 - - - - - - - - - % Population With Water Supply In Home Total 992,001 - - - - 71.00% - - - - Urban 992,002 - - - - - - - - - Rural 992,003 - - - - - - - - - TABLE 18B. FYR MACEDONIA: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 195.19 203.29 213.97 216.77 220.06 221.98 218.43 -- - Qualified nurses 270,202 263.96 273.89 283.30 275.79 273.27 274.56 271.97 - - Dentists 270,203 46.47 50.27 54.86 54.83 54.83 52.43 52.00 - - Pharmacists 270,204 17.04 18.44 20.02 18.34 19.27 20.14 17.27 - - Midwives 270,209 75.69 74.49 76.36 72.68 70.82 71.30 69.27 - -- % Doctors Working In Hospitals 270,321 28.30% 28.80% 30.00% 29.30% 29.60% 30.20% 30.30% - -- % Nurses Working in Hospitals 270,322 - - - -- -- - - -- Graduating Per 100,000 Population Doctors 360,301 15.79 16.79 11.20 8.19 7.90 8.61 7.77 158.00 - Nurses 360,302 -- -- - - - - -- - -- Dentists 360,303 5.41 6.08 3.96 4.44 3.63 3.02 3.47 42.00 -- Pharmacists 360,304 2.01 3.29 2.48 1.63 2.01 2.09 2.99 42.00 - Midwives 360,305 -- - -- - - - -- - -. Health Units Primary Care Units/100,000 Population 270,206 59.60 63.18 64.07 63.41 63.85 63.52 63.15 -- - Hospitals/100,000 Population 270,210 2.46 2.49 2.48 2.47 2.50 2.48 2.46 -- - Inpatient Beds/1 00,000 population 992,710 534.99 538.96 545.64 539.45 525.60 520.96 522.14 - -- Psychiatric Beds/1 00,000 Population 992,711 - - - 80.08 80.53 79.67 74.00 -- - Nursing Home Beds/100,000 Population 992,712 - - - - - -- - - - on Utilization % Children Immunized Against: Diptheria 280,101 97.40% 96.10% 95.20% 95.10% 95.70% 89.20% 89.70% 94.40% - Tetanus 280,102 97.40% 96.10% 95.20% 95.10% 95.70% 89.20% 89.70% 94.40% - Pertussis 280,103 97.40% 96.10% 95.20% 95.10% 95.70% 89.20% 89.70% 94.40% -- Measles 280,104 84.80% 86.50% 90.50% 88.20% 87.00% 66.90% 93.00% 96.80% -- Polio 280,105 95.40% 94.40% 93.50% 90.30% 94.60% 93.10% 96.00% 95.20% -- Tuberculosis 280,106 95.80% 96.70% 92.90% 93.10% 97.70% 87.20% -- - Abortions/1,000 Live Births 280,500 16.20 13.50 15.09 10.80 11.36 9.66 9.05 - - Ambulatory Care Contacts/Person 992,801 - - - - - - - - - Inpatient Admissions/100 Population 992,902 - - - -- - - - -- Average Length Of Stay (Days) 992,901 - -- - -- -- - -- - -- Quality SDR Appendicitis/100,000 Population 310,304 2.00 4.00 2.00 5.00 3.00 3.00 2.00 -- - SDR Drug Reactions/100,000 Population 310,306 -- - - - -- -- -- - - Surgical Wound Infection Rate 310,701 -- -- - - -- - -- - -- TABLE 18C. FYR MACEDONIA: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 103.71 80.82 28.49 64.25 8.88 8.75 120.36 229.00 - Malaria 50,112 0.00 0.10 0.00 0.00 0.05 0.00 0.05 1.00 - Diphtheria 50,113 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - Tetanus 50,114 0.15 0.20 0.20 0.00 0.05 0.05 0.14 1.00 - Acute Poliomyelitis 50,115 0.05 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - Neonatal Tetanus 50,118 0.00 0.20 0.05 0.00 0.05 0.00 0.05 0.00 - Rubella 50,130 196.79 36.82 71.11 81.46 21.73 22.13 14.57 2020.00 - Mumps 50,131 177.99 50.62 88.75 69.48 90.78 106.08 113.31 1653.00 - Chnicalty Diagnosed AIDS 50,132 - - - 0.10 0.10 - - - - Life Expectancy At Birth, In Years 60,101 - - - - 72.18 - - - - At Age 1, In Years 60,201 - - - - 73.37 - - - - At Age 15, In Years 60,202 - - - - 59.85 - - - - At Age 45, In Years 60,203 - - - - 31.16 - - - - At Age 65, In years 60,204 - - - - 14.64 - - - - Probability Of Dying Before 5 yrs /1,000 Population 60,401 - - - - 0.03 - - - - Infant Mortality/1,000 Uve Births - 41.92 39.81 36.71 31.64 28.25 30.63 27.33 - - Maternal Deaths/100,000 Live Births - 10.40 13.20 8.30 2.80 1.15 6.00 6.20 - - Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 340.10 335.28 345.34 350.74 359.29 310.75 385.82 - - Malignant Neoplasms, All Ages 100,102 95.74 105.68 101.59 109.86 107.85 108.17 111.24 - - AI Causes, All Ages - - - - - - - - - - Infectious/Parasitic, AI Ages 993,002 0.55 0.70 0.64 0.49 0.59 0.24 0.43 - - Respiratory System, All Ages 993,202 54.19 48.68 49.65 45.81 43.06 43.39 34.54 - - Mental/Nervous/Sensory, AlI Ages 993,702 7.97 7.27 6.69 5.82 5.84 6.03 5.84 - - Crude Birth Rate (Per 1,000 Population) 998,004 18.70 18.10 17.00 16.60 17.10 16.20 15.70 17.20 - Crude Death Rate (Per 1,000 Population) 998,005 7.10 7.00 6.90 6.90 7.30 7.80 7.45 8.10 - Total Fertility Rate 998,006 2.27 2.22 2.09 #N/A 2.30 2.18 - - - TABLE 19A. HUNGARY: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Lifestyles Incidence Tuberculosis/100,000 40,301 38.90 37.90 35.60 34.60 35.40 38.40 -- -- -- Incidence Hepatitis/100,000 40,310 29.50 19.30 22.00 23.80 22.70 23.40 -- -- -- Incidence Gonorrheall 00,000 40,322 55.80 - -- - - - - -- SDR Car Accidents/100,000 110,201 15.60 16.60 21.10 24.40 21.90 21.80 -- Fatalities-Work Accidents/100,000 110,503 4.30 4.40 4.20 4.10 3.50 2.80 -- -- SDR Suicide+Self Injury/100,000 120,101 43.80 39.90 40.00 38.20 36.90 37.00 -- -- Nutrition % Of Total Energy From Fat 160,306 37.50% 37.70% 37.40% 37.40% 38.80% 39.10% -- -- -- % Of Total Energy From Protein 160,307 11.10% 11.40% 11.10% 11.20% 10.70% 10.70% -- -- -- % Of Total Energy From Alcohol 160,308 6.70% 6.80% 6.80% 6.70% - -- -- - -- % Neonates Weighing More Than 2500g 160,401 -- -- - - -- 91.00% -- -- -- Annual Uters Alcohol/Person 170,101 10.70 10.40 10.90 10.80 10.50 10.50 - - -- Annual Cigarette Consumption/Person 170,902 2566.90 2512.90 2591.70 2748.60 2564.30 2647.30 2653.40 -- -- Nonsmokers In Population (%) 171,001 -- -- -- -- -- 0.66 -- -- -- Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 -- - 93.50% -- -- -- -- -- -- Urban 200,108 -- - 100.00% -- -- -- -- -- -- Rural 200,109 -- -- 85.00% -- - - -- -- -- % Population With Water Supply In Home Total 992,001 - - - - - -- -- - Urban 992,002 - -- - - -- -- - -- Rural 992,003 - - - - - - -- - TABLE 19B. HUNGARY: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refts 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 298.10 304.60 309.90 327.10 327.30 327.70 310.20 342.60 - Qualified nurses 270,202 291.30 293.70 305.90 - - - - - Dentists 270,203 35.90 36.90 38.10 41.20 - - - - Pharmacists 270,204 43.10 42.50 42.00 43.50 - - - - Midwives 270,209 25.50 24.70 25.10 26.00 - - - - % Doctors Working In Hospitals 270,321 - - - - - - - - % Nurses Working In Hospitals 270,322 - - - - - - - - Graduating Per 100,000 Population Doctors 360,301 9.20 9.10 8.70 - 9.40 - - - - Nurses 360,302 43.00 43.20 39.00 - 5.10 - - - - Dentists 360,303 1.30 1.40 1.40 - 1.70 - - - Pharmacists 360,304 1.80 1.80 1.70 - 2.20 - - -- Midwives 360,305 2.40 2.30 1.70 - - - - - - Health Units Primary Care Units/I100,000 Population 270,206 - - - - - - Hospitals/100,000 Population 270,210 - - - - - - - - 1.70 Inpatient Beds/100,000 population 992,710 - - - 980.00 1000.00 980.00 980.00 990.00 - Psychiatric Beds/100,000 Population 992,711 - - - - - - - Nursing Home Bedsli00,000 Population 992,712 - - - - - - - - - 00 Utilization % Children Immunized Against: Diptheria 280,101 100.00% 99.00% 99.00% 99.00% 99.90% 99.90% - - - Tetanus 280,102 100.00% 99.00% 99.00% 99.00% 99.90% 99.90% - - - Pertussis 280,103 100.00% 99.00% 99.00% 99.00% 99.90% 99.90% - - - Measles 280,104 100.00% 99.00% 99.00% 99.00% 99.80% 99.80% - - - Polio 280,105 99.00% 99.00% 99.00% 99.00% 98.40% 99.90% - - - Tuberculosis 280,106 100.00% 99.00% 99.80% 99.00% - - - - - Abortionsfi,000 Live Births 280,500 - - 734.00 - - 715.30 - - - Ambulatory Care Contacts/Person 992,801 - - - - - - Inpatient Admissions/1 00 Population 992,902 - - - - - - Average Length Of Stay (Days) 992,901 - - - 12.60 12.40 12.00 11.80 11.30 - Quality SDR Appendicitis/1 00,000 Population 310,304 0.70 0.60 0.60 0.60 0.50 0.60 - - - SDR Drug ReactionS10000 Population 310,306 0.20 0.00 0.10 0.10 0.10 0.00 - - - Surgical Wound Infection Rate 310,701 - - - - - - TABLE 19C. HUNGARY: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 0.20 10.40 160.00 0.30 0.50 0.40 0.40 - -- Malaria 50,112 0.20 0.10 0.10 - - -- - - -- Diphtheria 50,113 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - -- Tetanus 50,114 0.30 0.20 0.20 0.20 0.10 0.10 - -- - Acute Poliomyelitis 50,115 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - -- Neonatal Tetanus 50,118 0.00 0.00 0.00 0.00 0.00 0.00 - - -- Rubella 50,130 195.30 256.40 188.20 47.90 12.20 11.40 - - - Mumps 50,131 413.40 471.30 214.50 205.80 210.60 287.10 - - - Clinically Diagnosed AIDS 50,312 0.10 0.10 0.10 0.20 0.30 0.30 0.30 -- - Life Expectancy At Birth, In Years 60,101 69.70 70.10 69.60 69.40 69.40 69.00 69.00 69.40 -- At Age 1, In Years 60,201 69.90 70.20 69.70 69.40 69.50 69.00 - - - At Age 15, In Years 60,202 56.30 56.50 56.00 55.70 55.80 55.30 - -- -- At Age 45, In Years 60,203 28.60 28.80 28.50 28.30 28.30 28.00 - - -- At Age 65, In years 60,204 13.90 14.10 14.10 13.90 14.10 13.90 - -- - Probability Of Dying Before 5 yrs /1,000 Population 60,401 19.60 17.80 17.90 16.80 17.60 15.90 - - - Infant Mortality/1,000 Live Births 70,100 17.30 15.80 15.70 14.80 15.60 14.10 12.46 11.95 - Maternal Deaths/100,000 Live Births 80,100 13.50 16.90 15.40 20.70 12.60 9.90 18.80 10.38 -- 0 Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 636.60 620.60 624.50 644.70 638.20 639.80 - - - Malignant Neoplasms, All Ages 100,102 256.10 255.10 259.60 267.00 271.30 278.90 - - - All Causes, All Ages 990,102 1229.60 1197.30 1229.80 1261.60 1252.40 1284.20 - -- - Infectious/Parasitic, All Ages 993,002 9.80 9.20 10.00 8.50 8.30 8.30 -- - - Respiratory System, All Ages 993,202 54.10 50.90 58.20 57.20 53.80 59.30 - - -- Mental/Nervous/Sensory, All Ages 993,702 16.90 17.40 19.40 19.50 20.10 22.60 - - - Crude Birth Rate (Per 1,000 Population) 998,004 11.90 11.70 11.70 12.10 12.30 11.80 11.37 11.27 Crude Death Rate (Per 1,000 Population) 998,005 13.40 13.20 13.70 14.10 14.00 14.40 14.60 14.31 -- Total Fertility Rate 998,006 -- - 1.80 1.80 1.80 1.80 1.70 - -- TABLE 20A. LITHUANIA: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Lifestyles Incidence Tuberculosis/100,000 40,301 37.90 36.60 37.40 39.60 41.60 42.70 43.60 54.30 - Incidence Hepatitis/100,000 40,310 - - 206.60 128.00 74.20 86.40 111.00 153.40 - Incidence Gonorrhea/100,000 40,322 - - 93.70 79.50 82.10 107.80 150.00 147.80 - SDR Car Accidents/100,000 110,201 19.00 26.10 31.40 30.80 37.30 24.80 27.30 29.40 - Fatalities-Work Accidents/1 00,000 110,503 - - - - - - - - - SDR Suicide+Self Injury/00,000 120,101 30.30 27.50 28.10 27.00 31.70 36.00 43.50 48.30 - Nutrition % Of Total Energy From Fat 160,306 -- - - - - -- - - % Of Total Energy From Protein 160,307 -- -- - -- - .. % Of Total Energy From Alcohol 160,308 -- -- - -- -- .. % Neonates Weighing More Than 2500g 160,401 - - -- - -- - - - Annual Liters Alcohol/Person 170,101 4.80 5.50 6.30 5.00 4.80 4.30 4.40 4.60 - Annual Cigarette Consumption/Person 170,902 - 1243.60 1213.50 1195.20 1304.80 1304.50 1308.50 1312.30 - Nonsmokers In Population (%) 171,001 - - -- - -- - -- -- Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 - - -- -- - - - - .. Urban 200,108 - - -- - - - - Rural 200,109 - - - - - -- - - % Population With Water Supply In Home Total 992,001 - -- - -- - - -- - - Urban 992,002 - - - - - -- - - - Rural 992,003 -- - - - - -- - - - TABLE 20B. LITHUANIA: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 - - 397.70 401.30 386.60 388.40 393.30 400.30 - Qualified nurses 270,202 - - 820.00 805.00 779.00 783.00 781.00 794.00 - Dentists 270,203 - - 61.20 60.30 56.70 55.80 52.30 50.20 - Pharmacists 270,204 - - - - 53.10 - - - - Midwives 270,209 - - 112.00 106.00 53.00 49.00 49.00 47.00 - % Doctors Working In Hospitals 270,321 - - - - - - - - - % Nurses Working In Hospitals 270,322 - - - - - - - - - Graduating Per 100,000 Population Doctors 360,301 - - 10.10 10.00 10.30 12.60 12.60 12.20 - Nurses 360,302 - - 43.20 42.10 41.30 13.00 33.80 #N/A - Dentists 360,303 - - 1.30 1.40 1.90 2.10 2.80 3.20 - Pharmacists 360,304 - - 1.40 3.00 3.40 2.50 3.20 3.40 - Midwives 360,305 - - 1.40 3.00 3.40 2.50 3.20 - - Health Units Primary Care Units/100,000 Population 270,206 - - - - - - - - - Hospitals/100,000 Population 270,210 - - 5.20 5.29 5.30 5.32 5.32 5.32 - Inpatient Beds/100,000 population 992,710 - - - 1240.00 1270.00 1190.00 1180.00 1110.00 - Psychiatric Beds/100,000 Population 992,711 - - - - - - - - - Nursing Home Beds/100,000 Population 992,712 - - - 214.46 190.37 194.21 204.60 215.31 - 00 Utilization % Children Immunized Against Diptheria 280,101 - - 81.90% 78.40% 74.90% 87.20% 86.80% 87.20% - Tetanus 280,102 - - 81.90% 78.40% 74.90% 87.20% 86.80% 87.20% - Pertussis 280,103 - - 79.80% 76.20% 73.20% 77.60% 79.30% 82.20% - Measles 280,104 - - 92.40% 89.00% 85.70% 89.00% 91.80% 92.70% - Polio 280,105 - - 86.60% 77.10% 79.00% 88.20% 86.30% 87.70% - Tuberculosis 280,106 - - 91.80% 93.90% 87.40% 93.90% 97.60% 95.90% - Abortions/1,000 Live Births 280,500 - - 756.10 742.10 733.70 757.70 743.30 - - Ambulatory Care Contacts/Person - - - - - - - - - - Inpatient Admissions/100 Population - - - 19.23 18.56 18.83 18.88 19.73 20.13 - Average Length Of Stay (Days) - - - 18.20 17.90 17.60 17.10 16.70 16.00 - Quality SDR Appendicitis/100,000 Population 310,301 0.30 0.301 0.50 0.20 0.30 0.30 0.10 0.10 - SDR Drug Reactions/I00,000 Population 310,306 - - - - Surgical Wound Infection Rate 310,701 - - - - - - - - TABLE 20C. LITHUANIA: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 - -- 7.50 1.30 3.80 5.30 6.70 7.70 -- Malaria 50,112 -- -- 0.30 0.10 - 0.10 0.20 0.10 -- Diphtheria 50,113 -- -- -- 0.00 0.00 0.20 0.20 1.00 - Tetanus 50,114 -- -- 0.00 0.20 0.00 0.10 0.10 0.10 - Acute Poliomyelitis 50,115 -- -- 0.00 0.00 0.00 0.00 0.00 0.00 - Neonatal Tetanus 50,118 - -- - -- 0.00 0.00 0.00 0.00 - Rubella 50,130 -- -- 80.90 24.10 31.80 22.20 30.20 28.60 - Mumps 50,131 -- - 17.60 12.50 11.20 17.20 15.30 14.80 - Clinically Diagnosed AIDS 50,312 0.00 0.00 0.00 0.00 0.00 0.00 0.10 0.10 - Life Expectancy At Birth, In Years 60,101 72.20 72.00 71.80 71.50 70.70 70.50 69.00 68.7 -- At Age 1, In Years 60,201 72.10 71.80 71.50 71.30 70.70 70.70 69.10 -- -- At Age 15, In Years 60,202 58.50 58.40 58.00 57.70 57.20 57.20 55.60 - -- At Age 45, In Years 60,203 31.00 31.00 30.90 30.50 30.40 30.30 29.00 -- - At Age 65, In years 60,204 15.60 15.70 25.80 15.60 15.80 15.60 15.00 - - Probability Of Dying Before 5 yrs /1,000 Population 60,401 15.50 15.20 14.00 13.30 17.20 19.70 18.70 -- - Infant Mortality/1,000 Live Births 70,100 12.30 11.60 10.70 10.20 14.30 16.50 16.00 16.50 -- Matemal Deaths/100,000 Live Births 80,100 21.90 19.40 28.70 22.90 19.60 20.50 12.80 16.34 -- Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 590.20 580.00 571.00 587.20 573.20 563.00 626.80 -- -- Malignant Neoplasms, All Ages 100,102 181.20 185.10 186.50 192.50 193.80 199.90 204.20 -- - All Causes, All Ages 990,102 1014.00 1016.20 1018.40 1046.40 1070.40 1082.30 1196.40 -- -- Infectious/Parasitic, All Ages 993,002 9.20 9.80 9.30 9.60 10.60 10.90 13.90 -- -- Respiratory System, All Ages 993,202 52.40 53.30 46.60 47.50 44.30 40.30 46.80 -- - Mental/Nervous/Sensory, All Ages 993,702 13.90 14.20 16.10 16.30 20.20 21.00 28.90 - - Crude Birth Rate (Per 1,000 Population) 998,004 16.40 15.50 15.10 15.30 15.00 14.30 12.50 11.51 - Crude Death Rate (Per 1,000 Population) 998,005 10.20 10.30 10.30 10.70 11.00 11.10 12.40 12.44 - Total Fertility Rate 998,006 - - 2.00 - 2.00 1.90 1.80 - - TABLE 21A. POLAND: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Lifestyles Incidence Tuberculosis/100,000 40,301 52.50 49.00 42.60 42.30 43.10 43.10 43.80 -- -- Incidence Hepatitis/100,000 40,310 64.40 57.60 66.10 78.50 96.00 129.10 108.60 -- -- Incidence Gonorrhea/100,000 40,322 20.40 20.30 22.20 21.60 14.10 9.70 7.80 -- -- SDR Car Accidents/1 00,000 110,201 14.20 14.90 20.40 22.40 23.20 19.70 18.00 -- -- Fatalities-Work Accidents/100,000 110,503 2.70 2.60 2.40 2.10 2.10 1.70 1.70 - -- SDR Suicide+Self Injury/100,000 120,101 14.10 13.00 12.00 13.80 14.70 15.60 14.60 -- -- Nutrition % Of Total Energy From Fat 160,306 32.40% 32.60% 32.60% 31.70% 32.00% 32.10% -- -- % Of Total Energy From Protein 160,307 11.80% 11.80% 11.80% 11.90% 12.20% 12.00% -- -- % Of Total Energy From Alcohol 160,308 3.50% 3.50% 3.40% 3.30% % Neonates Weighing More Than 2500g 160,401 92.10% 92.40% 92.40% 91.10% 92.00% 92.10% 92.10% -- -- Annual Liters Alcohol/Person 170,101 7.20 7.10 7.00 6.20 7.10 -- .. Annual Cigarette Consumption/Person 170,902 2741.80 2511.00 2530.70 2700.60 2946.00 2424.10 2421.90 - -- Nonsmokers In Population (%) 171,001 54.50 59.00 - Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 - - 100.00% - -- -- -- - -- Urban 200,108 - - 100.00% -- - -- -- - -- Rural 200,109 - - 100.00% - - -- -- - -- % Population With Water Supply In Home Total 992,001 - - - -- .. -. -. -- Urban 992,002 - -- -- -- - - -- -- - Rural 992,003 - -- -- -- - -- -- -- - TABLE 21B. POLAND: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 205.80 207.80 208.70 214.30 216.80 218.20 222.00 - - Qualified nurses 270,202 488.30 491.70 501.40 527.10 519.00 517.60 518.20 - - Dentists 270,203 46.90 47.50 47.00 47.80 45.90 43.30 44.10 - - Pharmacists 270,204 42.50 42.80 42.00 39.60 42.10 42.60 45.70 - - Midwives 270,209 57.40 58.10 59.20 62.60 62.10 61.60 61.80 - - % Doctors Working In Hospitals 270,321 - - - - - - - % Nurses Working In Hospitals 270,322 - -- -- - - - -- - - Graduating Per 100,000 Population Doctors 360,301 8.60 8.30 8.00 8.50 9.00 9.70 10.50 - Nurses 360,302 0.80 0.60 0.60 0.60 0.70 0.80 0.90 - Dentists 360,303 2.30 2.40 2.40 2.30 2.50 2.80 2.90 -- -- Pharmacists 360,304 1.40 1.50 1.70 1.80 1.70 1.70 1.80 -- - Midwives 360,305 Health Units Primary Care Units/100,000 Population 270,206 17.40 17.60 17.60 17.30 16.50 15.70 15.60 - -- Hospitals/100,000 Population 270,210 1.90 1.90 1.90 1.90 1.90 1.90 1.90 - - Inpatient Beds/100,000 population 992,710 5.70 5.70 5.70 5.70 5.70 5.60 5.60 - - Psychiatric Beds/100,000 Population 992,711 90.90 88.80 88.10 87.00 84.50 81.40 80.20 - - Nursing Home Beds/100,000 Population 992,712 1.74 1.76 1.77 1.78 1.82 1.87 1.96 - Utilization % Children Immunized Against: Diptheria 280,101 99.30% 99.30% 99.30% 99.30% 99.10% 99.10% 99.20% - - Tetanus 280,102 99.20% 99.30% 99.10% 99.30% 99.20% 99.10% 99.20% -- - Pertussis 280,103 97.50% 97.60% 97.40% 97.20% 96.80% 96.70% 96.70% -- - Measles 280,104 95.20% 96.40% 96.70% 96.80% 96.10% 96.00% 96.50% - - Polio 280,105 98.70% 98.80% 98.40% 98.40% 98.50% 98.30% 98.50% - - Tuberculosis 280,106 94.80% 95.00% 95.00% 96.90% 94.00% 94.30% 95.20% - -- Abortions/1,000 Live Births 280,500 204.00 179.20 146.00 108.90 56.40 22.70 22.50 - -- Ambulatory Care Contacts/Person 992,801 7.80 7.60 7.40 7.10 7.00 6.50 6.40 - -- Inpatient Admissions/100 Population 992,902 12.20 12.20 11.90 12.10 12.20 12.40 12.80 - - Average Length Of Stay (Days) 992,901 12.30 12.60 12.50 12.50 12.30 11.80 11.40 - - Quality SDR Appendicitis/i 00,000 Population 310,304 0.60 0.50 0.60 0.40 0.40 0.40 - - - SDR Drug Reactions/100,000 Population 310,306 0.20 0.20 0.20 0.20 0.20 0.20 - - - Surgical Wound Infection Rate 310,701 - - - - - . TABLE 21C. POLAND: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 3.40 2.70 19.00 148.10 6.30 9.60 3.80 - -- Malaria 50,112 -- 0.00 0.00 -- -- - -- - -- Diphtheria 50,113 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -- - Tetanus 50,114 0.20 0.20 0.20 0.20 0.20 0.10 0.10 -- - Acute Poliomyelitis 50,115 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -- - Neonatal Tetanus 50,118 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - - Rubella 50,130 50.80 178.10 54.40 45.60 155.40 1039.20 166.50 -- -- Mumps 50,131 302.00 178.10 213.90 142.60 142.20 110.00 299.80 -- - Clinically Diagnosed AIDS 50,312 0.00 0.00 0.10 0.10 0.10 0.10 0.10 - - Life Expectancy At Birth, In Years 60,101 70.90 71.30 71.10 71.00 70.60 71.10 71.70 -- -- At Age 1, In Years 60,201 71.20 71.50 71.20 71.10 70.70 71.20 71.70 -- - At Age 15, In Years 60,202 57.50 57.80 57.60 57.40 57.00 57.50 57.90 - -- At Age 45, In Years 60,203 29.50 29.80 29.70 29.60 29.30 29.70 29.80 -- -- At Age 65, In years 60,204 14.30 14.60 14.60 14.60 14.40 14.70 14.30 -- -- Probability Of Dying Before 5 yrs /1,000 Population 60,401 19.80 18.40 18.30 18.30 17.10 16.50 -- -- -- Infant Mortality/1,000 Live Births 70,100 17.50 16.20 16.00 16.00 15.00 14.50 13.30 -- - Maternal Deaths/100,000 Live Births 80,100 15.50 11.60 10.70 12.80 12.80 9.90 11.70 -- Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 605.20 580.40 587.50 589.20 609.30 584.60 529.80 - -- Malignant Neoplasms, All Ages 100,102 209.50 212.10 211.00 212.80 213.80 211.10 199.40 -- - AlI Causes, All Ages 990,102 1145.30 1105.10 1118.20 1123.40 1157.30 1116.30 1016.30 -- - Infectious/Parasitic, All Ages 993,002 9.80 9.40 9.10 8.90 8.50 8.30 7.20 -- - Respiratory System, All Ages 993,202 53.50 47.10 48.50 44.90 42.90 37.40 35.80 - - Mental/Nervous/Sensory, All Ages 993,702 13.90 13.60 13.40 14.00 15.50 15.00 12.40 -- - Crude Birth Rate (Per 1,000 Population) 998,004 16.10 15.50 14.80 14.30 14.30 13.40 12.80 - - Crude Death Rate (Per 1,000 Population) 998,005 10.00 9.80 10.00 10.20 10.60 10.20 10.20 - -- Total Fertility Rate 998,006 - - 2.10 2.10 2.10 1.90 1.80 - -- TABLE 22A. ROMANIA: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence Tuberculosis/100,000 40,301 58.20 61.40 63.40 70.10 66.80 79.40 82.50 87.30 - Incidence Hepatitis/100,000 40,310 242.90 306.90 351.50 322.10 218.60 117.70 89.50 118.70 - Incidence Gonorrheall 00,000 40,322 46.20 41.50 35.70 33.50 28.10 28.30 26.40 25.80 - SDR Car Accidentsh100,000 110,201 - - 9.80 19.50 16.80 15.40 14.20 20.50 - Fatalities-Work Accidents'100,000 110,503 3.90 3.50 3.50 3.00 2.90 2.20 - - - SOR Suicide+SelfInjuryi100,000 120,101 - - 11.50 9.40 9.80 12.00 12.70 12.90 - Nutrition % Of Total Energy From Fat 160,306 26.90% 26.70% 24.90% 27.20% 27.60% 27.20% 34.20% - - % Of Total Energy From Protein 160,307 12.10% 12.30% 12.10% 12.20% 12.20% 11.70% 14.40% - - % Of Total Energy From Alcohol 160,308 47.00% 0.50% 4.80% 4.80% - - - - - % Neonates Weighing More Than 2500g 160,401 92.50% 92.50% 92.70% 92.90% 92.10% 91.80% 89.10% 91.40% - Annual Liters Alcohol/Person 170,101 7.80 7.90 6.60 7.30 6.40 - - - - Annual Cigarette Consumption/Person 170,902 1281.60 1367.50 1386.50 1383.20 1078.30 1206.70 1118.90 Nonsmokers In Population (%) 171,001 - - - 71.60% 72.00% - - 72.00% - Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 - - - - - 49.00% - - - Urban 200,108 - - - - - 85.00% - - - Rural 200,109 - - - - - - - - - % Population With Water Supply In Home Total 992,001 - - - - - 51.00% - - - Urban 992,002 - - - - - 72.00% - - - Rural 992,003 - - - - - - - - - TABLE 22B. ROMANIA: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 178.90 180.50 181.20 180.20 181.60 186.60 17700 176.50 -- Qualified nurses 270,202 373.90 370.80 367.50 354.80 337.50 346.50 346.90 386.90 -- Dentists 270,203 31.40 31.30 30.70 28.90 27.90 28.50 27.80 26.00 -- Pharmacists 270,204 28.40 28.10 27.80 27.10 21.90 16.80 12.30 12.40 -- Midwives 270,209 52.70 53.40 53.90 50.50 47.80 47.40 46.60 46.90 -- % Doctors Working In Hospitals 270,321 38.20% 38.40% 37.10% 40.70% 39.40% 39.20% 37.80% 40.80% -- % Nurses Working In Hospitals 270,322 41.90% 42.20% 42.60% 44.10% 45.00% 45.70% 47.20% 48.60% -- Graduating Per 100,000 Population Doctors 360,301 - -- -- 2.65 2.45 2.74 2.73 -- -- Nurses 360,302 - -- -- 3.29 3.30 3.57 4.56 -- Dentists - - - - -- Pharmacists 360,304 - - -- 0.13 0.13 0.12 0.13 -- Midwives -- -- -- -- -- -- -- -- -- Health Units Primary Care Units/100,000 Population 270,206 23.92 23.86 22.66 25.35 25.65 25.59 26.17 26.43 Hospitals/100,000 Population 270,210 1.84 1.84 1.84 1.82 1.84 1.89 1.90 1.82 Inpatient Beds/100,000 population 992,710 900.00 890.00 890.00 890.00 890.00 790.00 790.00 770.00 Psychiatric Beds/100,000 Population 992,711 80.00 79.00 79.00 78.00 79.00 77.00 77.00 76.06 -- Nursing Home Beds/100,000 Population 992,712 -- -- - -- -- - -- -- .. Utilization % Children Immunized Against: Diptheria 280,101 92.00% 96.00% 96.00% 96.00% 97.50% 97.50% 97.60% -- Tetanus 280,102 92.00% 96.00% 96.00% 96.00% 97.50% 97.50% 97.60% -- Pertussis 280,103 92.00% 96.00% 96.00% 96.00% 97.50% 97.50% 97.60% -- - Measles 280,104 90.00% 78.00% 90.00% 92.00% 92.30% 90.60% 90.20% -- -- Polio 280,105 90.00% 92.00% 95.00% 92.00% 90.30% 91.70% 97.60% -- - Tuberculosis 280,106 95.00% -- 90.00% 91.00% 99.10% 99.10% 99.10% -- -- Abortions/1,000 Live Births 280,500 476.10 487.90 522.30 3152.60 3149.30 2657.00 2343.10 2148.80 -- Ambulatory Care Contacts/Person 992,801 9.90 10.00 9.60 8.30 7.60 7.90 8.10 8.10 -- Inpatient Admissions/100 Population 992,902 22.60 23.00 22.60 20.10 19.00 20.20 20.40 21.10 -- Average Length Of Stay (Days) 992,901 11.10 11.00 11.10 11.40 11.70 11.70 11.60 11.10 - Quality SDR Appendicitis/100,000 Population 310,304 0.66 0.60 0.43 0.44 0.37 0.42 0.31 -- -- SDR Drug Reactions/100,000 Population 310,306 -- -- -- -- -- -- -- - - Surgical Wound Infection Rate 310,701 --1-- -- -- - - -- -- TABLE 22C. ROMANIA: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 51.60 7.90 16.70 20.20 7.70 26.60 124.50 27.40 -- Malaria 50,112 0.07 0.03 0.02 0.05 0.05 0.08 0.09 0.09 - Diphtheria 50,113 0.01 0.01 0.02 0.00 0.00 0.00 0.00 0.00 -- Tetanus 50,114 0.16 0.13 0.09 0.15 0.10 0.16 0.13 0.11 -- Acute Poliomyelitis 50,115 0.05 0.07 0.05 0.03 0.13 0.08 0.04 -- -- Neonatal Tetanus 50,118 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 -- Rubella 50,130 285.10 82.50 104.80 47.20 37.00 26.40 41.70 206.80 - Mumps 50,131 297.80 289.80 182.50 131.50 150.80 134.30 156.00 281.30 -- Clinically Diagnosed AIDS 50,312 0.02 0.06 1.20 4.50 2.31 2.33 1.76 - -- Life Expectancy At Birth, In Years 60,101 69.00 69.30 69.60 69.70 70.10 69.50 68.50 -- At Age 1, In Years 60,201 70.10 70.20 70.50 70.60 70.70 70.20 -- -- -- At Age 15, In Years 60,202 57.00 57.10 57.40 57.50 57.40 56.90 - -- -- At Age 45, In Years 60,203 29.20 29.30 29.70 29.70 29.60 29.10 -- -- - At Age 65, In years 60,204 13.80 13.80 14.20 14.40 14.20 14.00 - - Probability Of Dying Before 5 yrs /1,000 Population 60,401 36.90 33.90 34.90 34.30 28.70 28.90 -- - - Infant Mortality/1,000 Live Births 70,100 28.90 25.40 26.90 26.90 22.70 23.40 23.30 23.90 -- Maternal Deaths/100,000 Live Births 80,100 150.10 155.50 169.40 83.60 66.50 60.30 53.20 60.40 -- Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 765.10 751.70 712.30 705.70 729.50 751.10 712.40 709.90 -- Malignant Neoplasms, All Ages 100,102 146.40 150.00 148.50 147.90 149.30 154.30 158.90 162.20 -- All Causes, All Ages 990,102 1262.20 1241.10 1192.50 1168.60 1187.90 1223.70 -- - - Infectious/Parasitic, All Ages 993,002 12.30 11.40 12.10 12.50 12.10 13.50 - - - Respiratory System, All Ages 993,202 132.90 124.80 116.80 105.90 102.70 101.70 79.70 80.60 -- Mental/Nervous/Sensory, All Ages 993,702 17.30 18.20 17.10 15.80 14.40 16.30 - -- -- Crude Birth Rate (Per 1,000 Population) 998,004 16.70 16.50 16.00 13.60 11.90 11.40 11.00 10.90 -- Crude Death Rate (Per 1,000 Population) 998,005 11.10 10.90 10.70 10.70 10.90 11.60 11.60 11.70 -- Total Fertility Rate 998,006 -- -- 2.10 2.20 1.90 1.50 1.40 1.40 -- TABLE 23A. SLOVAKIA: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Lifestyles Incidence Tuberculosisit00,000 40,301 33.50 30.20 27.30 26.20 29.90 31.50 33.80 - - Incidence Hepatitis/100,000 40,310 51.30 69.40 48.10 37.60 44.30 51.90 51.90 33.90 - Incidence Gonorrhea/100,000 40,322 41.10 35.30 30.40 37.50 37.60 34.80 25.40 13.00 - SDR Car Accidents/100,000 110,201 - - - - - - - - - Fatalities-Work Accidents/100,000 110,503 - - - - - - - - - SDR Suicide+Self Injury/100,000 120,101 13.00 12.60 11.30 13.70 11.00 10.40 6.70 - - Nutrition % Of Total Energy From Fat 160,306 - - - - - - - - % Of Total Energy From Protein 160,307 - - - - - - - % Of Total Energy From Alcohol 160,308 - - - - - - - - % Neonates Weighing More Than 2500g 160,401 94.30% 94.10% 94.20% 94.00% 93.60% - - - - Annual Liters Alcohol/Person 170,101 9.80 9.50 9.60 10.40 10.30 9.70 - - - Annual Cigarette Consumption/Person 170.902 1636.00 1567.00 1535.00 5518.80 5056.00 5485.50 - - - Nonsmokers In Population (%) 171,001 - - - - 76.00% - - - - Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 48.00% 49.00% 49.90% 50.70% 51.20% 50.90% - - - Urban 200,108 - - - - - - - - - Rural 200,109 - - - - - - - - - % Population With Water Supply In Home Total 992,001 - - - - - - - - - Urban 992,002 - - - - - - - - - Rural 992,003 - - - - - - - - - TABLE 23B. SLOVAKIA: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 302.27 304.73 303.51 309.51 323.14 382.03 314.70 300.66 - Qualified nurses 270.202 676.32 686.16 693.50 700.84 708.12 723.72 709.85 701.24 -- Dentists 270,203 0.45 0.39 0.32 0.24 0.49 0.66 0.13 0.41 - Pharmacists 270,204 36.33 37.34 37.82 37.64 39.11 37.85 30.72 19.45 - Midwives 270,209 - - - 48.70 48.90 50.50 - - - % Doctors Working In Hospitals 270,321 13.00% 12.00% 13.00% 12.00% 14.00% 14.00% 13.00% 13.00% - % Nurses Working In Hospitals 270,322 48.00% 48.00% 48.00% 47.00% 51.00% 53.00% 51.00% 53.00% - Graduating Per 100,000 Population Doctors 360,301 - - - 7.70 8.40 - - - - Nurses 360,302 51.30 48.80 46.60 45.30 45.20 55.60 72.70 - - Dentists 360,303 - - - 0.70 0.80 - - - - Pharmacists 360,304 - - - 2.40 3.00 - - - - Midwives 360,305 - - - 2.20 3.50 4.30 - - - Health Units Primary Care Units/100,000 Population 270,206 43.30 43.30 42.50 41.70 37.90 36.20 33.80 31.20 - Hospitals/100,000 Population 270,210 1.50 1.50 1.50 1.50 1.60 1.65 1.60 1.60 Inpatient Beds/100,000 population 992,710 740.00 740.00 750.00 740.00 760.00 760.00 780.00 710.00 - Psychiatric Beds/100,000 Population 992,711 26.90 26.80 27.40 29.80 33.50 32.80 33.20 32.00 - Nursing Home Beds/100,000 Population 992,712 Utilization % Children Immunized Against: Dipthera 280,101 98.00% 99.00% 99.10% 99.40% 99.70% 99.30% 99.00% -- - Tetanus 280,102 98.00% 99.00% 99.10% 99.40% 99.70% 99.30% 99.00% - - Pertussis 280,103 98.00% 99.00% 99.10% 99.40% 99.70% 99.30% 99.00% -- - Measles 280,104 97.70% 99.20% 98.90% 98.50% 98.00%4 96.20% - -- - Polio 280,105 98.70% 98.90% 98.80% 99.00% 99.20% 98.60% 99.00% - - Tuberculosis 280,106 99.20% 98.70% 98.70% 98.20% 92.50% 98.60% -- - - Abortions/1,000 Live Births 280,500 681.10 705.10 702.00 702.60 671.40 660.00 621.80 622.20 - Ambulatory Care Contacts/Person 992,801 - -- - - - - - -- -- Inpatient Admissions/100 Population 992,902 -- - - - - - - -- - Average Length Of Stay (Days) 992,901 13.30 15.00 14.20 13.70 12.90 13.40 12.70 11.40 -- Quality SDR Appendicitis/1 00,000 Population 310,304 -- - -- - -- -- - SDRDrug Reactions/100000 Population 310,306 - - - - - - - -- -- Surgical Wound Infection Rate 310,701 - - - - - - -- -- - TABLE 23C. SLOVAKIA: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 -- - -- 0.90 4.00 7.80 - - -- Malaria 50,112 - -- -- 0.00 0.00 0.00 - - -- Diphtheria 50,113 - - - - 0.00 0.00 - -- -- Tetanus 50,114 - - - 0.00 0.00 0.00 - - - Acute Poliomyelitis 50,115 -- - - 0.00 0.00 0.00 -- - - Neonatal Tetanus 50,118 - - -- 0.00 0.00 0.00 - - -- Rubella 50,130 -- - - 3.20 42.80 1.40 - -- -- Mumps 50,131 - - - 39.60 21.50 9.80 -- -- -- Clinically Diagnosed AIDS 50,312 - - - 0.00 0.00 0.00 -- -- -- Life Expectancy At Birth, In Years 60,101 71.19 71.31 71.13 71.04 70.96 71.89 72.50 - At Age 1, In Years 60,201 71.38 71.41 71.26 71.12 71.13 #N/A 72.39 -- -- At Age 15, In Years 60,202 57.71 57.72 57.57 57.42 57.45 #N/A 58.67 -- -- At Age 45, In Years 60,203 29.40 29.40 29.30 29.30 29.30 #N/A 30.40 -- -- At Age 65, In years 60,204 14.29 14.27 14.26 14.30 14.20 #NIA 15.00 -- -- Probability Of Dying Before 5 yrs 11,000 Population 60,401 0.15 0.25 0.24 0.21 0.23 0.21 0.17 0.16 -- Infant Mortality/1,000 Live Births 70,100 14.60 13.30 13.50 12.00 13.20 12.60 10.60 11.20 - Maternal Deaths/100,000 Live Births 80,100 3.60 16.80 15.00 6.30 14.00 1.30 12.30 6.00 - Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 500.40 507.50 522.80 549.80 546.40 520.60 517.90 525.30 -- Malignant Neoplasms, All Ages 100,102 188.90 195.90 195.90 195.40 198.60 200.50 201.50 201.10 -- All Causes, All Ages 990,102 995.10 999.30 1021.60 1031.00 1033.80 1008.00 991.10 961.10 - Infectious/Parasitic, All Ages 993,002 3.10 2.80 2.90 2.50 3.70 3.90 3.70 4.10 - Respiratory System, All Ages 993,202 97.20 86.70 90.60 75.10 77.10 77.40 78.70 65.20 - Mental/Nervous/Sensory, All Ages 993,702 9.10 8.90 8.40 7.30 5.80 4.30 6.10 5.97 - Crude Birth Rate (Per 1,000 Population) 998,004 16.16 15.93 15.25 15.17 14.90 14.13 13.82 12.50 - Crude Death Rate (Per 1,000 Population) 998,005 9.95 9.99 10.22 10.31 10.34 10.08 9.91 9.61 - Total Fertility Rate 998,006 2.15 2.15 2.08 2.09 - -- - - - TABLE 24A. SLOVENIA: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Lifestyles Incidence Tuberculosis/100,000 40,301 32.10 31.30 39.40 37.00 29.20 29.10 29.10 - - Incidence Hepatitis/100,000 40,310 53.30 48.50 65.00 34.80 19.10 22.20 16.80 -- - Incidence Gonorrhea/100,000 40,322 46.10 33.50 29.10 20.30 17.10 14.80 12.00 - - SDR Car Accidents/100,000 110,201 21.70 23.20 23.10 21.70 21.10 21.70 22.50 - - Fatalities-Work Accidents/1 00,000 110,503 4.40 3.40 3.60 2.90 2.40 2.10 2.10 - - SDR Suicide+Self Injury/100,000 120,101 31.00 32.30 34.50 27.90 32.10 28.80 30.10 - - Nutrition % Of Total Energy From Fat 160,306 - - - 36.60% - - - - - % Of Total Energy From Protein 160,307 - - - - - - - - - % Of Total Energy From Alcohol 160,308 - - -- - - - - - - % Neonates Weighing More Than 2500g 160,401 94.10% 94.30% 94.40% 94.80% 94.50% 94.20% 94.50% - - Annual Liters Alcohol/Person 170,101 11.40% 10.90% 92.00% 10.20% 92.00% 11.30% 93.00% - - Annual Cigarette Consumption/Person 170,902 - - - - - - - - - Nonsmokers In Population (%) 171,001 - 65.90% - 64.00% - - - 71.90% - Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 - - - - 89.50% - - - - Urban 200,108 - - - - 94.90% - - Rural 200,109 - - - - 84.00% - - - - % Population With Water Supply In Home Total 992,001 -- - - - 100.00% - - - - Urban 992,002 - - - - 100.00% - - - - Rural 992,003 - - - - 100.00% - - - - TABLE 24B. SLOVENIA: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 200.40 202.40 206.30 205.50 207.90 209.10 203.10 -- -- Qualified nurses 270,202 553.00 590.60 559.00 561.30 546.80 562.80 590.10 -- -- Dentists 270,203 54.70 55.60 56.90 56.40 52.00 52.80 48.60 -- Pharmacists 270,204 45.60 48.20 31.50 32.60 30.00 23.60 35.90 -- -- Midwives 270,209 - -- 36.50 33.50 -- -- -- -- -- % Doctors Working In Hospitals 270,321 46.40% 48.70% 47.20% 46.30% 47.90% 47.50% 49.80% -- -- % Nurses Working In Hospitals 270,322 55.10% 66.10% 60.90% 63.50% 58.80% 61.10% 57.00% -- -- Graduating Per 100,000 Population Doctors 360,301 6.90 6.70 5.60 7.30 5.30 5.30 6.20 -- -- Nurses 360,302 47.70 34.10 29.70 32.80 36.30 50.10 48.30 -- -- Dentists 360,303 0.90 1.60 1.30 1.90 1.50 1.30 1.60 -- -- Pharmacists 360,304 2.30 0.00 2.50 3.10 3.00 3.00 3.10 -- -- Midwives 360,305 Health Units Primary Care Units/100,000 Population 270,206 1.00 1.00 1.00 1.00 1.00 3.00 4.00 -- -- Hospitals/100,000 Population 270,210 1.10 1.10 1.10 1.15 1.15 1.15 1.21 -- -- Inpatient Beds/100,000 population 992,710 540.00 530.00 530.00 520.00 520.00 510.00 500.00 - -- Psychiatric Beds/100,000 Population 992,711 78.00 81.00 81.00 81.00 81.00 79.00 78.00 - -- Nursing Home Beds/100,000 Population 992,712 -- -- - -- -- -- -- -- -- Utilization % Children Immunized Against: Diptheria 280,101 95.90% 96.70% 96.30% 97.80% 97.90% 98.50% 98.00% -- -- Tetanus 280,102 95.90% 96.70% 96.30% 97.80% 97.90% 98.50% 98.00% -- -- Pertussis 280,103 94.40% 95.10% 95.20% 97.10% 97.30% 97.70% 98.00% -- -- Measles 280,104 91.00% 90.90% 90.60% 92.30% 90.60% 90.30% 98.70% - -- Polio 280,105 94.40% 95.30% 95.10% 96.80% 97.60% 98.30% 98.00% -- -- Tuberculosis 280,106 92.00% 93.70% 94.30% 94.30% 87.00% 92.50% 96.00% -- -- Abortions/1,000 Live Births 280,500 661.00 650.30 671.90 651.30 648.70 663.10 616.50 -- - Ambulatory Care Contacts/Person 992,801 -- -- -- -- -- -- -- -- -- Inpatient Admissions/100 Population 992,902 16.00 15.90 15.90 15.70 15.10 15.70 15.80 -- Average Length Of Stay (Days) 992,901 12.00 11.60 11.40 11.30 11.00 10.90 10.90 -- Quality SDR Appendicitis/100,000 Population 310,304 0.64 0.28 0.31 0.10 0.30 0.60 0.46 -- -- SDR Drug Reactions/100,000 Population 310,306 0.06 0.00 0.14 0.00 0.20 0.20 0.11 -- -- Surgical Wound Infection Rate 310,701 -- -- -- -- -- -- -- -- -- TABLE 24A. SLOVENIA: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status HFA Refts 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 26.50 4.30 740 4.70 1.60 0.50 0.40 - - Malaria 50,112 0.20 0.10 0.50 0.50 0.10 0.20 0.30 - - Diphtheria. 50,113 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - - Tetanus 50,114 0.30 0.60 0.70 0.50 0.60 0.50 0.40 - - Acute Poliomyelitis 50,115 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - - Neonatal Tetanus 50,118 0.00 0.00 0.00 0.00 0.00 0.00 0.00 - - Rubella 50,130 405.20 583.20 265.10 92.50 340.10 26.40 10.10 - - Mumps 50,131 15.40 17.90 19.90 8.90 6.60 4.90 4.70 - - Clinically Diagnosed AIDS 50,312 0.05 0.10 0.40 0.10 0.40 0.20 0.40 - - Life Expectancy At Birth, In Years 60,101 72.10 72.30 72.80 73.30 73.35 73.45 73.35 74.10 - At Age 1, In Years 60,201 71.95 72.00 72.45 72.90 73.10 73.00 72.90 - - At Age 15, In Years 60,202 58.25 58.35 58.75 59.10 59.75 59.20 59.10 - - At Age 45, In Years 60,203 30.10 30.10 30.55 30.85 30.95 30.95 30.95 - - AtAge465, In years 60,204 14.45 14.55 14.80 14.95 14.95 15.00 15.25 - - Probability Of Dying Before 5 yrs /1,000 Population 60,401 Infant Mortalityl,000 Live Births 70,100 11.10 10.00 8.10 8.40 8.30 8.90 6.80 6.47 - Maternal Deathsl00,000 Live Births 80,100 3.90 11.80 4.20 8.80 4.60 5.00 5.07 - - Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 505.90 477.40 426.40 439.50 442.30 415.60 436.10 - - Malignant Neoplasms, Ail Ages 100,102 207.50 210.20 209.50 211.30 219.90 221.20 226.90 - - All Causes, All Ages 990,102 1035.50 989.40 960.80 936.10 963.90 953.80 974.60 - - Infectious/Parasitic, All Ages 993,002 800 7.20 8.50 5.70 6.20 6.20 4.90 - - Respiratory System, Al Ages 993,202 43.10 45.20 73.60 57.70 54.30 58.50 57.90 - - Mental/Nervous/Sensory, All Ages 993,702 9.80 8.90 7.50 8.50 9.30 9.20 9.20 - - Crude Birth Rate (Per 1,000 Population) 998,004 12.90 12.70 11.80 11.30 10.80 10.00 9.90 9.79 - Crude Death Rate (Per 1,000 Population) 998,005 9.40 9.60 9.30 9.30 9.70 9.70 10.10 9.73 - Total Fertility Rate 998,006 - - 1.52 1.46 1.42 1.34 1.31 - - TABLE 25A. TURKMENISTAN: HEALTH STATUS AND HEALTH SERVICES, LIFESTYLES AND HEALTHY ENVIRONMENT Health Status And Health Services HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Lifestyles Incidence Tuberculosis/100,000 40,301 59.00 -- 47.00 43.80 43.60 43.20 -- - -- Incidence Hepatitis/100,000 40,310 47.50 - 48.40 59.60 - 33.10 - - -- Incidence Gonorrhea/i 00,000 40,322 3.10 - - - - -- .. - -. SDR Car Accidents/1 00,000 110,201 - - - - - - -- - -. Fatalities-Work Accidents/1 00,000 110,503 2.20 - 2.60 2.80 2.80 3.00 -- - - SDR Suicide+Self Injury/100,000 120,101 - -- -- - - - .. .- Nutrition % Of Total Energy From Fat 160,306 23.10% 24.10% 24.30% 25.00% 24.00% 24.30% -- -- % Of Total Energy From Protein 160,307 10.80% 10.90% 10.60% 10.50% 11.60% 11.70% -- - -- % Of Total Energy From Alcohol 160,308 0.05% 0.05% 0.05% 0.05% -- -- - -- -- % Neonates Weighing More Than 2500g 160,401 -- - -- - -- - - -- Annual Liters Alcohol/Person 170,101 0.60 0.40 0.50 0.70 0.80 - -- -- Annual Cigarette Consumption/Person 170,902 1444.20 1263.50 1311.50 1429.70 1311.30 1406.80 -- -- Nonsmokers In Population (%) 171,001 0.57 0.56 -- 0.56 - -- -- -- -- Healthy Environment % Population With Access To Hygienic Sewage Disposal Total 200,107 - -- 94.40% - - - - -- -- Urban 200,108 -- - 99.00% - -- -- - -- -- Rural 200,109 - - 90.00% - -- -- -- -- -- % Population With Water Supply In Home Total 992,001 - - - - - -- - - -- Urban 992,002 - -- -- - - -- -- -- - Rural 992,003- - - - - - - - - TABLE 25B. TURKMENISTAN: HEALTH STATUS AND HEALTH SERVICES, APPROPRIATE CARE Appropriate Care HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Medical Personnel Per 100,000 Population Doctors 270,201 352.74 354.73 340.23 361.37 367.28 358.87 356.98 353.24 - Qualified nurses 270,202 - - -- - -- --- - Dentists 270,203 - - - - - -- .. .. Pharmacists 270,204 -- - - - - - .. Midwives 270,209 - -- -- - - -- % Doctors Working In Hospitals 270,321 - - - - - -- % Nurses Working In Hospitals 270,322 - - - - -- - .. Graduating Per 100,000 Population Doctors 360,301 5.60 - 7.10 8.10 8.10 - - -- - Nurses 360,302 2.20 - 3.40 4.00 4.90 -- - - - Dentists 360,303 1.20 - 1.30 1.30 1.20 1.30 - - - Pharmacists 360,304 1.20 - 1.20 1.30 1.40 - -- - - Midwives 360,305 - - 4.10 5.10 5.50 - -- - - Health Units Primary Care Units/100,000 Population 270,206 -- -- -- - - - -- - - Hospitals/100,000 Population 270,210 1.50 1.50 1.60 1.60 1.60 - -- Inpatient Beds/100,000 population 992,710 210.00 210.00 210.00 210.00 240.00 -- -- -- -- Psychiatric Beds1 DD,DDD Population 992,711 10.00 10.00 10.00 10.00 - - - - - Nursing Home Beds/100,000 Population 992,712 -- -- - - - - -- -- -- Utilization % Children Immunized Against Diptheria 280,101 71.00% 68.00% 74.00% 74.00% 72.00% 68.00% 65.00% - Tetanus 280,102 71.00% 68.00% 74.00% 74.00% 72.00% 68.00% 65.00% -- -- Pertussis 280,103 71.00% 68.00% 74.00% 74.00% 72.00% 68.00% 65.00% -- -- Measles 280,104 50.00% 59.00% 67.00% 68.00% 66.00% 65.00% - -- -- Polio 280,105 71.00% 68.00% 74.00% 74.00% 72.00% 62.00% 65.00% - -- Tuberculosis 280,106 34.00% 15.00% 16.00% 16.00% 53.00% 59.00% 59.00% - -- Abortions/1,000 Live Births 280,500 - - - - - -- -- - .. Ambulatory Care Contacts/Person 992,801 - -- -- - - -- -- -- - Inpatient Admissions/1 00 Population 992,902 5.50 5.40 5.60 5.60 -- -- - -- - Average Length Of Stay (Days) 992,901 7.10 6.90 6.80 6.90 - - - - - Quality SDR Appendicitis/100,000 Population 310,304 - - - - - - - - .. SDR Drug Reactions/100,000 Population 310,306 - - - - - - -- - .. Surgical Wound Infection Rate 310,701 - - - - - -- -- .. .. TABLE 25C. TURKMENISTAN: HEALTH STATUS AND HEALTH SERVICES, HEALTH STATUS Health Status HFA Refs 1987 1988 1989 1990 1991 1992 1993 1994 1995 Incidence, Cases Per 100,000 Population Measles 50,111 4.20 - 34.00 20.40 39.00 41.80 58.10 - - Malaria 50,112 38.90 - 21.30 15.50 21.20 31.70 - - - Diphtheria 50,113 0.10 - 0.00 0.00 0.00 0.00 0.10 - - Tetanus 50,114 0.20 - 0.20 0.20 0.20 0.20 0.20 - - Acute Poliomyelitis 50,115 0.00 - 0.00 0.00 0.10 0.00 0.00 - - Neonatal Tetanus 50,118 0.10 - 0.10 0.10 0.10 0.00 0.10 - Rubella 50,130 - - - - - - - - - Mumps 50,131 - - - - - - - - - Clinically Diagnosed AIDS 50,312 0.00 - 0.00 0.00 0.00 0.00 0.10 - - Life Expectancy At Birth, In Years 60,101 65.20 65.10 65.10 66.50 65.50 66.40 64.20 63.90 - At Age 1, In Years 60,201 - - - - - - - - - At Age 15, In Years 60,202 - - - - - - - - At Age 45, In Years 60,203 - - - - - - - - At Age 65, In years 60,204 - - - - - - - - - Probability Of Dying Before 5 yrs 11,000 Population 60,401 - - - - - - - - Infant Mortality/1,000 Live Births 70,100 56.40 53.30 54.70 45.20 47.00 43.60 45.90 - - Maternal Deaths/100,000 Live Births 80,100 48.11 33.60 59.20 42.28 45.94 58.00 42.70 42.93 - Standard Death Rates Per 100,000 Population Circulatory, All Ages 90,102 - - - - - - - - _ Malignant Neoplasms, All Ages 100,102 - - - - - - - - - All Causes, All Ages 990,102 - - - - - - - - Infectious/Parasitic, All Ages 993,002 - - - - - - - - - Respiratory System, All Ages 993,202 - - - - - - - - - Mental/Nervous/Sensory, All Ages 993,702 - - - - - - - - - Crude Birth Rate (Per 1,000 Population) 998,004 37.20 36.00 35.00 34.20 33.60 34.00 33.10 34.76 - Crude Death Rate (Per 1,000 Population) 998,005 7.90 7.80 7.70 7.00 7.30 7.10 8.20 7.93 - Total Fertility Rate 998,006 - - 3.60 3.50 3.40 3.40 3.90 - - -101- CHAPTER III: FIGURES Table of Contents Figure 1. Life Expectancy at Birth by Country, 1989 and 1993 (males) .......................................103 Figure 2. Age-Standardized Death Rates by Selected Causes in 1993 (European standard population)........................................................................................................104 Figure 3. Infant Mortality Rate (IMR) by GDP per Capita for FSEs in 1993................................105 Figure 4. Infant Mortality Rates (IMR) by GDP Per Capita for EMEs in 1993 ............................106 Figure 5. Life Expectancy by GDP Per Capita for Males in FSEs and EMEs in the E arly 1990s......................................................................................................................107 Figure 6. Life Expectancy by GDP per Capita for Females in FSEs and EMEs in the E arly 1990s......................................................................................................................108 Figure 7. 50ql5 by GDP per Capita for Males in FSEs and EMEs in the Early 1990s.................109 Figure 8. 50q15 by GDP per Capita for Females in FSEs and EMEs in the early 1990s..............110 Figure 9. 5Oql 5 and Infant Mortality Rate (IMR) in FSEs and EMEs in the Early 1990s............11 Figure 10. Percentage Changes in Annual Cigarette Consumption/Person by Country, 19 87-1992 ........................................................................................................................112 Figure 11. Changes in Abortions and Maternal Deaths in Romania, 1987-1993.............................113 Figure 12. Immunization Coverage and Incidence of Measles in FYR Macedonia, 1987-94.........114 Figure 13. Public Sector Health Expenditures as a Percent of Gross Domestic Product by GDP per C apita (1993).............................................................................................................115 Figure 14a. Public Sector Health Expenditures as a Percent of GDP (1987-1994)...........................116 Figure 14b. Public Sector Health Expenditures as a Percent of GDP (1987-1994)...........................117 Figure 15. Reduction in Real Public Spending for Health (1990-1993)..........................................118 Figure 16a. Evolution of Real Spending (1990-1994) Total Health Expenditures............................119 Figure 16b. Evolution of Real Spending (1990-1994) Total Health Expenditures............................120 Figure 17a. Evolution in Real Spending (1990-1994) Personnel Expenditures ................................121 -102- Figure 17b. Evolution in Real Spending (1990-1994) Personnel Expenditures ................................122 Figure 18a. Evolution in Real Public Spending (1990-1994) Drug Expenditures.............................123 Figure 18b. Evolution of Real Public Spending (1990-1994) Drug Expenditures.............................124 Figure 19a. Evolution of Real Public Spending (1990-1994) Capital Expenditures.........................125 Figure 19b. Evolution of Real Public Spending (1990-1994) Capital Expenditures.........................126 Figure 20. Breakdown of Recurrent Public Spending for Health (1993).........................................127 Life Expectancy at Birth (years) co ODæ Russia Ukraine Hungary m any Finland *%weden WS 4* 0 0l Japan 0 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 1993 GDP Per Capita Figure 5: Life Expectancy by GDP Per Capita for Males in FSEs and EMEs in the Early 1990's 78 78 * *Japan 76 USA 76 Greece a a * 74 g Denmark 74 72 -- 72 LL N Portugal 7 *E 70 70 Armenia Poland 68 A 68 A *A 66-66- W Hungary w *-64 --64 A Ukraine 62 62 A FSE - - 60 60 Russia EME A 58 III-5 0 500 1000 1500 2000 2500 3000 3500 4000 Multiply by a factor of 10 for GDP Per Capita of EMEs Figure 6: Life Expectancy by GDP Per Capita for Females in FSEs and EMEs in the Early 1990's 84 84 Japan 82 82 U LI 80 Greece U 80 Uj LL DenmarkW > 78 Portugal 78 , A ~A C 0 76 Poland A 76 0. Armenia CL WU A A A U.1 14m _ -- 2l 74 m " m - " m m - Russia A Hungary Ukraine A 72 A72 A FSE - EME - 70 III 70 0 500 1000 1500 2000 2500 3000 3500 4000 Multiply by a factor of 10 for GDP Per Capita of EMEs Figure 7: 50qi5 by GDP Per Capita for Males in FSEs and EMEs in the Early 1990's 60 60 FSE - - 55 EME A Russia 55 A 50 -50 00 LUI A AUkraine 0 0 45 A A Hungary 45 O 40_, 40 00 ~35 00 A Poland 35 0 000 A A 30 - Armenia A 30 A Cr 25 USA 2510 20 A 20 Greece a Japan 15 I15 0 500 1000 1500 2000 2500 3000 3500 4000 Multiply by a factor of 10 for GDP Per Capita of EMEs Figure 8: 50q15 by GDP Per Capita for Females in FSEs and EMEs in the Early 1990's 24 24 FSE EE- A 22 EME A 22 Hungary A 20 A AUkraine A 20 18 A 18 ALUw _ 16 16C Armenia A e) to Poland Denmark - T-A A Q 14 USA A 14 C- 12 Portugal 12 T 10 A a 10 U Greece * 8 Japan* 8 6 6 0 500 1000 1500 2000 2500 3000 3500 4000 Multiply by a factor of 10 for GDP Per Capita of EMEs Figure 9: 50q15 and Infant Mortality Rate (IMR) in FSEs and EMEs in the Early 1990's 60- 55 * Russia Latvia 50 Hungary * Estonia Kazakhstan 45 Lithuania * kraine o40 90 * Poland Slovenia Bulgaria * Uzbekistan *zchArmenia. 30 tzech Tajikistan 25 Albania 20 # ii 0 5 10 15 20 25 30 35 40 45 50 IMR per 1,000 live births Figure 10: Percentage Change in Annual Cigarette Consumption/Person by Country, 1987 - 1992 250 200 --- - -- - - - 0 0. E 150 - --- ---- --o- Albania o -*-- Bulgaria -a- Czech 100 --- -ungary -- Poland --o- Romania -*-- Slovakia (D I 01 -50 1987 1988 1989 1990 1991 1992 Figure 11: Changes in Abortions and Maternal Deaths in Romania, 1987 - 1993 3500 180 160 3000 140 2500 120 40 0 ct CD 002000 (A 100~ a 0 .c IlIIAbortions/1,000 Live Births >a -4Maternal 180 to Mortality Ratio 0 1500 60 1000 40 500- 20 00 1987 1988 1989 1990 1991 1992 1993 Figure 12: Immunization Coverage and Incidence of Measles in FYR Macedonia, 1987-1994 100 250 90 - 80 __200 70-- 60- 150 c I 0 j 0 I 0 --*1**% Children1 S50o Immunized E 50 - ** Incidence OA per 100,000 40 100 POP. 30- 20- 0/ 50 0/ 10' 0 0 1987 1988 1989 1990 1991 1992 1993 1994 Figure 13: Public Sector Health Expenditures as a Percent of GDP by GDP Per Capita (1993) 12%- 10% 8% Czech *FYRM Croatia FYR* Hungary 0 * Slovakia S 6% Bulgaria * Poland 4% * Lithuania * *Romania Albania 2% * Turkmenistan 0% i 0 1000 2000 3000 4000 5000 6000 7000 1993 GDP per capita (US$) Figure 14a: Public Sector Health Expenditures as a Percent of GDP (1987-1994) 12% 10% - - - - - - - - - - - - - - - - - - - - ---- - - - -- --- - - - - - - - - - ----- - ----- ----- - ------- - --- --- --- 10% 8% - - - - - - - - - - - - - - - - - - --- - --- - -- - --------------- - ---- - - -- --- --------- - -- -- -- -0 Croatia - Czech I-- Hungary 5%-] -*FYRM 6% -- - - - - - - - - - - - - - - - - - - ---- ---- ------- --- --- ----- ---- ----- ---- ----- __9__N__ _ _ M F R o0- Slovakia --Slovenia 4% --- - ------ --- --- --- ---- ---- --- ----------------- ---- ----- - - - - - - - -- - - - - - - - - - 2% ------------- ---------- ----- ---- ----- --- --- ---- ----- ------- --- ----- - - - - - - - - - - - - - 0% 1987 1988 1989 1990 1991 1992 1993 1994 Year Figure 14b: Public Sector Health Expenditures as a Percent of GDP (1987-1994) 12%- 10% ---------- ----- - - - ----------------------------- --------------------------- -- -- -o- Albania --o- Bulgaria --- Poland o --o- Romania --- Lithuania -o- Turkmenistan 4% , - ---------- -- ------- - ------- -------- ------- ----------- ---------- - 2% -- - --- - --------- ------- ----------- ---------------- - - - ---------- ------- 0% 1987 1988 1989 1990 1991 1992 1993 1994 Year Figure 15: Reduction in Real Public Spending for Health (1990 - 1993) 65 Lithuania 55 Albania o 45 w Turkmenistan 35-- Bulgania 0 sFYRM 0 25 Slovakia e * Croatia Czech Hu gary * Romania 15 Poland II IIII# -15 -5 5 15 25 35 45 55 65 -5 % Reduction in Health Spending Figure 16a: Evolution of Real Spending (1990-1994) Total Health Expenditures 140 120 ---------------- ----------------- ---------- - - - - - ---------- - ---------- 1001 8 0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -B u lg a ria to +Czech AHungary -m- Poland 60 _--_--_-_ --_-_--_-_--_--_- ----- ----- -------- --- ------------------------ -------- - - o - m a i -a Romania 0 --- Slovakia 40 - - -- ------- ------ --------------- -------------- - - - - - - - - -- -- - - - - - - - - - - 20 ------- ---------------- -------------- - - - - - - - - - - - - ----------------------- --- 0 1990 1991 1992 1993 1994 1990 = 100 Figure 16b: Evolution of Real Spending (1990-1994) Total Health Expenditures 140- 120 --- ---------- --------- -- ----------------------------------------------- --- --- 100( - -- -- ---- ----- ---------- --- ------------------------------- -------- - - -- co .S --- Albania - 80 - -- - ---- - - - - --- --- -- --- -- - -- - - -- -- - - -- --- -- Croatia a. -o-x-FYRM --- Lithuania 0 60 - --- - - -- - ---- -- --- --- --- -- ---- --- --- --- --- --- --- - - - - - - -- - - - --- - - - - - -- - - -- x --o- Turkmenistan S 40 --- --- ------ ----- ----- ---- - - - - - - -- - - - - ------ --------- ----- _ _ _ __ _ _ 20 ---- ---- --------- ---- ---- ---- --- --- --- ---- --- --------- ------------------ 0 1990 1991 1992 1993 1994 1990 = 100 Figure 17a: EvOIution in Real $pending 《1990-1994) Pers。nnel E〕tpenditure$ ―신「「 1990 1991 1992 1993 1994 1990 & 100 Figure 17b: Evolution in Real Spending (1990-1994) Personnel Expenditures 140- 120 ----------------- -------- --------------------------------------------------------------- 100 ------------------- ----------- -------------------------------------------------------- 0 Le 0 --G-Albania IL Croatia FYRM 80 ---------------- ------------- --- --------- --------------------------------------------- --o- Lithuania CL --o-- Turkmenistan X 60 ----------------------------- --------- ---- -- ------------------------------------------ 40 ----------------------------------------- ---------------- ---------------- 20 1 i . 0 1990 1991 1992 1993 1994 1990 = 100 Figure 18a: Evolution in Real Public Spending (1990-1994) Drug Expenditures 180 140 ---- ------- - - - - --------------- ------ ------ -- ------------- ---------- ---------- ----- 0) .-+-- Bulgaria --Czech g 100 -- ------- -------------------- ------------- ------------- - --------- -- u g r 0 --6- Hungary x -o- Romania ---- Slovenia 80 - ---------- - ------ -- - --- ------------------------- ---------- --- ----------- - 60 --------- -------------- ---- -------------------- ------------- ------------- - - - -- - - - - - - 40 1990 1991 1992 1993 1994 1990 = 100 Figure 18b: ㅌvoIution in Real Public Spending (1990-1994) D『ug Expenditure$ &―긷「― 1 990 1991 1992 1993 1994 1 990 = 1 00 Figure 19a: Evolution in Real Public Spending (1990-1994) Capital Expenditures 120- 110 ------------------------- - -------- ------------------------------------------ 1001 ----------------------------------------------------- ---------------------------------- E 90 ------- ---------- ------------------ ---------- ------------ ----------------------- -- --o- Bulgada Czech a Hungary V Yl r- 80 ---------------- -------------- --------------- ------ ------------------ ---- ---------- Poland 0 CL 70 ----------------------- -------------------------------- -- ------------- ---------------- X S 60 ---------------------------------------------- ---------- ------------------------ 50 ------------------------------------------------------------------------------------------ 40 1990 1991 1992 1993 1994 1990 = 100 Figure 19b: Evolution in Real Public Spending (1990-1994) Capital Expenditures 160 140 ----- ------ - ----- -- - ---- --- --------- - - - - - - - - - - - - - - - - - - - - - 120 - - - ---- -- - - - - ----- - ----- ---- ---------- --- -------- - - - - - - - - - - - C a E 100 -------------------- ------- ------ -D- Albania -+- Croatia - Lithuania 80 ---------- -------------- --- --- - -*-Turkmenistan . 60 -- - - - - - ------ ----- - - ----- - - - - - ----- --- - --- -- ------ --- - 0 e 40 - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - -- - ----- - ----- - - - -- - - - - - - 2 0 - --.- - - - - - ---- ---- --- -- -- -- --- -- -- --- - 0 1990 1991 1992 1993 1994 1990 = 100 % of Recurrent Public Spending - ~ r, c> c' > -_i Mc <0 0> 0 0 0) 0) 0) 0) 0 0 0> 0> 0 FYR Mac. 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