Introduction
Only a small portion of today's existing research has made use of rigorous empirical methods to convincingly isolate the impact on the health sector of the new provider-payment arrangements from those which resulted from other changes occurring at the same time. Throughout the 1990s and early 2000s, several transitional countries in Central and Eastern Europe and Central Asia (ECA) aimed at reforming their provider-payment systems in order to achieve the general objectives of protecting health-spending levels and improving the overall performance of the health sector.
We use such reforms as a natural experiment to investigate, empirically, the system-wide impacts of introducing patient-based (casemix) and fee-for-service methods for hospital reimbursement (compared to line-item budgets) on a set of outcomes including hospital-activity rates, capacity utilization, national-health spending, and mortality amenable to healthcare.