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In the two decades since the fall of the Berlin Wall, former communist countries in
Europe have pursued wide-ranging changes to their health systems. We describe three
key aspects of these changes-an almost universal switch to health insurance systems,
a growing reliance on out-of-pocket payments (both formal and informal), and efforts
to strengthen primary health care, often with a model of family medicine delivered
by general practitioners. Many decisions about health policy, such as the introduction
of health insurance systems or general practice, took into account political issues
more than they did evidence. Evidence for whether health reforms have achieved their
intended results is sparse. Of crucial importance is that lessons are learnt from
experiences of countries to enable development of health systems that meet present
and future health needs of populations.