The economic consequences of reorganizing hospital services in Bishkek, Kyrgyzstan

Kyrgyzstan gained independence from the Soviet Union in 1991 and has since been thrown into severe financial crisis. All public sector funding has bee n significantly reduced and international aid agencies are supporting the g overnment in rebuilding the economy. The health sector requires a radical o verhaul and a major part of this process involves rationalization of existi ng facilities, particularly in the capital Bishkek, where 26 secondary and tertiary hospitals support a population of approximately 800000 people. Thi s paper describes the development of a plan for rationalization with partic ular emphasis on the economic aspects of the process. This involved calcula ting future hospital requirements by modelling a variety of policy options, ranging from changes to clinical practice to hospital closures. The model generates estimates of resource requirements at each hospital, from which t he costs falling on the health budget and patients are derived. Copyright ( C) 1999 John Wiley & Sons, Ltd.