Causal Mechanisms in the Introduction of Mandatory Health Insurance in the Post-Soviet Region

After the end of the Soviet Union, mandatory health insurance (MHI) emerged as the most popular reform model. This chapter first describes the resistance avoidance mechanism leading to its legal introduction. Actual implementation of MHI schemes, however, faced severe problems. We identify two causal mechanisms which were at the core of these problems: Fight for state funding and informalisation. We argue that against this background, (partially) successful introduction of MHI was only possible if the reform supporter mechanism occurred, meaning that a strong supporter in favour of the new healthcare model was created in the form of a centralised MHI Fund.