The political transition in central and eastern Europe has not spared the region's health systems. Almost everywhere governmentshave abandoned the Soviet model of health care. Initially, this model achieved much at first in ensuring universal access to health services and tackling common infectious diseases. Yet, by the 1970s, the cracks were appearing, and now many people in the region are dying from causes that should be preventable with timely and effective health care. Health systems in the region have had to respond to a variety of economic and political pressures as well as to the populations' longstanding healthcare problems. Many services were of low quality and were characterised by poorly motivated health professionals, poor responsiveness to citizens' needs, and outdated clinical practices. Although the range and depth of challenges has varied between countries, some are common to many of them. One of the greatest challenges has been the quest for sustainable financing. Most countries in the region were quick to reject the former model of financing from general government revenues, owing to general mistrust in governments and to the desire to follow what were perceived as superior models used in neighbouring countries. Some form of social health insurance, based on contributions from individuals according to their earnings, seemed to offer a solution.