This article is an updated version of the previous edition article by Dina Balabanova, Richard Coker, volume 5, pp. 627–637, © 2008, Elsevier Inc. Abstract After 1991, when the USSR dissolved, the ensuing sociopolitical transformation resulted in deepening poverty, increasing marginalization, and widening income inequality. Overall, compared with countries of the European Union, health indicators deteriorated markedly as did access to health care. Across the region, reforms have been dependent upon varying economic and political imperatives, but similarities exist. For the more reform-oriented countries, there has been a shift from a taxation based to an insurance-based system. All countries have sought to address the weaknesses of the inherited primary care system, usually by seeking to introduce family medicine or general practice models. However, a substantial network of vertical structures with narrowly specialized professional staff persists in most countries. Building integrated, coordinated, evidence-based, multidisciplinary, patient-centered care to respond to the chronic disease burden and (re-)emerging communicable diseases remains a challenge.