The article discusses main developments in the organization and financing of health care in the Czech Republic, Hungary and Poland. These countries exemplify different approaches to health care reform and different processes of institutional change of health care systems. The article charts main policy developments and offers explanation of dynamics of changes. It emphasizes the role of politics and broadly understood institutions, which are often neglected in the literature on health care reform in the region. It is argued that political institutions, party politics and rivalries within the governments influenced the scope and timing of policy changes. Institutional changes were also affected by the patterns of interest representation and organizational and normative developments that resulted from decisions and non-decisions taken in the past.