Health care systems in Central and Eastern Europe

The healthcare situation in the Central and Eastern European countries, which had deteriorated somewhat at the beginning of transition, has clearly been improving since 1995-1996, even though it remains below EU standards. Delayed for a long time, the reform of the health service has become a priority on the political agenda.

• Healthcare provision remains inadequate

Today, the health services still retain traces of the old centralised system based on the principle of free treatment, which was also characterised by the density of the network and overstaffing in hospitals:

a) the number of hospital beds (for the most part public) per capita remains high, except in Latvia, Slovenia and Estonia; b) primary care is not yet sufficiently developed and specialist medicine is still oversized (5,000 general practitioners in the Czech Rep. for 38,000 specialists); c) there is insufficient emphasis on prevention (the death rate from cardiovascular diseases is very high); d) the socio-economic status of health professionals remains very poor, wages are often low and training is often inadequate. "Backhanders" have developed, creating a two-tier system.

• Despite a rise in budgets, financing remains under pressure

• After having undergone a severe adjustment at the beginning of transition, health budgets have risen sharply in the majority of countries. In the Czech R. and Slovenia, countries with the best health indicators, they approach Western European levels, in proportion to their level of wealth. In Poland and Hungary, private spending on health developed very early. This remained marginal in Slovakia and the Czech Republic, where the proportion of health funding from private insurance or direct payments scarcely reaches 10% (compared with 25% in the Union countries). In the poorest countries (Bulgaria and Romania, where the health situation remains particularly rundown, but also in Latvia and Lithuania), public spending on health remains low.

• The initial reforms failed to increase accountability and incentives to limit costs. Competitive tendering via private or regional health funds was set up (Czech Republic, Poland, and Slovakia), but these funds negotiate prices with the medical service providers, whereas consumers determine the supply without bearing the direct cost. The decentralisation of hospital management has begun (Poland, Hungary, Estonia and the Czech Rep.), but this decentralisation has often passed on the financial burden to the local authorities. Lastly, spending on medicines has rocketed (more than 10% per annum in the Czech Rep. over the recent period). In Poland, the proportion of spending on medicines within the total health expenditure increased from 23% in 1994 to 29.5% in 1999 (as against 17% in the UK and 13% in Germany).

• The pressure on health service financing, which should increase in the medium term, makes reform urgent, all the more so when considering the unfavourable demographic trends and the need to renew investments. Reform has begun well in Slovakia, with the introduction of a patient contribution and a new scale for the refund of the costs of medical treatment, and it seems imperative in Poland, but also in the Czech R. and Hungary within a context of deteriorating public finances.

Number of hospital beds and doctors per 100,000 inhabitants (2001) and number of annual visits to the doctor (2000)

 

	BEDS	DOCTORS	VISITS
BU	699	334	5.4
CZ	1096	378	14.5
EST	670	313	6.3
HU	806	293	14.7
LAT	518	296	4.9
LIT	869	380	6.6
POL	718	224	5.4
RO	749	189	6.4
SK	767	334	16.4
SLV	533	227	7.4
EU-15	660	390	5.8

Source: Eurostat

Total public health spending as % of GDP (2001) and per inhabitant in USD PPA (2000)

	TOTAL SPENDING	PUBLIC SPENDING	/INHAB.
BU	4.2	4.0	-
CZ	7.3	6.7	1106
EST	5.5	4.3	594**
HU	6.8	5.1	911
LAT	4.8	3.4	338**
LIT	5.7	4.0	426**
POL	6.2	4.4	558**
RO	4.5	4.5*	272**
SK	5.7	5.1	682
SLV	8.5	7.1	1389**
EU-15	8.5	6.3	2230,6
FR	9.5	7.2	-
GRE	9.4	5.2	-

Source: OMS, OCDE *1999** 2000

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The full report is available in French on theenlargement website of DREE.