Health Care Reform in Central and Eastern Europe: Setting the Stage for Discussion

The paper examines the transformation and reforms of Central and Eastern European (CEE) health care systems taking the examples of Poland, Hungary, the Czech Republic, Slovenia and Romania. After the fall of communism, health care systems in CEE countries provided universal access but suffered from gross inefficiencies and outdated technologies. Patient choice and empowerment was non-existent. Since then, with differing priorities and reform paces, the region has broadly moved towards more open and flexible (Bismarck-style) social insurance systems. Health care financing has been diversified, away from pure tax funding towards the inclusion of social insurance premiums, user fees and, in some cases, private health insurance. Yet, the free choice of specialists and health insurers, and easy access to information is largely the exception rather than the rule. CEE health systems still waste resources by hospitalising patients that could be treated in ambulatory care, or by referring simple cases to specialists instead of treating them at the GP (general practioner) level. Much more needs to be done on this front. But this would have to include an end to the comfortable illusion of ‘free health care’ and a shift towards a healthcare system based on more diverse sources of funding and provision, including the use of the private sector. CEE societies are experiencing demographic changes at a very high speed, which will put increased strains on their health services.

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