Financing healthcare in central and Eastern European Countries : how far are we from Universal Health Coverage?

After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000-2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care

Źródła finansowania opieki zdrowotnej

The sources of health care funding The question how to mobilize financial resources for health care is one of the most frequently asked questions in health care debates. It is also relevant in Poland, where although various health care reforms in the last two decades, there is still no consensus on how health care should be funded. The ambiguous nature of health care services indicates that both public and private methods of funding should be applied in order to obtain the best value for money. In practice both private and public sources are used. However wealthier European countries, rely strongly on public solidarity-based funding. Whereas in the framework of public sources there is a never ending debate what is more effective: general taxation or insurance contribution. Debate on private sources is still on the agenda as well, particularly in post socialistic countries. Private insurance or co-payment and what kind in both cases are the main question. In this paper, we present a review of public and private methods of health care funding focusing on their main characteristics, their application in European countries, and their effects. TQhe analysis relies on secondary data, i.e. a review of the literature and health expenditure databases.

Raport dla WHO o zadłużeniu szpitali

W dniach 30 czerwca–11 lipca 2008 roku odbyła się III Międzynarodowa Konferencja pt. „European Summer University on Medical Law” zorganizowana przez Polskie Towarzystwo Prawa Medycznego przy współpracy Francuskiego Stowarzyszenia Badań i Edukacji w dziedzinie Prawa Medycznego, Wydziału Nauk o Zdrowiu, Uniwersytet Jagielloński Collegium Medicum oraz Uniwersytetu im. Paula Sabatiera w Tuluzie. Inicjatywa organizacji międzynarodowych letnich konferencji prawa medycznego podjęta była w roku 2005 w toku IX seminarium prawa medycznego, które odbyło się w Tuluzie we Francji. Rok później w dniach 3–11 sierpnia został zorganizowany pierwszy Europejski Uniwersytet Letni w Tuluzie, przy udziale kilkunastu uniwersytetów europejskich (z Francji, Belgii, Hiszpanii, Włoch, Polski – UJ), a także z Kanady oraz Algierii i Tunezji. W toku jego obrad Komitet Pedagogiczny składający się z przedstawicieli wymienionych uczelni podjął decyzję, że w następnych latach 2-tygodniowe konferencje będą się odbywać każdego roku w dwóch krajach. W rezultacie tego w roku 2007 pierwszy tydzień II Europejskiego Uniwersytetu Letniego odbył się na Uniwersytecie w Tuluzie, drugi zaś na Uniwersytecie w Madrycie. W roku 2008 tradycyjnie pierwszy tydzień konferencji zorganizował także Uniwersytet w Tuluzie (30 czerwca–2 lipca), drugi zaś Instytut Zdrowia Publicznego Wydziału Nauk o Zdrowiu UJ CM (7–11 lipca)

Wprowadzenie dopłat pacjentów do świadczeń opieki zdrowotnej finansowanych ze środków publicznych – opinie głównych uczestników polskiego systemu opieki zdrowotnej

Introduction of patient payments for publicly financed health care services – opinions of the main Polish health care system’s stakeholdersDuring the last decades many European governments have introduced patient payments in their public health care system with the aim to improve efficiency of health care provision, contain overall health care expenditure, and also to generate additional resources. In Poland, since 1999 patients have met formal payment obligations when they use dental services. Though introduction of formal patient payments for primary care services, out-patient specialists’ services and hospital services has been discussed, such payments do not exist. Empirical evidence suggests that the successful implementation of patient payments, to a large extent, depends upon public acceptance and political consensus. The paper presents the results of study on attitudes towards formal patient payments for publicly financed health care services, among different groups of Polish health care system’s stakeholders (health care consumers, providers, insurers and policy makers). The data are collected via focus group discussions and in-depth interviews carried out in Poland in June–October 2009 as part of project ASSPRO CEE 2007. The results are used to out-line policy recommendations

Are patient charges an effective policy tool? Review of theoretical and empirical evidence

Policy-makers assign various objectives to the implementation of patient charges for public health care services. These charges impose prices on health care consumption and as such, they are expected to affect the quantities of health care service demanded, and to generate revenues. The actual ability of patient charges to achieve these objectives depends to a great extent on the patient payment mechanism implemented in a country, as well as on the health care system and context-specific factors. This paper reviews and discusses the theoretical and empirical evidence on the effectiveness of patient payment policies. The paper suggests that patient charges can be a successful policy tool for controlling the pattern of health care utilisation and improving the quality of health care provision. However, an additional condition for success is the appropriateness of the design of patient charges with respect to efficiency and equity in the public health care secto

Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). Objectives: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. Results: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. Discussion and conclusions: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions