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Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019 : a comparative analysis

This paper aims to: (1) provide a brief overview of hospital sector characteristics in 11 Central and East-ern European countries (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland,Romania, Slovakia, Slovenia); (2) compare recent (2008 – 2019) hospital reforms in these countries; and(3) identify common trends, success factors and challenges for reforms. Methods applied involved fivestages: (1) a theoretical framework of hospital sector reforms was developed; (2) basic quantitative datacharacterizing hospital sectors were compared; (3) a scoping review was performed to identify an initiallist of reforms per country; (4) the list was sent to national researchers who described the top threereforms based on a standardized questionnaire; (5) received questionnaires were analysed and vali-dated with available literature. Results indicate that the scope of conducted reforms is very broad. Yet,reforms related to hospital sector governance and changes in purchasing and payment systems are muchmore frequent than reforms concerning relations with other providers. Most governance reforms aimedat transforming hospital infrastructure, improving financial management and/or improving quality ofcare, while purchasing and payment reforms focused on limiting hospital activities and/or on incen-tivising a shift to ambulatory/day care. Three common challenges included the lack of a comprehensiveapproach; unclear outcomes; and political influence. Given similar reform areas across countries, thereis considerable potential for shared learning

Balancing financial incentives during COVID-19: a comparison of provider payment adjustments across 20 countries.

Objective Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. Method We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. Findings We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff. Conclusions We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care