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Default paragraph font;is there a place for an increased reliance on patient charges in central and eastern european countries?

M. Pavlova


The study is financed by the European Commission under FP7 Theme 8 Socio-economic Sciences and Hu- manities, Project ASSPRO CEE 2007 (GA no. 217431). The views expressed in this publication are the sole re- sponsibility of the authors and do not necessarily reflect the views of the European Commission or its services. Abstract: Charges for public health care services are being extended all over Europe as a means to shift health care costs to consumers and to reduce the need of government funds. Such reforms are expected to restrict the deficit in the state budget but also to provide incentives to consumers for an efficient health care use and a healthier life-style. The issue of patient charges occupies the policy debates in Central and Eastern European countries as well, even though it remains controversial in most of these countries. Above all, patients in this European region are already paying a variety of charges (both formal and informal), which impose a consid- erable burden on their household budgets. Would they be able to cope with new or increased formal charges? Taking this question as a perspective in our analysis, we provide evidence on the affordability of public health care services in Central and Eastern Europe, and the future challenges related to their introduction or in- crease. The findings presented here are based on representative surveys among health care consumers carried out in several countries. Data for Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine were collected in July 2010 as a part of project ASSPRO CEE 2007, and data for Albania, Serbia and Russia were obtained from existing datasets collected in previous years. An increased reliance on formal patient charges is indeed a rational policy choice in a public health care system that is adequately organized and funded. However, as our results indicate, in Central and Eastern Europe, there are major health care system problems that should be resolved before such reforms can be successful. Meanwhile, new or increased formal charges should be imple- mented with precautions (e.g. exemptions or compensations for vulnerable pupation groups at risk of poverty or with chronic diseases). The implementation should also take into account the country specific contextual factors since the function and impact of formal patient charges will vary between the countries. Even though Central and Eastern European countries had similar health care systems at the beginning of the transition process, the diversity in their health policy and overall development resulted in very different health care sys- tems at presents.


out-of-pocket payments; health care reforms; Central and Eastern Europe

Full Text


Tambor M., M. Pavlova, P. Woch, W. Groot W., Diversity and dynamics of patient cost-sharing for physicians' and hospital services in the 27 Euro- pean Union countries. European Journal of Public Health, 2010, DOI:10.1093/eurpub/ckq139.

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Stepurko T., M. Pavlova, I. Gryga, W.

Groot., (2010). Empirical studies on informal pa- tient payments for health care services: A systematic and critical review of research methods and instru- ments. BMC Health Services Research,

DOI:10.1186/1472-6963-10- 273.



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M. Pavlova

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