Financing Healthcare in Central and Eastern European Countries: How Far Are We from Universal Health Coverage?

Int J Environ Res Public Health. 2021 Feb 3;18(4):1382. doi: 10.3390/ijerph18041382.


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.

Keywords: Central and Eastern European countries; healthcare financing; universal health coverage.

MeSH terms

  • Delivery of Health Care*
  • Estonia
  • Health Expenditures
  • Humans
  • Hungary
  • Latvia
  • Lithuania
  • Poland
  • Slovakia
  • Slovenia
  • Universal Health Insurance*