Rural Healthcare And Health Insurance Coverage In European Countryside

Rural Healthcare And Health Insurance Coverage In European Countryside – Self-reported waiting times for ambulatory health care services in Hungary: Results of a cross-sectional survey on a nationally representative sample

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Rural Healthcare And Health Insurance Coverage In European Countryside


Rural Healthcare And Health Insurance Coverage In European Countryside

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By Marzena Tambor Marzena Tambor Scilit Google Scholar 1, * , Jacek Klich Jacek Klich Scilit Google Scholar 2 and Alicja Domagała Alicja Domagała Scilit Google Scholar 3

What Is Universal Health Care?

Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland

Department of Health Policy and Management, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland

Received: December 10, 2020 / Revised: January 25, 2021 / Accepted: January 29, 2021 / Published: February 3, 2021

Rural Healthcare And Health Insurance Coverage In European Countryside

The health systems of the countries of Central and Eastern Europe underwent a huge transformation after the fall of communism, which resulted in a departure from publicly funded health care. This had significant adverse effects on health equity that are still evident. In this article, we analyzed the role of government and households in health care financing in eight countries (EU-8): the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia. A desk research method was used to collect quantitative data on health care expenditures and qualitative data on gaps in universal health coverage. Linear regression analysis was used to analyze the trend of health care spending in 2000–2018. Our results indicate that high dependence on pocket payments persists in many EU-8 countries, with only a few countries showing a significant downward trend over time. Gaps in universal coverage in EU-8 countries are caused by explicit allocation (limited benefits package, patient cost sharing) and implicit mechanisms (waiting times). In Central and Eastern European countries, the role of public funding needs to be increased through setting budget priorities, reducing patient co-payments for medicines and drugs, and expanding the benefits package for these goods, as well as improving the quality of care.

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The economic and political transformation in post-socialist countries initiated after 1989 has received an impressive amount of literature [1, 2, 3, 4, 5, 6]. The transformation processes in the countries of Central and Eastern Europe (CEE) belong to the most significant events of the end of the twentieth century [7]. An important part of the transformation in post-socialist countries was the change in the healthcare system. Reforms after the fall of communism, triggered by a sharp economic decline, led to a shift away from the centralized and nationalized healthcare systems of Semashka’s model [8, 9, 10]. The scope of the transformation was wide ranging from ownership transfer (conversion of public entities to private and/or establishment of private healthcare entities), through changes in organization (disintegration of care and strengthening of primary healthcare), to changes in the healthcare sector. financing (introduction of social health insurance in most CEE countries) [9, 10, 11].

The shift to an insurance-based system with market-oriented features in CEE countries was expected to ensure sufficient and more stable funding for health care and improve efficiency (also by increasing patient responsibility for health care financing) [8, 9, 10]. However, reforms were rarely evidence-based and suffered from institutional weaknesses, such as insufficient contribution rates or low efficiency in contribution collection [8, 9, 12]. Moreover, their implementation ran into a difficult economic situation. The results of the reforms were therefore far from expected. Patient out-of-pocket payments have increased significantly, increasing inequality in health care systems [13]. Households were responsible for financing health care through formal cost sharing [14, 15, 16]. In addition, informal patient payments that already existed during the communist era became even more widespread during the transition period [17, 18].

Currently, 30 years after the fall of communism, the countries of Central and Eastern Europe are still struggling with securing sufficient public resources for healthcare and catching up with Western European countries in ensuring universal health insurance, i.e. equal access to the necessary healthcare without financial difficulties for patients [19] . . In the way stood the economic crisis of 2008, which strongly affected many countries of Central and Eastern Europe and maintained the differences between Eastern and Western Europe [20]. The current crisis caused by the COVID-19 pandemic may have similarly damaging effects on health care systems. The future also brings challenges for countries in the region. The rapid aging of the population due to particularly low birth rates together with migration is very likely to exacerbate the fiscal imbalance in health budgets in CEE countries [21].

In this article, we analyzed the role of government and households in health care financing in eight Central and Eastern European countries: the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia. These countries were the first in the CEE region to join the European Union (EU) in 2004 (referred to as the EU-8). We analyzed quantitative data on health care expenditures since 2000, as well as qualitative data on public health care coverage gaps in terms of populations and services excluded from coverage, as well as patient cost-sharing obligations for publicly funded health care. This allowed us to see where Central and Eastern European countries are moving in terms of government responsibility for health care financing and to indicate barriers to achieving universal health coverage – one of the health-related Sustainable Development Goals.

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Details of the methods used in this study are provided in the next section. This is followed by results presented separately for quantitative and qualitative data analysis. The last two sections include a discussion of the results and conclusions from our research.

The aim of this study was to analyze the role of the government and households in the financing of health care in the EU-8 countries. All the countries included share similar experiences with the Siemasko health system and all initiated a series of health reforms in the 1990s, although it should be noted that there are differences between countries, e.g. in the extent of reforms implemented. , their speed and the economic and social environment of health systems. Currently, all these countries, with the exception of Latvia, rely on social health insurance to raise health care resources, although only the Czech Republic and Slovakia have a competitive insurance model [22, 23, 24, 25, 26, 27, 28, 29]. The countries differ significantly in demographic, social and economic characteristics, with Latvia having the smallest population, the highest old-age dependency ratio and the lowest GDP per capita. Slovenia and the Czech Republic are the most developed countries with the highest GDP per capita and the highest human development index, as well as the longest average life expectancy. The World Bank’s management efficiency index is relatively low in all analyzed countries, especially in Hungary and Poland. Across countries, there is almost universal support for the state being responsible for ensuring access to health care. See Table 1 for details.

The desk research method was used to fulfill the aim of the study. A narrative literature review of Organization for Economic Co-operation and Development (OECD), World Health Organization (WHO) and EU databases and publications was conducted between May 2020 and January 2021 to identify and collect quantitative and qualitative data. on health care spending and health care coverage by government programs in EU-8 countries.

Rural Healthcare And Health Insurance Coverage In European Countryside

The quantitative component of our study was based on health care expenditure data from national health accounts available in the OECD and WHO databases [33, 34]. We selected five health expenditure indicators that enabled a comprehensive analysis of health financing, focusing on the respective roles of government and households, namely:

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To present the changes in healthcare spending over the years, we considered a time span of 19 years (from 2000 to 2018) in our analysis. To examine whether a trend in the health expenditure data was evident over the years, we used linear least squares regression analysis (using MS Excel 2016 and R version 4.0.3) where time was used as an explanatory variable. The analysis was also carried out for each country

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