London, 23 December 2004 (RFE/RL) -- A new report by the Economist Intelligence Unit (EIU) finds that health-care systems in the new EU member and candidate countries have been starved of funds since the fall of communism.
It notes that up to 50 percent of funding is reliant on a system of under-the-table payments made to medical staff. And it concludes that the region simply cannot afford to maintain comprehensive state health care.
Dennis McCauley, the editor of the EIU report, told RFE/RL: "Reform of the health sector in Central and Eastern Europe has been delayed for quite a long time. While economic reform has proceeded fairly steadily, governments in the region have essentially delayed serious health-sector reform. And many of the health-care problems that existed in the 1970s and '80s unfortunately still exist today."
Titled "A Long Recovery: Health Care in Central Europe," the report is based on the online questioning of 79 executives from health-care providers, pharmaceutical suppliers, and government representatives in the EU accession and candidate nations. Interviews were also conducted with senior health-care specialists in the Czech Republic, Slovenia, Poland, and Hungary.
One of the report's key recommendations is that authorities should look at distortions in medical staffing and facilities. Many hospitals lack basic general practitioners. There is also the question of whether to privatize health-care funding.
"Our recommendation is to not view private funding as a panacea. Essentially, a mixture or complementary system, whereby private funding coexists alongside public funding, may be a better alternative in today's environment," the EIU's McCauley said.
The report notes that several countries in the region have conducted experiments with the privatization of health-care funding. McCauley said most of them have not been successful, so governments have had to consider hybrid systems.
"Countries such as Slovenia, for example, have experimented with hybrid insurance systems that combine publicly funded and competing funds," he said. "They've made it work in some ways, and they've had some serious problems in some ways. So I think it would be wise for countries such as Ukraine, Bulgaria and Romania to consider the experience of the likes of Slovenia and Estonia, for example."
Some experts in the criticized countries feel the report is too harsh. Dr. Michal Andel is the head of the Second Internal Clinic at the University Hospital Kralovske Vinohrady in Prague. "The Czech system reflects the pre-World War II health-care insurance situation, as well as the insurance funding tradition of Central Europe," he told RFE/RL. "Thus, in its own way, it communicates with the Austrian and German systems, as well as the Swiss one. It has a whole number of various disadvantages. It is not very effective. Yet, on the other hand, thanks to this system, it has been possible to significantly improve the quality of health care over the past 15 years."
The EIU report recommends ways to minimize the problems. One is preventive health care. McCauley said this is an area where the more advanced Central and Eastern European countries have already shown promise.
"In the economically more developed countries of the region, there is more investment, more attention given to education on some of the major health problems -- how they can be alleviated without having to turn to medical care," he said. "Certainly, diet and things such as smoking and alcohol intake. In some countries, there is a more effective effort under way to educate people on the dangers of abuse of these types of things. So governments can do a lot more."
Dr. Andel agrees that, although difficult to quantify, preventive care is an important component of a functioning health-care system. "That is definitely a great challenge. It is well known that people bring a lot of illnesses on to themselves by a wrong diet, lack of movement, smoking, and also by inappropriate behavior that leads to injuries," he said. "This is easily said, but the implementation is much more complicated. There is no effective way to include it in any insurance. But, on the other hand, prevention can positively influence [the rate of] sicknesses."
McCauley said both richer and poorer countries of the region need to speed up reform. "We have not found a wealth of progress in any of the countries, to be honest," he said. "In some of the indicators, countries such as Romania and Bulgaria and Ukraine come out lower than the likes of Slovenia or the Czech Republic. I think each country has some specific circumstances that may warrant a different approach than that being taken in a more developed country."
McCauley said these countries have no other option but to introduce health-care reform. He said they simply cannot afford to waste money any longer, or keep alive the harmful practices of the past, such as payments made under the table to medical staff.
"I'd wholly recommend that they take our advice. I don't think we'll see collapses of the systems, but you will see, for example, continuation of serious funding gaps. And authorities in various countries will have to make tough choices as to where to allocate the scarce funds," McCauley said.
Andel agrees that health-care reform has been slow to take root in some countries in the region. And he admits that the "money-under-the-table" practices of the past die hard, even if they no longer survive in his hospital.
It notes that up to 50 percent of funding is reliant on a system of under-the-table payments made to medical staff. And it concludes that the region simply cannot afford to maintain comprehensive state health care.
Dennis McCauley, the editor of the EIU report, told RFE/RL: "Reform of the health sector in Central and Eastern Europe has been delayed for quite a long time. While economic reform has proceeded fairly steadily, governments in the region have essentially delayed serious health-sector reform. And many of the health-care problems that existed in the 1970s and '80s unfortunately still exist today."
Titled "A Long Recovery: Health Care in Central Europe," the report is based on the online questioning of 79 executives from health-care providers, pharmaceutical suppliers, and government representatives in the EU accession and candidate nations. Interviews were also conducted with senior health-care specialists in the Czech Republic, Slovenia, Poland, and Hungary.
One of the report's key recommendations is that authorities should look at distortions in medical staffing and facilities. Many hospitals lack basic general practitioners. There is also the question of whether to privatize health-care funding.
"Our recommendation is to not view private funding as a panacea. Essentially, a mixture or complementary system, whereby private funding coexists alongside public funding, may be a better alternative in today's environment," the EIU's McCauley said.
The report notes that several countries in the region have conducted experiments with the privatization of health-care funding. McCauley said most of them have not been successful, so governments have had to consider hybrid systems.
"Countries such as Slovenia, for example, have experimented with hybrid insurance systems that combine publicly funded and competing funds," he said. "They've made it work in some ways, and they've had some serious problems in some ways. So I think it would be wise for countries such as Ukraine, Bulgaria and Romania to consider the experience of the likes of Slovenia and Estonia, for example."
Some experts in the criticized countries feel the report is too harsh. Dr. Michal Andel is the head of the Second Internal Clinic at the University Hospital Kralovske Vinohrady in Prague. "The Czech system reflects the pre-World War II health-care insurance situation, as well as the insurance funding tradition of Central Europe," he told RFE/RL. "Thus, in its own way, it communicates with the Austrian and German systems, as well as the Swiss one. It has a whole number of various disadvantages. It is not very effective. Yet, on the other hand, thanks to this system, it has been possible to significantly improve the quality of health care over the past 15 years."
The EIU report recommends ways to minimize the problems. One is preventive health care. McCauley said this is an area where the more advanced Central and Eastern European countries have already shown promise.
"In the economically more developed countries of the region, there is more investment, more attention given to education on some of the major health problems -- how they can be alleviated without having to turn to medical care," he said. "Certainly, diet and things such as smoking and alcohol intake. In some countries, there is a more effective effort under way to educate people on the dangers of abuse of these types of things. So governments can do a lot more."
Dr. Andel agrees that, although difficult to quantify, preventive care is an important component of a functioning health-care system. "That is definitely a great challenge. It is well known that people bring a lot of illnesses on to themselves by a wrong diet, lack of movement, smoking, and also by inappropriate behavior that leads to injuries," he said. "This is easily said, but the implementation is much more complicated. There is no effective way to include it in any insurance. But, on the other hand, prevention can positively influence [the rate of] sicknesses."
McCauley said both richer and poorer countries of the region need to speed up reform. "We have not found a wealth of progress in any of the countries, to be honest," he said. "In some of the indicators, countries such as Romania and Bulgaria and Ukraine come out lower than the likes of Slovenia or the Czech Republic. I think each country has some specific circumstances that may warrant a different approach than that being taken in a more developed country."
McCauley said these countries have no other option but to introduce health-care reform. He said they simply cannot afford to waste money any longer, or keep alive the harmful practices of the past, such as payments made under the table to medical staff.
"I'd wholly recommend that they take our advice. I don't think we'll see collapses of the systems, but you will see, for example, continuation of serious funding gaps. And authorities in various countries will have to make tough choices as to where to allocate the scarce funds," McCauley said.
Andel agrees that health-care reform has been slow to take root in some countries in the region. And he admits that the "money-under-the-table" practices of the past die hard, even if they no longer survive in his hospital.
