Case study C: Transforming healthcare financing in Central and Eastern European countries
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After the end of the communist rule, Central and Eastern European countries (CEECs) profoundly reformed healthcare financing. This case study focuses two principal reform objectives: to increase funding levels, and to generate more stable public revenue streams, independent from states’ government. To achieve the latter, almost all these countries (with the notable exception of Lativa) had established a Bismarckian social health insurance model by the end of the 1990s. Based on WHO data on the level and structure of healthcare financing, the case study finds that spending levels increased on average. However, as unemployment rates persist at high levels and due to a large ‘shadow economy’, social insurance funding declines in most countries over time. This paves the way for a constant increase in private funding sources. The case study concludes that this changing public/private mix in healthcare financing in CEECs is deteriorating affordability and access to care.