Kurpas Donata, Stefanicka-Wojtas Dorota, Shpakou Andrei, Halata David, Mohos András, Skarbaliene Aelita, Dumitra Gindrovel, Klimatckaia Ludmila, Bendova Jana, Tkachenko Victoria
Wroclaw Medical University, Faculty of Medicine, Wroclaw, Poland.
IFIC Board Member; EURIPA.
Int J Integr Care. 2021 Nov 8;21(4):14. doi: 10.5334/ijic.5632. eCollection 2021 Oct-Dec.
Health and social care systems in Central and Eastern European (CEE) countries have undergone significant changes and are currently dealing with serious problems of system disintegration, coordination and a lack of control over the market environment.
The increased health needs related to the ageing society and epidemiological patterns in these countries also require funding needs to increase, rationing to be reformed, sectors to be integrated (the managed care approach), and an analytical information base to be developed if supervision of new technological approaches is to improve. The period of system transitions in CEE countries entailed significant changes in their health systems, including health care financing.
Large deficits in the public financing of health systems were just one of the challenges arising from the economic downturn of the 1990s, which was coupled with inflation, increasing unemployment, low salaries, a large informal sector and tax evasion in a number of CEE countries. During the communist period, there was universal access to a wide range of health services, proving it difficult to retain this coverage. As a result, many states sought to ration publicly funded health services - for example, through patient cost-sharing or decreasing the scope of basic benefits. Yet, not all of these reform plans were implemented, and in fact, some were rolled back or not implemented at all due to a lack of social or political consensus.
CEE health systems had come to practice implicit rationing in the form of under-the-table payments from patients, quasi-formal payments to providers to compensate for lack of funding, and long waiting lists forcing patients to the private sector. All these difficulties pose a challenge to the implementation of integrated care.
中东欧国家的卫生和社会护理系统经历了重大变革，目前正面临系统瓦解、协调以及对市场环境缺乏控制等严重问题。
这些国家与老龄化社会和流行病学模式相关的卫生需求增加，这也要求资金需求增加、配给制度进行改革、各部门进行整合（管理式医疗方法），并且如果要改善对新技术方法的监管，还需要建立一个分析信息库。中东欧国家的系统转型期使其卫生系统发生了重大变化，包括医疗保健融资。
卫生系统公共融资的巨额赤字只是20世纪90年代经济衰退带来的挑战之一，当时中东欧一些国家还伴随着通货膨胀、失业率上升、低工资、庞大的非正规部门以及逃税现象。在共产主义时期，人们可以普遍获得广泛的卫生服务，而现在很难维持这种覆盖范围。因此，许多国家试图对公共资助的卫生服务进行配给——例如，通过患者费用分摊或缩小基本福利范围。然而，并非所有这些改革计划都得到了实施，事实上，由于缺乏社会或政治共识，一些计划被撤回或根本没有实施。
中东欧的卫生系统已开始以患者的私下支付、向提供者的准正规支付以补偿资金不足以及迫使患者转向私营部门的长等待名单等形式实行隐性配给。所有这些困难对综合护理的实施构成了挑战。
