2007年-世界发展银行全球_Health_Care_Spending_in_the_New_EU_Member_States___Controlling_Costs_and_Improving_Quality_72页_1mb

Summary of "Health Care Spending in the New EU Member States"

Core Content

This report by Mukesh Chawla analyzes the trends and challenges in health care spending in the eight new EU member states (EU8), which joined the European Union in 2004. It focuses on the financial sustainability, efficiency, and quality of health care services in these countries, comparing them with the EU15 (original EU members) and OECD countries.

Main Points

1. Health Care Reforms and Financing

• The EU8 countries transitioned from centrally planned systems to market-based economies, introducing reforms in health sector finance, management, and organization.
• These reforms aimed to remove the state monopoly on healthcare by privatization and decentralization.
• Most EU8 countries adopted the Bismarckian social health insurance model, with Social Health Insurance Agencies operating independently of the state budget.
• Public financing accounts for about three-fourths of total health spending in the EU8, similar to the EU15.
• Out-of-pocket payments have been increasing, reflecting a shift toward more patient involvement in health financing.

2. Expenditure Structure

• Inpatient care and pharmaceuticals are the main components of health spending, accounting for roughly 40% and 30%, respectively.
• Primary and specialist outpatient care, long-term care, and administrative expenses make up the rest.
• The trend has been rising pharmaceutical costs, falling inpatient care costs, and increasing outpatient care costs.
• The structure of health spending in the EU8 is not very different from OECD countries, though pharmaceutical costs have grown more rapidly.

3. Key Challenges

• Excessive hospital infrastructure is a major drain on health sector resources.
• Rising salaries in the health sector, which account for over 60% of total expenditures, have increased faster than average.
• New and expensive medical technology is becoming a significant cost driver, especially in EU15 countries, and this trend is likely to continue in EU8 countries.
• Informal payments and lack of transparency in the health system are serious impediments to reform and contribute to corruption and inefficiency.
• Aging populations are expected to significantly increase future health care costs, with the proportion of people over 60 projected to rise from 16% in 1995 to 27% in 2025.

4. Health Status and Expenditure

• The health status of EU8 populations is commensurate with their health spending and income, but generally poorer than EU15.
• Life expectancy in EU8 countries ranges from 70 years in Estonia to 77 years in Slovenia, compared to 79 years in the EU15.
• The health status gap between EU8 and EU15 is about 5 years, and gender disparities in life expectancy are higher in the EU8.
• Infant mortality and tuberculosis incidence are also higher in the EU8 than in the EU15.

5. Fiscal and Structural Deficits

• Indebtedness in the health sector is widespread and growing, particularly in the Visegrad countries.
• Hospital contracts do not cover full maintenance costs, and public hospitals often operate with insufficient funding.
• Health insurance systems in many EU8 countries are not efficient in managing costs, leading to unpaid bills and financial strain.

6. Recommendations for Reform

• Rationalize the benefit package and introduce supplementary health insurance.
• Implement co-payments and cost-sharing mechanisms to increase patient responsibility and reduce unnecessary demand.
• Create competition among healthcare providers to improve efficiency and quality.
• Consolidate and close public hospitals and reduce the number of hospital beds to match EU15 levels.
• Improve administrative capacity and management within hospitals.
• Regulate pharmaceutical prices and usage, as well as the use of high-end medical technology.

Key Information

Countries Covered

• EU8 Countries: Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, Slovenia.

Key Expenditure Areas

• Pharmaceutical Costs
• Hospital Infrastructure
• Salaries of Medical Personnel

Trends in Health Expenditure

• Pharmaceutical spending is growing rapidly due to higher volumes and new, more expensive drugs.
• Hospital beds per 100,000 inhabitants in EU8 countries are still 30% higher than in the EU15.
• Out-of-pocket payments are increasing, which may affect access for vulnerable populations.

Reform Proposals

• Co-payments have been introduced in Slovenia and Slovakia, resulting in significant savings.
• Private insurance and risk-pooling are suggested to enhance efficiency and equity.
• Public-private partnerships and decentralization are seen as potential solutions to financial sustainability.

Conclusion

Despite a decade of reforms, the supply-side incentives in the health systems of EU8 countries remain weak, and demand-side incentives are also lacking. To ensure fiscal sustainability, improve efficiency, and enhance quality, the report recommends a combination of supply-side and demand-side reforms, including cost management, better governance, and more transparent systems. The report emphasizes the importance of targeted interventions and policy coordination among stakeholders in the health sector.

References and Appendices

• The report includes a list of boxes, tables, and figures to illustrate key findings.
• It references country-specific studies and peer reviews from various experts and institutions.
• Appendices provide detailed data and analysis on health expenditures, population demographics, and institutional structures.