2012年-CEPS欧洲政策研究中心_Health__Morbidity_in_the_New_Member_States_12页_195kb

Summary of "HEALTH & MORBIDITY IN THE NEW MEMBER STATES" (ENEPRI Policy Brief No.1, December 2007)

Core Content

This policy brief summarizes the findings of the AHEAD project (Ageing, Health Status and the Determinants of Health Expenditure), which examined health and morbidity trends in Central and Eastern European (CEE) countries that joined the European Union. The analysis focuses on demographic and epidemiological changes, health status self-assessment, and medical service utilization patterns in Bulgaria, Estonia, Hungary, Poland, and Slovakia.

Main Points

1. Health Status and Life Expectancy

• Life Expectancy (LE): CEE countries are gradually approaching Western European levels, with Poland and Slovakia showing the most improvement. However, the gap between LE and Healthy Life Expectancy (HALE) remains significant.
• HALE: The gap between LE and HALE is larger in CEE countries (12–14 years) compared to the EU-15 (8 years), indicating lower quality of life and higher prevalence of disability and chronic diseases.
• Country-specific health indicators:
  • Bulgaria: Shows relatively better cancer mortality but worse cardiovascular disease and infant mortality compared to Central European countries.
  • Estonia: Despite successful transition, has poor health indicators, similar to CIS countries, with high mortality from external causes and lifestyle-related diseases.
  • Hungary: Has higher healthcare expenditures (7.8% of GDP) but lags in health status compared to its northern CEE neighbors, likely due to earlier demographic changes and lifestyle factors.
  • Poland: Experiences high rates of old-age diseases and disability, with significant health disparities between urban and rural areas.
  • Slovakia: Demonstrates the most positive self-assessment of health status and has made notable improvements in objective health indicators.

2. Health Status Self-Assessment

• There is a strong correlation between self-assessed health status and age, education, income, and professional activity.
• Slovakia leads in positive self-assessment, while Bulgaria has the most negative.
• In Estonia, half of the population self-assesses their health as "fair," with a notable shift towards "good" in other countries.

3. Medical Service Utilization

• Hungary and Slovakia show higher utilization of medical services compared to Poland, Estonia, and Bulgaria.
• Estonia has low utilization, which is linked to low health status.
• Primary care is the most utilized service, and self-assessed health status is the strongest determinant of service use.
• Old age is only a significant determinant for primary care, not for specialist or hospital services. This suggests that healthcare costs may not rise sharply with age if health status improves.

4. Epidemiological Trends

• There has been an improvement in health indicators since the 1990s, especially in cardiovascular diseases and external causes mortality.
• Neoplastic diseases still show a less pronounced decline in mortality.
• CEE countries are entering a phase of increased chronic diseases, poly-morbidity, and disability due to aging populations.

5. Healthcare System Reforms and Funding

• The healthcare sector in CEE countries has undergone significant institutional changes, including privatization of service providers and a shift from public funding through taxation to health insurance.
• Out-of-pocket payments by patients have increased, and co-payments for medical services have been introduced in Estonia (2002) and Slovakia (2004).
• Health insurance premiums are not effective due to high unemployment rates and non-wage labor costs.
• The healthcare system is fragmented, with PHC, specialist care, and inpatient care operating as separate modules with different financing sources.

6. Challenges and Policy Implications

• Coordination problems are widespread due to decentralized administration and lack of integration.
• Aging populations and epidemiological shifts necessitate increased healthcare funding and reforms in rationing, cost-effectiveness, and managed care.
• Information systems need development for better governance and supervision of new technologies.
• Health promotion and addressing lifestyle-related risks (e.g., smoking, alcohol, poor diet) are critical for improving health outcomes.

Key Information

• The study is based on country reports and external data sources such as WHO and OECD.
• Surveys used for analysis include:
  • Bulgaria: 1997 (Bulgaria Integrated Household Survey)
  • Estonia: 1999 (Norbalt II)
  • Hungary: 2003 (National Health Interview Survey)
  • Poland: 1996 and 1998–2003 (Health Status Population Survey and Healthcare in Households Survey)
  • Slovakia: 2003 (CINDY Health Monitor Questionnaire)
• Health status self-assessment is strongly influenced by age, education, income, and professional activity.
• Healthcare funding is mixed, combining public and insurance sources, with increasing reliance on individual out-of-pocket payments.
• Epidemiological transition is occurring rapidly, with CEE countries facing increased burden of chronic and mental diseases.
• Policy recommendations include:
  • Increasing healthcare funding.
  • Implementing cost-effectiveness and rationing mechanisms.
  • Promoting managed care approaches.
  • Developing information and analytical systems for better governance.
  • Addressing lifestyle-related health risks through public health initiatives.

Conclusion

The CEE countries have experienced significant demographic and epidemiological changes since the end of the 1990s. While life expectancy has improved, the gap with Western Europe remains large. Health status self-assessment is a strong indicator of objective health conditions, and the correlation between health status and socioeconomic factors is evident. The healthcare system is fragmented and faces coordination challenges. To address these, reforms in funding, integration, and health promotion are essential to support sustainable development and improved quality of life.