Quality of CEE healthcare systems among the worst in Europe

The Eurobarometer survey revealed that the countries in which citizens are the least satisfied with the national healthcare system are Greece, with 75% saying that it is fairly or very bad, followed by Hungary (72%), Romania (69%), Bulgaria (68%), Poland (67%), Latvia (62%) and Lithuania (58%).On average, 70% of the respondents of the Eurobarometer survey regard the overall quality of healthcare provided in their countries as good. However, significant differences have been observed among the respondent countries: 97% of Belgian respondents consider the quality of healthcare in their country to be good, whereas only 25% of Romanians, 28% of Bulgarians and Hungarians and 30% of Polish respondents claim the same. Apart from the Czech Republic, where 78% of the respondents claim that their healthcare system is good, the rest of the CEE countries are placed far below the EU average.

 

 

Similarly, among the CEE countries overall, the highest percentage of those who claim that the quality of healthcare in their country is better than or the same as those of other EU countries is found in the Czech Republic: 66%, whereas only 14% of Bulgarians, 16% of Romanians, 22% of Hungarians, 26% of Poles and 44% of Slovaks make that claim.

 

 

The Eurobarometer survey results are corroborated by the 2010 Euro-Canada Health Consumer Index, which evaluates European healthcare systems in five categories: patient rights and information, waiting times for treatment, outcomes, range and reach of services provided, and pharmaceuticals.

Among 34 countries which took part in the EHCI assessment, the Czech system was in 15^th place. According to EHCI data, the Czech healthcare system seems to be stable, maintaining good healthcare standards during the crisis, which suggests that the healthcare reforms implemented in the country have paid off.

The Czech Republic scored 687 out of a maximum of 1,000 points. The Index places the country not only before other CEE countries but also in front of e.g. the UK. It warns, however, that waiting periods for treatment are growing longer and that the country still has some work to do in the area of patient rights and access to information.

According to the 2010 Euro-Canada Health Consumer Index, the Bulgarian healthcare system is ranked in 34^th and last place with only 468 points of a possible 1,000, in stark contrast to the Netherlands, which was in first place, with 857 points. The EHCI results demonstrate the weakness of Bulgarian healthcare in each of the five categories evaluated in the survey: patient rights and information, waiting times for treatment, outcomes, range and reach of services provided, and access to medicines. Similar findings have been revealed by the local NGO, the National Patients’ Organisation (NPO), which, during its national information campaign on patients’ rights, collected 2,706 reports of healthcare irregularities from patients. 878 of the reports received pertained to unjustified limitation of access to healthcare. This was because of low levels of reimbursement of treatment, or because GPs did not provide a referral to a specialist. 772 people complained about disrespectful treatment and excessive bureaucracy in the healthcare system. 252 patients notified the NPO of corruption in hospitals, and 238 cases involved doctors’ errors identified by patients, with eight of the cases resulting in death.

The poor performance of the Bulgarian healthcare system demonstrated by the EHCI survey is proof that the country is in need of extensive healthcare system reform. Along with the financial crisis the healthcare budget of Bulgaria has recently been facing substantial distortion, with a limited number of admissions to hospitals, shortages of drugs and delays in payment by the National Health Insurance Found (NHIF) to doctors, pharmacies and healthcare facilities.

 

According to the 2010 Euro-Canada Health Consumer Index, the discrepancies in the quality of healthcare between the Czech Republic and Bulgaria can be explained in terms of the general differences in the performances of systems based on the Bismarck model and the Beveridge model.

The Czech Republic is an example of the Bismarck system, a “social insurance” model with a number of insurance organisations which are independent of the healthcare providers and which compete with one another. Bulgaria, on the other hand, uses the Beveridge model, in which the funding and provision of healthcare are handled within one organisational system.

According to the EHCI pilot project carried out in the 12 European countries in 2005, the healthcare systems based on the Bismarck model have been shown to outperform the Beveridge systems and tend to be more responsive to the needs of consumers. The healthcare reform plan announced by the Bulgarian government in 2009 seems to deploy the Bismarck model solutions, i.e. the introduction of a three-pillar health insurance model: basic, additional and voluntary health insurance, which would be the principle underpinning the development of an efficient healthcare system.

 

 

Anna Skoczylas-Ligocka

Business Editor

PMR Publications