BACKGROUND: The Alma-Ata Declaration was a big step in the development of primary care, defining the main tasks and populations' expectation. Celebrating the 40th year's anniversary is a good opportunity to make an analysis. Development of primary care was not parallel in the Eastern and Western part of Europe. AIM: To provide an overview on the societal and economic situation, structural and financial changes of healthcare systems in the former 'Soviet bloc' countries, to present an analysis of the primary healthcare (PHC) provision and to find relationships between economic development and epidemiological changes of the respective countries. METHOD: Epidemiological data, healthcare expenditures and structure, and financing schemes were compared; systematic literature search was performed. RESULTS: Visible improvements in population health, in the national economic condition, structural changes in healthcare and more focus to primary care were experienced everywhere. Higher life expectancies with high inter-country variation were observed in the former 'Soviet bloc' countries, although it could not be clearly linked to the development of healthcare system. PHC provision improved while structural changes were rarely initiated, often only as a project or model initiation. Single-handed practices are yet predominant. The gate-keeping system is usually weak; there were no effective initiatives to improve the education of nurses and to widen their competences. Migrations of workforce to Western countries become a real threat for the Central-East European countries. CONCLUSION: Lack of coordination between practices and interdisciplinary cooperation were recognized as the main barriers for further improvement in the structure.

Department of Family and Occupational Medicine University of Debrecen Debrecen Hungary

Department of General Practice 1st Faculty of Medicine Charles University Prague Czech Republic

Faculty of Health Care University of Miskolc Miskolc Hungary

Independent Macroeconomic adviser Budapest Hungary

Zobrazit více v PubMed

Afrite A (2013) The impact of multi-professional group practices on healthcare supply. Evaluation aims and methods for ‘maisons’, ‘pôles de santé’ and ‘centres de santé’ within the framework of experiments with new mechanisms of remuneration. Paris, IRDES (Questions d’économie de la santé no. 189).

De Maeseneer J (2017) Family medicine and primary care. At the Crossroads of Societal Change. Tielt: Lanno Campus; Lanno Campus, Tielt.

EFPC – European Forum for Primary Care (2005). [online] Available at: www.euprimarycare.org. Accessed 17 August 2018.

EGPRN – European General Practice Research Network (2018). Available at: https://www.egprn.org/. Accessed 24 August 2018.

EOROSTAT- European Commission, Eurostat (2015). Current healthcare expenditure, 2015. [online] Available at: https://ec.europa.eu/eurostat/statistics-explained/index.php?title = File:Current_healthcare_expenditure,_2015_FP18a.png. Accessed 21 August 2018.

European Commission (2018). ECHI – European Core Health Indicators. [online] Available at: https://ec.europa.eu/health/indicators/echi/list/. Accessed 16 August 2018.

Gree LA, Phillips RL Jr and Fryer GE (2005) The nature of primary medical care In Jones R editor, Oxford textbook of primary medical care. Oxford: Oxford University Press.

Győrffy Z, Kalabay L, Mohos A, Márkus B, Nánási A, Rinfel J, Girasek E and Torzsa P (2017) What do family medicine trainees think about gratitude payment? Orvosi Hetilap 158, 1028–35. [Hungarian] PubMed

Ilyés I, Jancsó Z and Simay A (2012) Trends and current questions of cardiovascular prevention in primary healthcare. Orvosi Hetilap 153, 1536–46. Review. [Hungarian]. PubMed

Jack B, Zs Nagy and Varga Z (1997) Healthcare reform in Central and Eastern Europe. Family medicine in Hungary. European Journal of General Practice 3, 152–58.

Jancsó Z, Márton H, Simay A, Kovács E and Ilyés I (2006) Continuing care of patients with cardiovascular risk in general practice: patients with hypertension and their care. Orvosi Hetilap 147, 339–44. [Hungarian]. PubMed

Kringos D, Boerma W, Bourgueil Y, Cartier T, Dedeu T, Hasvold T, Hutchinson A, Lember M, Oleszczyk M, Rotar Pavlic D, Svab I, Tedeschi P, Wilm S, Wilson A, Windak A, Van der Zee J and Groenewegen P (2013) The strength of primary care in Europe: an international comparative study. British Journal of General Practice 63, e742–50. doi: 10.3399/bjgp13X674422. PubMed DOI PMC

Kringos DS (2012) The Strength of primary care in Europe. PhD Theses. NIVEL. Utrecht.

Kringos DS, Boerma WGW, Hutchinson A and Saltman RB (editors) (2015) Building primary care in a changing Europe. European Observatory on Health Systems and Policies, WHO Europe. PubMed

Lord Dawson of Penn (1920) Interim Report on the Future Provision of Medical and Allied Services. UK Ministry of Health. Consultative Council on Medical Allied Services. London: Her Majesty’s Stationary Offices.

Nagy A, Kovács N, Pálinkás A, Sipos V, Vincze F, Szőllősi G, Csenteri O, Ádány R and Sándor J (2018) Exploring quality of care and social inequalities related to type 2 diabetes in Hungary: Nationwide representative survey. Primary Care Diabetes 12, 1–13. PubMed

OECD. Organisation for Economic Cooperation and Development (2018). Current expenditure on health. [online] Available at: https://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics/system-of-health-accounts-health-expenditure-by-function_data-00349-en. Accessed 13 August 2018.

Rurik I (2014) How can the Swiss contribution improve Hungarian primary care? Primary Care 14, 155–6.

Rurik I and Kalabay L (2009) Primary healthcare in the developing part of Europe. Medical Science Monitor 15, PH78–84. PubMed

Sándor J, Kósa K, Fürjes G, Papp M, Csordás A, Rurik I and Ádány R (2013) Public health services provided in the framework of general practitioners’ clusters. European Journal of Public Health 23, 530–2. PubMed

Sándor J, Nagy A, Jenei T, Földvári A, Szabó E, Csenteri O, Vincze F, Sipos V, Kovács N, Pálinkás A, Papp M, Fürjes G and Ádány R (2018. a) Influence of patient characteristics on preventive service delivery and general practitioners’ preventive performance indicators: a study in patients with hypertension or diabetes mellitus from Hungary. European Journal of General Practice 24, 183–91. PubMed PMC

Sándor J, Pálinkás A, Vincze F, Sipos V, Kovács N, Jenei T, Falusi Z, Pál L, Kőrösi L, Papp M and Ádány R (2018. b) Association between the general practitioner workforce crisis and premature mortality in Hungary: cross-sectional evaluation of health insurance data from 2006 to 2014. International Journal of Environmental Research and Public Health 15, 1388–1400. PubMed PMC

Schäfer WLA (2016) Primary care in 34 countries. PhD Theses. NIVEL, Utrecht.

Simay A, Lakatos Z, Ilyés I and Jancsó Z (2005) Assessment of cardiovascular risk factors and their correlation in 28,000 Hungarians. Public Health 119, 437–41. PubMed

Starfield B (1994) Is primary care essential? Lancet 344, 1129–33. PubMed

Švab I, Rotar Pavlič D, Radić S and Paula Vainiomäki P (2004) General practice East of Eden: an overview of general practice in Eastern Europe. Croatian Medical Journal 45, 537–42. PubMed

The World Bank (2018. a) GDP per capita (current US$). [online] Available at: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?end=2015&start=1990. Accessed 20 August 2018.

The World Bank (2018. b) Health indicators. [online] Available at: https://data.worldbank.org/indicator. Accessed 23 August 2018.

Torzsa P, Hargittay C and Kalabay L (2017) The importance of anxiety and depression in family practice. Neuropsychopharmacologia Hungarica 19, 137–46. [Hungarian] PubMed

UEMO – The European Union of General Practitioners. Available at: http://www.uemo.org/ Acessed 14 August 2018.

WHO – World Health Organization (1981) Global Strategy for health for all by the Year 2000. Geneva: World Health Organization; [online] Available at: http://iris.wpro.who.int/bitstream/handle/10665.1/6967/WPR_RC032_GlobalStrategy_1981_en.pdf. Accessed 11 August 2018

WHO – World Health Organization (2008) World Health Report 2008, Primary Health Care, Now More Than Ever, 2008. [online] Available at: https://www.who.int/whr/2008/en/. Accessed 13 August 2018.

WHO – World Health Organization (2008) Declaration of Alma-Ata: International Conference on Primary Health Care, Alma-Ata, USSR, Sept 6–12, 1978. [online] Available at: http://www.who.int/publications/almaata_declaration_en.pdf. Accessed 10 August 2018.

WHO – World Health Organization (2018) Global Health Expenditure Database. [online] Available at: http://apps.who.int/nha/database. Accessed 15 August 2018.

Windak A and van Hasselt P (2005) Primary care and general practice in Europe: Central and East In Jones R, editor, Oxford textbook of primary medical care. Oxford: Oxford University Press, 70–73.

WONCA – World Organization of Family Doctors (2018) [online] Available at: https://www.wonca.net/. Accessed 23 August 2018.

Health care provider payment schemes and their changes since 2010 across nine Central and Eastern European countries - a comparative analysis

The Advantages and Disadvantages of Integrated Care Implementation in Central and Eastern Europe - Perspective from 9 CEE Countries