This paper aims to: (1) provide a brief overview of hospital sector characteristics in 11 Central and Eastern European countries (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland, Romania, Slovakia, Slovenia); (2) compare recent (2008 - 2019) hospital reforms in these countries; and (3) identify common trends, success factors and challenges for reforms. Methods applied involved five stages: (1) a theoretical framework of hospital sector reforms was developed; (2) basic quantitative data characterizing hospital sectors were compared; (3) a scoping review was performed to identify an initial list of reforms per country; (4) the list was sent to national researchers who described the top three reforms based on a standardized questionnaire; (5) received questionnaires were analysed and validated with available literature. Results indicate that the scope of conducted reforms is very broad. Yet, reforms related to hospital sector governance and changes in purchasing and payment systems are much more frequent than reforms concerning relations with other providers. Most governance reforms aimed at transforming hospital infrastructure, improving financial management and/or improving quality of care, while purchasing and payment reforms focused on limiting hospital activities and/or on incentivising a shift to ambulatory/day care. Three common challenges included the lack of a comprehensive approach; unclear outcomes; and political influence. Given similar reform areas across countries, there is considerable potential for shared learning.

Department of Health Care Management Technische Universität Berlin Germany; European Observatory on Health Systems and Policies Brussels Belgium

Department of Public Health Institute of Health Sciences Faculty of Medicine Vilnius University Lithuania

Health Services Management Training Centre Semmelweis University Budapest Hungary

Institute of Economic Studies Faculty of Social Sciences Charles University Prague Czech Republic

Institute of Public Health Faculty of Health Sciences Jagiellonian University Medical College Krakow Poland

international health financing consultant Tallinn Estonia

Medical University of Varna Bulgaria

Ministry of Health of the Slovak Republic Bratislava Slovakia

National Institute of Public Health Ljubljana Slovenia

National School of Public Health Management and Professional Development Bucharest Romania

Riga Stradiņš University Riga Latvia

School of Medicine University of Zagreb Croatia

References provided by Crossref.org

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