Although countries in central and eastern Europe (CEE) have relatively younger populations compared to the West, their populations are often affected by higher prevalence of chronic conditions and multi-morbidity and this burden will likely increase as their populations age. Relatively little is known about how these countries cater to the needs of complex patients. This Perspective piece identifies key initiatives to improve coordination of care in Czechia, Hungary, Poland, and Slovakia, including some pioneering and far-reaching approaches. Unfortunately, some of them have failed to be implemented, but a recent strategic commitment to care coordination in some of these countries and the dedication to rebuilding stronger health systems after the COVID-19 pandemic offer an opportunity to take stock of these past and ongoing experiences and push for more progress in this area.

European Observatory on Health Systems and Policies London United Kingdom

Faculty of Public Health Slovak Medical University Bratislava Slovakia

Faculty of Social Sciences Charles University Prague Czechia

Health Services Management Training Centre Semmelweis University Budapest Hungary

Institute of Public Health Jagiellonian University Krakow Poland

London School of Economics and Political Science London United Kingdom

London School of Hygiene and Tropical Medicine London United Kingdom

Zobrazit více v PubMed

EC . Eurostat [Online database]. Luxembourg: European Commission. (2022).

van der Heide I, Snoeijs S, Melchiorre MG, Quattrini S, Boerma W, Schellevis F, et al. . Innovating Care for People with Multiple Chronic Conditions in Europe. Brussels: ICARE4EU. (2015). 10.1093/eurpub/ckv168.036 DOI

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. (2012) 380:37–43. 10.1016/S0140-6736(12)60240-2 PubMed DOI

Nolte E, Knai C, Saltman R. Assessing chronic disease management in European health systems: concepts and approaches. In: Observatory Studies Series, Copenhagen: World Health Organization. Regional Office for Europe. (2014). PubMed

Alexa J, Recka L, Votapkova J, van Ginneken E, Spranger A, Wittenbecher F. Czech Republic: health system review. In: Health Systems in Transition. Copenhagen: World Health Organization. Regional Office for Europe. (2009). PubMed

Gaál P Szigeti S Csere M Gaskins M Panteli D World Health Organization . Hungary: health system review. In: Health Systems in Transition. Copenhagen: World Health Organization. Regional Office for Europe. (2011). vol. 13. PubMed

Sowada C, Sagan A, Kowalska-Bobko I, Badora-Musial K, Bochenek T, Domagala A, et al. . Poland: health system review. In: Health Systems in Transition, Copenhagen: World Health Organization. Regional Office for Europe. (2019). vol. 21. PubMed

Smatana M, Pazitny P, Kandilaki D, Laktisova M, Sedlakova D, Paluskova M, et al. . Slovakia: health system review. In: Health Systems in Transition, Copenhagen: World Health Organization. Regional Office for Europe. (2016). vol. 18. PubMed

Rechel B, McKee M. Health reform in central and eastern Europe and the former Soviet Union. Lancet. (2009) 374:1186–95. 10.1016/S0140-6736(09)61334-9 PubMed DOI

Rechel BM. Lessons from polyclinics in Central and Eastern Europe. BMJ. (2008) 337:a952. 10.1136/bmj.a952 DOI

McKee M, Nolte E. Health sector reforms in Central and Eastern Europe: How well are health services responding to changing patterns of health? Demogr Res. (2004) S2:163–182. 10.4054/DemRes.2004.S2.7 DOI

McKee M. Health services in central and eastern Europe: past problems and future prospects. J Epidemiol Commun Health. (1991) 45:260–265. 10.1136/jech.45.4.260 PubMed DOI PMC

Oleszczyk M, Svab I, Seifert B, Krztoń-Królewiecka A, Windak A. Family medicine in post-communist Europe needs a boost. Exploring the position of family medicine in healthcare systems of Central and Eastern Europe and Russia. BMC Family Practice. (2012) 13:15. 10.1186/1471-2296-13-15 PubMed DOI PMC

Gaál P, Szigeti S, Panteli D, Gaskins M, van Ginneken E. Major challenges ahead for hungarian healthcare. BMJ. (2011) 343:1251–4. 10.1136/bmj.d7657 PubMed DOI

Gaál P, Riesberg A. Hungary: health system review. In: Health Systems in Transition, Copenhagen: World Health Organization. Regional Office for Europe. (2004). vol. 6.

Alderwick H, Ham C, Buck D. Population Health Systems: Going Beyond Integrated Care. London: The King's Fund. (2015).

Singh D, Ham C. Improving care for people with long-term conditions: A review of UK and international frameworks. NHS Instiute for Innovation and Improvement University of Birmingham HSMC. (2006).

Polin K, Hjortland M, Maresso A, van Ginneken E, Busse R, Quentin W, et al. . “Top-Three” health reforms in 31 high-income countries in 2018 and 2019: an expert informed overview. Health Policy. (2021) 125:815–32. 10.1016/j.healthpol.2021.04.005 PubMed DOI

Ádány R, Kósa K, Sándor J, Papp M, Fürjes G. General practitioners' cluster: a model to reorient primary health care to public health services. Eur J Pub Health. (2013) 23:529–30. 10.1093/eurpub/ckt095 PubMed DOI

Sinkó E, Dózsa K, Elek P, Kiss N, Merész G, Gaál P. Az egészségügy forrásainak felhasználásával népegészségügyi fókuszú alapellátás-szervezési modellprogram Virtuális Ellátó Központ támogatásával" cím? program egészségpolitikai értékelése. [Health policy evaluation of the “Public health focused Model Programme for organising primary care services backed by a virtual care service centre”]. NÉPEGÉSZSÉGÜGY. (2017) 95:86–94. Available online at: http://real.mtak.hu/id/eprint/64373 (accessed January 16, 2022).

Badora-Musiał K, Sagan A, Domagała A, Kowalska-Bobko I. Testing the 2017 PHC reform through pilots: Strengthening prevention and chronic care coordination. Health Policy. (2021) 125:185–90. 10.1016/j.healthpol.2020.10.014 PubMed DOI

Sagan A, Kowalska-Bobko I, Badora-Musiał K, Gałazka-Sobotka M. A reform proposal from 2019 aims to improve coordination of health services in Poland by strengthening the role of the counties. Health Policy. (2022) 126:837–43. 10.1016/j.healthpol.2022.06.006 PubMed DOI

Sagan A, Kowalska-Bobko I, Gałazka-Sobotka M, Holecki T, Maciejczyk A, McKee M. Assessing recent efforts to improve organization of cancer care in Poland: what does the evidence tell us? Int J Environ Res Public Health. (2022) 19:9369. 10.3390/ijerph19159369 PubMed DOI PMC

Alexa J, Recka L, Votapkova J, van Ginneken E, Spranger A, Wittenbecher F. Czech Republic: health system review. In: Health Systems in Transition, Copenhagen: World Health Organization. Regional Office for Europe. (2023). PubMed

Bryndová L, Bar M, Herzig R, Mikulík R, Neumann J, Šanák D, et al. . Concentrating stroke care provision in the Czech Republic: The establishment of Stroke Centres in 2011 has led to improved outcomes. Health Policy. (2021) 125:520–5. 10.1016/j.healthpol.2021.01.011 PubMed DOI

Ministry of Health of the Republic of Poland. Projekt uchwały rady ministr'ow w sprawie ustanowienia polityki publicznej pt. Zdrowa przyszłość. Ramy strategiczne rozwoju systemu ochrony zdrowia na lata 2021–2027, z perspektywa do 2030 R.” [Draft Resolution of the Council of Ministers on Establishing Public Policy entitled “Healthy Future. Strategic framework for the development of the health care system for 2021–2027, with a perspective until 2030”]. Warsaw: Ministerstwo Zdrowia [Ministry of Health]. (2021). Available online at: https://legislacja.rcl.gov.pl/projekt/12348352/katalog/12798638#12798638 (accessed January 16, 2022).

Ministry of Health of the Czech Republic. Strategický rámec rozvoje péče o zdraví v Ceské republice do roku 2030 (Zdraví 2030) [Strategic Framework for the Development of Health Care in the Czech Republic until 2030]. Prague: Ministerstvo zdravotnictví Ceské republiky [Minsitry of Health of the Czech Republic]. (2020). Available online at: https://zdravi2030.mzcr.cz/zdravi-2030-strategicky-ramec.pdf

Ministry of Health of the Slovak Republic. Strategic framework for health 2014 – 2030. Available online at: https://www.health.gov.sk/Zdroje?/Sources/Sekcie/IZP/Strategic-framework-for-health-2014-2030.pdf

Office of the Government. Programové vyhlásenie vlády Slovenskej republiky 2020 – 2024 [Manifest of the Government of the Slovak Republic for 2020 – 2024]. Bratislava: Government of the Slovak Republic. (2020). Available online at: https://www.mpsr.sk/download.php?fID=18769

Ministry of National Resources . Újraélesztett egészségügy, Gyógyuló Magyarország, Semmelweis Terv az egészségügyi megmentésére, Szakmai konzultáció – vitairat [Resuscitated health care – recovering Hungary, Semmelweis Plan for saving health care, Discussion Paper], Budapest, Ministry of National Resources (2010). Available online at: http://www.weborvos.hu/adat/files/EgpolVitairat2010%5B1%5D.pdf

Sinkó E. Az irányított betegellátás hazai tapasztalatai [The experiences with care coordination in Hungary]. Esély. (2005) 2:52–72.

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

Follow-up of patients with chronic conditions within primary care practices during COVID-19: Results from 7 Central and Eastern-European countries from the cross-sectional PRICOV-19 study

Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries